Nurses' retention and hospital characteristics in New South Wales, CHERE Discussion Paper No 52

NURSES’ RETENTION AND HOSPITAL CHARACTERISTICS IN NEW SOUTH WALES

5. CONCLUSIONS

In this study, we analyse a sample of RNs working in public hospitals in NSW in 1996. Specifically the
retention of these nurses in NSW in 1997 is studied using the nurses’ personal characteristics as
well as the characteristics of the hospitals in which they work. It is found that the type of hospital per
se does not help explain the retention probability of the nurses employed in the premise but the
hospital characteristics do. Hospital characteristics include measures of size, complexity, intensity,
expenditures and staffing levels. The results suggest that the effects of these various dimensions of
the nurses’ job are complex and depend on the measures used. For example, complexity of the work
as measured by admissions from emergency increase retention while high cost procedures and
large ANDRG weights reduce retention. These effects are large and significant. Levels of
expenditures (at constant staffing levels) increase retention except for expenditures on VMOs which
reduce retention. Again the effects on the expected retention probability are very large and significant.
The effects of hospital size depend on whether the cases are acute or non-acute and whether they
involve babies.

We offer some possible interpretations of these effects in the main text. Overall, the details of the
work arrangements, the nurses’ responsibilities, learning possibilities and stress levels are the key to
understanding these relationships and more specific information will be needed to sort out these
effects. However, an implication of our findings is that simply increasing staffing levels is unlikely to
achieve much impact on nurses’ retention levels unless problem areas of the job are also addressed.
Frijters, Shields and Wheatley (2003) find no significant wage effects on nurses quitting behaviour in
UK data and as well present evidence that nurses quit for jobs with lower wages and different
conditions.

The data used in this study do not allow an analysis of the entry decision into nursing but one of the
most significant effects found in this paper is that age is strongly related to retention probability. New
entrants to nursing have a retention probability of about 60% compared to the average of around
80%. This suggests that the relative attractions of nursing compared to other occupations are
considerably less highly valued by new entrants. Clearly, in the longer term new entrants are
required to close nursing gaps but keeping them in nursing once trained is likely to require far more
detailed investigation of nursing conditions. The current major policy initiative is at the moment has
involved reforms to the education policy in regards to nursing. Specifically, the number of university
nursing places has been increased and the HECS rate has been lowered relative to other degrees in
the hope of encouraging more nursing graduates. Our findings suggest that this policy initiative will
have limited success unless accompanied by changes in the working arrangements within the
hospital system.

Australia imports twice as many nurses as it exports. However resort to the temporary solution
provided by international recruitment of nurses has mixed results. The foreign born comprise a
sizeable 23% of the sample, while 7% of the workforce are foreign citizens. Quit rates are very high
amongst non permanent residents but very low amongst foreign (not UK or NZ) born. This suggests
that higher immigration weighting of nursing applicants might prove a relatively successful means of
boosting nursing numbers.

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