Evaluation of Employee Turnover Rates and Leaving Reasons of Nurses Working in the Intensive Care Units

Aim: The current study has been retrospectively carried out due to specify the rotation rate of health care staff worked at intensive care units of Ankara Atatürk Training and Research Hospital between 1st January 2015 and 30th May 2016. Method: The fully available records of 110 health staff, who worked at the written time, have been searched and the data has been computed by SPSS. Results: Fifty-four health staff separated from intensive care units during the 17 months period. By calculating with the formula which was used for calculating the work force rotation by managers of human sources, intensive care staff rotation rate has been determined as 50%. Of the separation reasons 35, 2% are pregnancy, delivery permit and continuing unpaid vacation. 57.9% were between 25-29 age intervals. Of those 38.1% reported work overload, 33.3% negative effect on family life, 19% stressful working environment, 9.6% bad work settings. Conclusion: It is concluded that intensive care rotation rate is high at the hospital. Mostly the pregnancy and continuing unpaid vacations increase the rotation rate.


Introduction
Employee turnover rate is stated as "the ratio of people who leave their job to the people who are working, in a certain period in a company" or as "entry or exit move into the work force of a company within a certain period". Human resources managers usually use the below formula to calculate the employee turnover rate [1]. The formula is as follows: The factors affecting employee turnover have been defined as personal factors, organizational factors, and economic factors. Personal factors include age, gender, educational level, marital status, working time and experience, work satisfaction, and stress. Organizational factors include organizational structure and employee policies, size of the organization, salary, manager behavior, success evaluation, promotion, and friendship relations [2]. Economic factors include state of the job market, level of employment, and general salary level [1]. The reasons for employee turnover can vary from one sector to another and from one workplace to another, and even it can vary depending on the class, type, location of the workplace, and most importantly the characteristics of the employees [2].
It is not possible for the companies to benefit from the workers efficiently, find good employees, and retain them in the company for a long time as long as the employee turnover rate remains high. Thus, it is suggested for companies to keep their employee turnover rate at a normal level [3]. A good human resources planning is required to eliminate or decrease the factors that affect employee turnover. In this context, the planning should be as such to not create much loss for the company or the worker. Nursing profession, which has a high employee turnover rate in the medical field, is also an occupational group that historically had a high turnover rate in the world. High turnover rate of nurses is an important problem affecting both the quality of patient care and the nurses. At the same time, it also negatively affects the morale and efficiency of other nurses and may cause voluntary or involuntary withdrawal from employment [4].
Resignation of an employee with high work performance is a disadvantageous situation for the organization. Even if a new employee has been replaced, time is needed for the new employee to get used to the work environment and carry out the job at the same pace [5]. The researchers agree that a new employee will cause unfavorable results due to decreased efficiency, low morale of the staff, and decrease in efficiency. Along with negative consequences for the patient and the nurses, there is also agreement on the fact that the services provided are very costly. Especially in societies with limited resources, such as in Turkey, the cost of these negative consequences is higher. Thus, employee turnover rate and reasons of nurses for leaving is a subject that the healthcare and nursing directors should lay particular emphasize on and establish effective strategies. There are also factors affecting employee turnover that develop out of the control of the organization.
Usually there are factors such as retirement, reassignment, pregnancy which generally develop out of the control of the hospitals and nurses, the timing of which cannot be estimated, and which are at the same time difficult to be controlled by the organization. In the case that the employee turnover reaches a critical level in the organization, it is necessary to analyze and reveal the reasons for high employee turnover in order to solve the problem [6]. In the case that the employee turnover reaches a critical level in the organization, it is necessary to analyze and reveal the reasons for high employee turnover in order to solve the problem [7]. High or low turnover rate by any means is closely related to the organizational activities. It continues to be of highest priority in the agenda of administrator nurses. Despite that, there are no data showing the leaving rates and reasons of leaving for nurses in Turkey.

Purpose
The purpose of the study was to determine the employee turnover rate in the intensive care units between January 2015 and May 2016, to determine the reasons for the turnover rates, to determine the factors that cause the nurses withdraw from their job in the intensive care units, and to evaluate the satisfaction levels of the nurses in the clinic in which they are currently working.

Scope
The study involves the healthcare staff who worked at and who left Ankara Atatürk Training and Research Hospital Intensive Care Units between January 2015 and May 2016.

Method of the Study
The data were collected retrospectively by evaluating the nurses who worked at and left Atatürk Training and Research Hospital intensive care units between January 2015 and May 2016. The nurses who voluntarily changed clinics were contacted and surveyed. The survey includes questions regarding sociodemographic characteristics, reasons for leaving, and their satisfaction with the clinic for which they are currently working. The data were analyzed using SPSS. When calculated according to the formula used by the human resources directors to calculate employee turnover rate, it is seen that the intensive care employee turnover rate was 50% in the 17-month study period.

Results
The reason for job withdrawal was pregnancy and maternity leave with subsequent unpaid leave in 35.2% of the employees, whereas 29.6% changed their ward due to various reasons. The factors that cause the healthcare staff to leave the intensive care unit are presented in the Figure 1. Of healthcare staff that voluntarily changed departments or hospitals, 76.2% were between the ages of 21 and 30 years, 52.4% were single, 47.7% had a graduate degree, and 47.6% had provided service in the intensive care unit for the duration of 1-5 years. Their socio-demographic characteristics are presented in the Table 2. The reason for requesting department change was high workload of the intensive care unit in 38.1%, negative effects on their family lives in 33.3%, stressful working environment in 19%, and poor working conditions in 9.6% of the nurses Figure 2.  The healthcare personnel who have been voluntarily transferred to another clinic were asked whether they were satisfied with their current working environment and 52.4% reported satisfaction with their clinic (Table 3).

Discussion
In this study where the turnover rates of the healthcare staff working in the Atatürk Training and Research Hospital Intensive care units were analyzed, turnover rate profiles between January 2015 and May 2016 were determined. Approximately 108 out of 507 actively working nurses in the hospital have been employed in the intensive care units. The mean age of the staff working in the intensive care unit is 30.3, the mean working time in the occupation is 7.7 years, and 52.7% have graduate degree. During a total of 17 months period, 54 healthcare personnel have left the intensive care unit. When calculated according to the formula used by the human resources directors to calculate employee turnover rate, it can be seen that the intensive care employee turnover rate is 50%. According to the classification in the study carried out abroad regarding the level of nurse turnover rate; a turnover rate between 4% and 12% is considered to be low, a rate of 12-22% is considered to be medium, and a rate of 22-44% is considered to be high [8].
When the employee turnover rate reaches 50%, it affects productivity and other staff negatively [9,10]. It can be said that the turnover rate in our study is high. In another study, turnover rate of intensive care unit nurses was found to be 64.6%, a finding indicating a high turnover rate, and it was thought that high turnover rate reported in this study may have been caused by the fact that the study was conducted by the nurses [11]. However, turnover rates of nurses in Norway and other European studies have exceeded the results reported by Leite et al. [11,12].In a study, it was detected that high turnover rate of nurses shows that emotional burnout is increasing amongst the intensive care employees and that the communication bonds between the nurses are decreasing. In a meta-analysis study, low work satisfaction and low institutional loyalty are amongst the factors that affect turnover rate of nurses [14,15].
In our study, it can be seen that the reason for leaving for 35.2% of the healthcare staff working in intensive care units is unpaid leave following pregnancy and maternity leave and 57.0% of them are between the ages of 25-29. 44.4% of the 54 intensive care staff who left is also in this age group. According to the data of Turkish statistical institute, it was reported that individuals aged 25-29 years represent the fertility age group [16]. Considering the fact that healthcare staff working in the intensive care units should have a certain amount of knowledge and experience and be in the 25-30 years age range when their physical strength and endurance is at the highest level, it can be said that there is a loss of workforce. Individuals leaving workplace for reasons other than pregnancy leave, relocation out of city, educational reasons and spouse-related relocation account for 29.6% of the turnover rate. Environmental factors, geographical factors such as a job opportunity outside of the organization can affect the turnover rate [9].
Amongst the healthcare employees who had their departments changed or who changed hospitals as per their own request, 76.2% were between the ages of 21-30, 52.4% were single, 47.7% had graduate degree, 47.6% worked at the intensive care unit between 1-5 years. 38.1% of these stated too much workload as the reason, 33.3% stated that their family life is being negatively affected, 19% stated that the work environment is stressful, and 9.6% stated that working conditions are poor. When the satisfaction states of the 21 people who had their department or hospital changed are considered, it was detected that 19% are very satisfied, 52.4% are satisfied, and 4.8% are not satisfied at all with the units they are currently working. In a study, it was reported that the authors thought that turnover rate increases related to the nurses having too many working hours, having too many night shifts, not being compensated for the extra work, and not being able to take leaves [17].

Conclusion
In conclusion, it can be seen that the turnover rate is increased mostly by the unpaid leaves taken after the pregnancy and the following period. Employees who have left voluntarily have stated the reason of excessive workload as another factor and it was detected that the employees who were shifted to another place were satisfied with their new place. It was concluded that the intensive care turnover rate in the hospital is high.