Factors contributing to high turnover rates of emergency nurses : a review of the literature

Objectives The objective of this study was to identify factors that contribute to high turnover rates of nurses working in emergency departments. Review methods/Data sources The search strategy for the review complied with Preferred Reporting Items for Systematics Reviews and Meta-Analyses (PRISMA) guidelines. Electronic databases, Medical Literature Analysis and Retrieval System Online (MEDLINE), Cummulative Index of Nursing and Allied Health Literature (CINAHL), and Google Scholar were systematically searched for literature studies published between 2006 and 2018. A predefined set of exclusion and inclusion criteria was used by two of the authors. Inclusion criteria included full-text articles available in English, original research that meets National Health and Medical Research Council (NHMRC) guidelines, peer-reviewed articles, and articles related to emergency departments (EDs) only. Data were analysed thematically using Braun and Clarke's six key phases of thematic analysis. Results A total of 20 articles, comprising 16 quantitative and four qualitative studies, met the inclusion criteria and identified factors that contribute to high turnover rates in EDs. This review identified three major themes: aggression and violence, critical incidents, and work environment. Conclusions This review has identified that there are multiple challenges faced by nurses working in EDs. These challenges may result in high levels of occupational stress, burnout, compassion fatigue, and posttraumatic stress disorder or secondary traumatic stress, which further contributes to attrition rates.