¶ … Nurses Leaving? Findings from an Initial Qualitative Study on Nursing Attrition Substantive and Theoretical Dimensions

Problem and Significance

Conceptual Framework

Methodological Dimensions

Ethical Dimensions

Interpretive Dimensions

Presentation and Stylistic Dimension

Qualitative Research Article Critique: Why Are Nurses Leaving? Findings from an Initial Qualitative Study on Nursing Attrition

In her article Why Are Nurses Leaving? Findings from an Initial Qualitative Study on Nursing Attrition, MacKusick (2010) outlines the fact there is a nursing shortage that remains problematic, however, research with nurses no longer in clinical practice is rare. This study focused was to understand the factors that are influencing the decision of registered nurses (RNs) to leave clinical nursing. MacKusick's report indicates a phenomenological research design was done in order to disclose the complex phenomena persuading the RNs' choices to leave clinical nursing practice. During the course of the study, certain themes emerged from the data which were collected and coded -- these themes are charted in the results section of the report. As these themes are developing, they permit the researcher to inductively produce hypotheses which result, essentially, in a grounded theory regarding the reason why nurses are leaving the profession.

Substantive and Theoretical Dimensions

Problem and Significance

The problem of the study is implied in the abstract and the introduction, and it is obviously and openly stated in the 'Method' sector of the report. Here, the researcher states that the problem of the research was "was to identify the factors that are influencing the decision of RNs to leave clinical nursing practice (MacKusick, 2010). Particularly, as noted in the abstract, the focus of the study rested primarily on nurses leaving their professions and never coming back "strategies the hospitals try to apply to try and make the nurses stay" (MacKusick, 2010). By examining the factors that are leading to RNs leaving clinical nursing practice. MacKusick is in effect exploring the shortages of nurses that are in the profession. While the goal of qualitative research is not generalizability, it must to be clear that the findings reported in this article are certainly convenient to other contexts and circumstances. That is to say, not many explore the perceptions of the RN who make the decision to leave clinical nursing. Understanding factors related with RNs' practice decisions is the first step essential in developing effective nursing-retention policies.

Conceptual Framework

There was no mention of a conceptual framework in the article. Conceptual frameworks are products of qualitative processes of theorization. However, in this article I would suggest that building a conceptual framework from existing multidisciplinary literature is a procedure of theorization, which uses grounded theory methodology instead of an account of the data and the targeted phenomenon.

Research Question

In direct relation to the purpose of this case study, certainly, the driving force behind the research, are one question which MacKusick highlights on page 336 of the published article. Above all, these questions are 1. "What is the experience of RNs who leave clinical nursing?" Investigators conducted semi-structured interviews with nurses who left clinical practice. The questions used to guide the interviews were presented in Table 1.

Literature review

In qualitative research it is important to review relevant literature on the subject of study in an exertion to provide a logical background for the efforts assumed by the researcher in an assumed context. MacKusick does indeed draw on some applicable literature to contextualize her research, even though no clear account, synthesis, or analysis of that literature is obvious. For example, in the introduction to the article, the author talks about how in the United States, nursing workforce projections specify the registered nurse (RN) could may exceed 500,000 RNs by 2025. As background to her research, this is chiefly useful in that it provides evidence which suggests that an examination of how such testing affects teaching and learning is wanted. While this specific reference is helpful in giving out some background, the lack of a clear discussion concerning such literature in the introductory section of the article is to some extent disappointing. In later sections, nonetheless, MacKusick does certainly refer to literature which supports the opinions --, this is not equal to providing a clear background.

Methodological Dimensions

The sample for this case study was chiefly and purposely chosen. There were a number of factors which donated to the sample...

Inclusion criteria consisted of licensed RNs with a least of 1 year of clinical practice and no clinical practice in the last 6 months. RNs with in excess of 1 year of experience were selected as they could deliver information about the factors guiding to their decision to leave clinical nursing; investigators' supposition was that the choice to leave clinical practice was not linked exactly to the initial shock of becoming a RN (Patton, 2002).. From the researcher's conversation of the sampling method, one can obviously surmise that the kind of sampling here is what qualitative researchers refer to as Maximum Variation
Sampling -- where the goal is to look at and study the utmost range of experience likely in an effort to obviously understand the social contexts of the members in the study at the same time, marinating a level of transferability. MacKusick specifically sought out a sample which would offer the best opportunity for research into the struggle of nurses that were unhappy with their jobs ... this particular setting had a large setting of nurses that did not like their profession and wanted to leave or were on the verge of leaving "about 15% of the nurses did not want to be there anymore, and about 17% were on their way out" (MacKusick, 2010). No effort was made to recognize whether or not these proportions were coincided in any type of way, which could advise a subversive method on the part of the researcher to make the sample seem more conflictingly "ill-used" than it is in actuality.

Ethical Dimensions

To make sure things were confidential MacKusick used study codes on data forms in place of recording recognizing information and then they were able to keep a separate document that links the study code to all of those that were involved in the project. All of the identifying information was locked in a separate location and restrict admission to this text. MacKusick maintaining confidentiality of information that they collected from research participants meant that only he or individuals of the research team are able to recognize the replies of individual subjects; on the other hand, MacKusick had to make sure every effort to stop anyone outside of the project from linking individual subjects with their responses in this project. MacKusick clearly understood that the use of study codes is a real method for shielding the confidentiality of research participants. MacKusick clearly knew that the study codes may be used on data collection tools in place of recognizing information to protect participants' replies / data when data documents are stored or out in the open. Also, MacKusick made it clear that in the event that a data document is stolen, lost, etc. having the data sheltered by a study ID will stop anyone who might view the data from determining those that were involved in the study participant's identity.

Interpretive Dimensions

The discussion of findings is logical, and clear with each of the identified themes discussed in turn. The authors' state that the major finding of the study is that participants were the ones that believed they had to leave clinical nursing practice; this was the single recourse for them in essentially untenable circumstances. Most members felt a lack of support in the place of work at numerous levels, and these RNs were most troubled when the lack of support ascended from their friends. This also protracted vertically to feelings that management and medical doctor did not support the RN in clinical practice (as opposed to total care or poor nursing skills joint with unclear capabilities), and that this was said to have made it hard for patients to recognize and describe. These ideas are inacceptable in that it seems to divert consideration away from the inherent difficulties of the research, to limits in the patients.

MacKusick made sure to include that despite acknowledgement of HH in the nursing place of work, the cycle of abuse has led some individuals to leave an occupation about which they were once happy. MacKusick did a good job in showing that the moral dilemmas and conflicts come across by numerous nurses have left such permanent marks on their insights of nursing that they wavered to come back to clinical nursing. The researcher did a good job in showing that the study participants in the beginning believed they could make a valued contribution through clinical nursing, however they believed they never could go back to nursing practice in that background. MacKusick also made sure that he expressed the fact that all the nurses conveyed guilt about not working clinically, nevertheless none were willing to go back to clinical practice.

The results segment went through four major themes about prospects with statements that propose negative and positive experiences in the nursing setting…