Critical Appraisal Why are Nurses Leaving?

CriticalAppraisal: Why are Nurses Leaving?

CriticalAppraisal: Why are Nurses Leaving?

Nurseturnover is among the critical challenges that a few researchers haveaddressed. A few of the researchers who have addressed this issuerarely focused on the major cause of this phenomenon. This paper willappraise one of the articles that have identified factors thatinfluence the decision of the registered nurses to leave clinicalpractices. The article “Why are nurses leaving? Findings from aninitial qualitative study on nursing attrition” was written byCarol Isaac and Ptlene Minick and published in the MedSurg NursingJournal. This paper will focus on the problem statement, purpose,literature review, and conceptual framework.


Theresearch problem addressed in the article “Why are nurses leaving?Findings from an initial qualitative study on nursing attrition” isthe exponential increase in the rate of nurse turnover, with a focuson the case of the United States. The current challenge of the nurseshortage in both the private and the public health care facilities isassociated with the high rate of the turnover of qualified nurses.The case if even worse with registered nurses, where it is estimatedthat the shortage will exceed half a million registered nurses by theyear 2015. This has given rise to a clinical problem where thequality of care and treatment outcome has been decreasing with timebecause of the limited number of nurses who is expected to serve anincreasing number of patients. In spite of this pressing challenge,the exact cause of the nurses’ decision to leave, either thenursing profession or their current jobs has remained unknown. Theidentification of factors that result in the nurse turnover will helpthe stakeholders in ensuring that the health care sector had anadequate supply of qualified and registered nurses by addressingthose factors. The findings reported in the article being analyzed inthis paper sought to fill this knowledge gap.

Theclinical issue reported in the article is of interest to the readerbecause nurse turnover will create a shortage, which will in turnresult in poor treatment outcomes. Apart from the direct impact ofthe nurse turnover on health nurse shortage and treatment outcome,the authors state that the current rate of turnover will create anegative perception of the nursing profession. This will discouragestudents from pursuing nursing in colleges, which will in turn worsenthe situation of shortage and the quality of treatment in the nearfuture. However, the authors did not make a project of the number ofpatients who might be affected by this clinical challenge.

Purposeand research questions

Theauthors aimed at identifying the key factors that influence thedecision of registered nurses to leave their clinical practices. Theauthors decided to pursue this purpose by interviewing nurses whochose to leave their practices in an interview setting of theirchoice. The study was designed to answer one research question, whichis “What is the experience of the experience of registered nurseswho leave the clinical nursing? By answering this question, theauthors intended to identify the key factors that influence thesenurses to leave their bedside nursing roles.

Thestated purpose of the research is directly related to the problem ofnursing turnover. This is because the authors made a direct statementof purpose, which is to identify factors that influence theregistered nurses to leave their practices. However, the researchquestion was stated in an indirect way, but it is relevant to thestudy problem that was being addressed.

Aqualitative method was the most appropriate choice for answering theresearch question and addressing the research problem stated in thearticle. The focus of the research was the perceptions of theregistered nurses and the influence of nurses` perceptions on theirdecisions to leave their present practices. It would be difficult toanswer such a research question using a different approach, such asthe quantitative method. In that case a phenomenological design,which is suitable for a qualitative research, was an effective toolthat helped the authors acquire an in-depth understanding ofdecisions made by nurses to leave clinical practices. In addition,the decision to leave clinical practices can be conceptualized as onethat is affected by multiple factors that are compounded over time,which makes the qualitative approach the suitable option. Moreover,an interpretative hermeneutic phenomenology, which is only possiblein a qualitative study, was an effective tool that helped the authorsin studying the experiences of the registered nurses recruited in thestudy. Identifying the experiences of registered nurses addressed theresearch question directly.


Theauthors cited a few quantitative and several qualitative studies thatwere relevant to the statement of the problem being addressed. Forexample, one of the quantitative study indicated that between 35 and50 % of the newly recruited registered nurses in the United Statescontemplated leaving their current position or leaving the nursingprofession altogether. A similar study indicated that the vacancyrate of the registered nurses in the United States was 8 %, whichindicates that the current rate of turnover will exacerbate thechallenge of nursing shortage and the quality of health care servicesin the country. About 36 % of the sources used in the article werewithin the limit of five years at the time the research wasconducted. In addition, the authors included 63.64 % of sources thatwere five years and older, but they were credible and useful sourcesfor the research. The review of the literature identified gaps andweaknesses on what had already been accomplished in the previousstudies. For example, the authors identified that there was noliterature documenting the decision-making process and perceptions ofregistered nurses. Although the literature review helped the authorsmake a local argument, it was short and almost inadequate.

Conceptual/ theoretical framework

Theauthors of the article did not identify a specific perspective orframework with which the study would be developed. However, theyconceptualized that the nurses’ decision to leave the clinicalpractices was influenced by multiple factors, including unfriendlyworkplace, emotional distress, exhaustion, and fatigue.


Thearticle “Why are nurses leaving?” addressed the critical issue ofnurse turnover, but it focused on the case of the United States.MacKusick and Minick came up with a clear statement of the problem,which was to identify different factors that influence the decisionof registered nurses to leave the clinical practices. MacKusick andMinick purposed to explore the experiences of registered nurses in aclinical setting in order to determine issues within their workingenvironment that make them decide the leave their present jobs orprofession as a whole.


MacKusick,C. &amp Minick, P. (2010). Why are nurses leaving? Findings from aninitial qualitative study on nursing attrition. MedicalSurgical Nursing,19 (6), 335-340.

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