William James has recently been hired as the director of human resources for an academic medical center located in the Northeast. While he was interviewing for the position, several administrators and physicians told him that employee morale, particularly among registered nurses, was extremely low. James later learned that the annual turnover rate of nurses at this facility has averaged 18.4 percent as compared to 11.6 percent in the metropolitan area over the past three years.

James was aware that all exiting employees are required to complete an exit interview questionnaire and interview prior to receiving their final paycheck. He then asked his assistant to pull the files for all exit interviews of departing nurses and prepare a summary of the major reasons for leaving and specific suggestions for how the facility could increase its retention of nurses.

When the results were compiled, James was disappointed. The utility of these data was very low. Most of the respondents indicated they were leaving for personal reasons, family responsibilities, or another job offer. Very few volunteered recommendations for how the facility could improve nurse retention even when asked directly on both the questionnaire and during the interview. The recommendation mentioned most frequently was better parking.

The prevailing opinion of individuals with whom James spoke was that departing employees are reluctant to discuss any sensitive issues or concerns for fear of alienating the interviewer or supervisor. He was told no one wanted to possibly jeopardize their recommendation to other employers due to anything they might say during the exit interview. Through his informal conversations with nurses and nurse supervisors, he knew there were many problems and concerns shared by many nurses including inadequate staffing, lack of respect and support from supervisors and top management, favoritism in salary increases and promotions, and high stress levels due to all of the above. Yet, he was unable to document these problems and others with the current exit interview data.

James is now attempting to determine the best methods of identifying employee problems and assessing employee reaction to the organization, its various components, and various human resource policies and programs. He is also interested in determining the factors which cause many of the long-tenured nurses to stay.

1. Discuss the nature and causes of the problem of nurse retention.

2. Should James attempt to improve the exit interview process? If so, how should this be done?

3. What other assessment alternatives should he consider using in addition to, or rather than, exit interviews in order to determine the underlying causes of turnover and enhance retention in the future?

4. How can James use the information generated about why nurses stay or leave to improve nurse retention?