The determinants and consequences of adult nursing staff turnover: a systematic review of systematic reviews.

BACKGROUND: Nurses leaving their jobs and the profession are an issue of international concern, with supply-demand gaps for nurses reported to be widening. There is a large body of existing literature, much of which is already in review form. In order to advance the usefulness of the literature for nurse and human resource managers, we undertook an overview (review of systematic reviews). The aim of the overview was to identify high quality evidence of the determinants and consequences of turnover in adult nursing. METHODS: Reviews were identified which were published between 1990 and January 2015 in English using electronic databases (the Cochrane Database of Systematic Reviews, MEDLINE, EMBASE, Applied Social Sciences Index and Abstracts, CINAHL plus and SCOPUS) and forward searching. All stages of the review were conducted in parallel by two reviewers. Reviews were quality appraised using the Assessment of Multiple Systematic Reviews and their findings narratively synthesised. RESULTS: Nine reviews were included. We found that the current evidence is incomplete and has a number of important limitations. However, a body of moderate quality review evidence does exist giving a picture of multiple determinants of turnover in adult nursing, with - at the individual level - nurse stress and dissatisfaction being important factors and -at the organisational level - managerial style and supervisory support factors holding most weight. The consequences of turnover are only described in economic terms, but are considered significant. CONCLUSIONS: In making a quality assessment of the review as well as considering the quality of the included primary studies and specificity in the outcomes they measure, the overview found that the evidence is not as definitive as previously presented from individual reviews. Further research is required, of rigorous research design, whether quantitative or qualitative, particularly against the outcome of actual turnover as opposed to intention to leave. TRIAL REGISTRATION: PROSPERO Registration 17 March 2015: CRD42015017613

The utility of transactional and transformational leadership for predicting performance and satisfaction within a path-goal theory framework

In a test of hypotheses derived from the integration of principles of path-goal theory (House, 1996) and transformational leadership theory (Bass, 1985), data collected from 179 high school teachers and their principals were examined with hierarchical regression analysis. Augmentation analysis indicated that transactional leadership had a stronger role in explaining unique criterion variance beyond the contribution of transformational leadership, than did transformational leadership relative to transactional leadership. In addition, both the transactional and transformational leadership had a negative interactive relationship for predicting the outcome of performance, such that leader vision and leader intellectual stimulation were more positively correlated with employee performance when leader use of contingent reward was low. These augmentation effects, in conjunction with the findings of negative moderation, suggest that transactional leadership may have greater potential predictive value than previously assumed