Towards an understanding of nurses leaving nursing practice in China: a qualitative exploration of nurses leaving nursing practice from recruitment to final exit

Abstract

The nursing shortage in China is more serious than in most developed countries, but the loss of nurses through their voluntarily leaving nursing practice has not attracted much attention in Chinese society. The aim of this study is to add to the understanding of nurses leaving nursing practice in China by exploring the process from recruitment to final exit. The qualitative research method draws on a grounded theory approach, especially the constant comparative method of analysis. The indepth interviews were conducted with 19 nurses who have left clinical care. The selection of the study participants was guided by the principle of theoretical sampling. Two core conceptual categories emerged from leavers’ account of their leaving: “Mismatching Expectations: Individual vs. Organizational” and “Individual Perception of Power”. By illuminating the interrelationship between these two core categories, four nursing behaviour patterns are identified: (1) Voluntary leaving (2) Active staying (3) Adaptive staying (4) Passive staying. These behaviour patterns provide an explanation about why and how nursing wastage occurs. The analysis suggests: (1) the higher the degree of mismatch that the nurses recognised between individual and organizational expectations of nursing and the greater the extent of imbalance of power the individual nurses perceived, the more likely it is that the nurses intend to leave the powerless status of being a clinical nurse within the organization; (2) the more difficult it becomes for the nurses to achieve their individual expectations by exercising nursing autonomy in their nursing career, the more likely it is that they actually empower themselves to leave nursing practice. The study suggests that nursing wastage could be avoided if the individual and organizational expectations of nursing were more aligned, and the individual nurses were able to exercise nursing autonomy in their professional practice and career. Although the findings are limited in studying the current nursing workforce situation in China, the theoretical perspective may contribute to the international debate on nursing employment towards effective nursing workforce management and retention strategies.