Why do nurses leave rural jobs? This DBA candidate is seeking answers

Learn more about the Doctor of Business Administration program.

With a shortage of nurses in many provinces, Canadian hospitals struggle with staff retention. The shortage is even more critical in rural settings and leads to closures of beds and rural residents and families to be seeking critical care including emergency care and labour and delivery care in distant locations away from home. While recruitment has been the strategic focus in reducing nurse shortage problems, retention of the nurses is not only important but in need of urgent attention in these rural and remote settings. 

In the segmented case of rural hospitals, research by Royal Roads University Doctor of Business Administration candidate Nathan Banda found that internal factors related to workplace culture and around job satisfaction and support are critical in many nurses’ decisions to leave for urban centres.

Nathan Banda is director of surgical services at Grande Prairie Regional Hospital and Queen Elizabeth II Ambulatory Care Centre Hospital in Alberta. He started his career as a health care aide before becoming a licensed practical nurse, then a registered nurse. While Banda was working as a site manager at one of the rural hospitals in central Alberta in 2018, the hospital lost 64 per cent of its acute care nurses in the first six months of the year to urban hospitals. That led to service disruptions including bed closures and hiring of contract nurses for temporary relief in care delivery. These were nurses who had been fully trained and settled in rural nursing.

That prompted him to ask, “What factors led nurses to leave rural facilities for urban facilities or the profession altogether?”

Banda’s RRU DBA research, Factors That Affect Nurse Retention in Rural Canada: Strategies for Managing Nursing Shortages in Rural Alberta was funded by a Mitacs Accelerate Internship. The research used mixed methods that included interviews and surveys of nurses and their managers, which then informed focus group discussions to provide recommendations from the identified themes in the interviews and surveys.

Banda notes that previous studies have highlighted the importance of work placements in rural areas for nursing students, and that ensuring lifestyle needs of nurses outside the workplace are met,including availability of recreation facilities and amenities improves retention. While the factors identified in the previous studies might be true, Banda’s research suggests that the external factors that mattered highly in rural Alberta, included having family and social connections and support in the community including employment for spouses. 

However, Banda’s research findings suggest that on-the-job frictions and lack of support can cause nurses to leave for other institutions. These include: lack of management support, including insufficient feedback or regular check-ins; an overwhelming workload, especially compared to peers in urban centres; and disrespect shown to nurses by doctors, a concern that was “pervasive” at the four sites where he conducted his research.

“My research says it’s not money,” he says. “I should be happy in my workplace. I need to feel respected. I need to have a voice. And if I feel disrespected, if I don’t have support from my managers, I will not stay even if you pay me more money. That’s a significant finding in my research.”

Banda also says he believes if managers and physicians understand that how they conduct themselves has an effect on nurse retention, they’ll act differently.

“There are two things here: recruitment and retention. My focus here is on… let’s shut the back door. Let’s keep who we have.”

Learn more about Royal Roads’ Doctor of Business Administration program.