US Army Primary Care: Nursing Practice Environment, Team Performance, & Outcomes


Name: Melissa Miller

Rank: CPT

Organization: Rutgers University

Performance Site: Rutgers University

Year Published: 2019

Abstract Status:


The current national rate of turnover for bedside registered nurses (RNs) is 16.7%, a 2% increase from 2016 (Nursing Solutions Inc., 2018). Licensed practical nurse turnover has been reported as high as 18% (Wisconsin Hospital Association, 2018). The national vacancy rate for bedside nurses is 8.2% (Nursing Solutions Inc., 2018). The estimated cost of RN turnover is $38,000 to $61,000 annually (Nursing Solutions Inc., 2018). Hospitals lose $4.4 - $7 million annually due to RN turnover alone (Nursing Solutions Inc., 2018).The Military Health System is not immune to the nurse attrition problem. Nurse attrition hinders the Army Medical Department mission by diminishing readiness (Army Medicine, 2019). Yet, the retention of a stable nursing staff within the Army Nurse Corps has been linked to reductions in adverse events and higher quality care (Breckenridge-Sproat et al., 2017; Patrician et al., 2017). In order to compete with the private sector in retaining highly competent and skilled nurses, it is critical to identify, through rigorous research methods, those system characteristics that contribute to or conversely, reduce attrition so that evidenced-based retention strategies can be designed and implemented. Although there is an empirical literature linking favorable nursing practice environments, team performance, patient safety, and nurse job satisfaction with lower nurse attrition and intent to leave, these relationships have rarely been explored in primary care settings, and there have been virtually no studies that have tested these relationships in Army primary care settings within the Military Health System.The proposed cross-sectional, correlational study will examine the relationship among the nursing practice environment, team performance, staff perception of overall safety, staff nurse job satisfaction, and staff nurse intent to leave in Army primary care settings in Army medical treatment facilities. These relationships will be examined utilizing secondary data collected in 2016 by the Army Nurse Corps and the Defense Health Agency Patient Safety Program. A limitation of the proposed study is reliance on staff perceptions of theoretical concepts, however, empirical indicators included in this proposal demonstrate strong validity and reliability across the literature for measuring the concepts of interest.An exploration of the nursing practice environment in Army primary care clinics and staff and organizational outcomes is essential to ensure staff nurse retention and the provision of safe, quality care in these settings. The proposed study will inform military nursing leaders regarding system characteristics that contribute to or reduce staff nurse attrition in Army primary care settings. Findings from the proposed study will provide military nursing new knowledge necessary to design and implement evidence-based retention strategies to compete with the civilian sector in retaining highly competent and skilled nurses in primary care settings.