Perceived Strategies to Decrease

Attrition Rates Among Nurses

Practicing at Healthcare Institutions
in India

Lyn S. Prater, PhD, RN, CNE

Shelby L. Garner, PhD, RN, CNE
Leena Raj, MPhil, RN
 The Global Workforce
• A 2015 analysis estimated the global health
workforce to be slightly above 43 million
workers, including 20.7 million
nurses/midwives, 9.8 million physicians
and approximately 13 million other health
workers (WHO, 2016).
 The Global Workforce Shortage
• Needs-based estimates, relative to a
Sustainable Development Goals threshold
of 44.5 skilled health professionals per
10,000 population indicated a shortage of
approximately 17.4 million health workers
in 2013
• 2.6 million physicians
 The Global Workforce Shortage
• Over 9 million nurses and midwives
• Around 5.8 million other health-care cadres
(WHO, 2016).
 Shortage in South East Asian
Region
• Relative to population density, the WHO
Africa Region and WHO South-East Asia
Region, which bear the greatest burdens of
preventable disease, have the lowest density
of health workers (WHO, 2016).
 Shortage in India
• A severe nursing shortage exists in India, where
nurses are increasingly migrating abroad to practice
nursing (Senior, 2010; WHO, 2016).
• A gap in the literature exists on perceived and
tested strategies to retain nurses and decrease
attrition rates in Indian healthcare facilities.

Retrieved from http://www.itbhuglobal.org/chronicle/553b-migration.png

 Aim
• To assess perceived strategies to decrease
attrition rates among nurses practicing in
healthcare facilities in India

Retrieved from http://i.ndtvimg.com/i/2016-02/nurse_650x400_71454674755.jpg

 Theoretical Framework
• Paulo Freire’s theory on oppression and education for a
critical consciousness was used to guide this study.
• Freire’s original research with the working class people of
Brazil demonstrated and illuminated the idea of oppression
and how oppressed people might make their own changes
through dialogue, reflection, action, and education.
 Methods
• A qualitative descriptive approach was
used. Purposive sampling resulted in N=10
participants who were interviewed using
face-to-face semi structured, in depth,
individual interviews. Data were collected
from November 2014 to March 2015.
Interviews were audio recorded and
transcribed using a directed content analysis
approach.
Results
Results
 Results
• Implement Reasonable Remuneration
• Establish Equitable Pay
Participant 5: An engineer comes out of 4 year course…
His salary starts with 25,000 [Rs. per month], but our
BSc nurse covers same 4 years and more into life studies.
They are working with machines and computers but we
work more in terms of caring individuals, society or the
community. There she takes 12 to 15,000 [Rs. per month].
So the disparity is there.

• Align Salary Scales

 Results
• Provide a Safe & Effective Environment
• Standardize Nursing Workload Policies

Participant 1: If you are working in a

government hospital, in a 60 bed ward, at
times we have 120 patients … If it is 60 bed
ward, two staff nurses will be allocated. It
doesn’t matter they’ll be looking after 100
patients or 30 patients or 120 patients. In
a corporate sector … more or less they’re
able to maintain norms… if it is general
ward five patients to one nurse.
 Results
• Provide a Safe & Effective Environment
• Ensure Equipment Availability and Use
Participant 1: And they’re able to
maintain that over there but other things
like I have told about the vaccination
[Hepatitis B], the availability of gloves or
the personal protective equipment for the
nurses, these things still we are fighting
for it and definitely that proves a great
occupational hazard for the nurses.
 Results
• Provide a Safe & Effective Environment
• Offer Transportation/Housing Services

Participant 4: But it is not safe to come alone at nighttime.

Participant 6: Those who are coming for 11:30 [PM] duty,

what they will do, they will come at 8’o clock itself.

Participant 5: Transportation if it is taken care by the

organization then the attrition rate will come down.
Transportation in India is a major concern…. Nowadays
you know what is happening around the world with women.
 Results
• Recognize Nursing as a Profession
• Build Pathways for Nurses

Participant 5: See,
one thing is that
education is the
major thing that
brings change
 Results
• Recognize Nursing as a Profession
• Provide Opportunities for Recognition

Participant 10: Marathons, events, seminars, poster

competitions should be initiated for nurses. A council,
which works for the nurses, by the nurses, of the nurses,
will play a good strategy to keep nurses in India.
 Discussion
• Nursing stakeholders, nursing organizations, and
nurse researchers from India and around the world
are called to partner with Indian nurses to advocate
for change and to test and implement effective
strategies to retain nurses in India.

• Participants in this study advocated for change in

health and workforce policy to start from within the
nursing profession towards positive practice
environments to increase nursing capacity.
 What’s Next?
• Grant awarded by the US Agency for International
Development (USAID) American Schools and
Hospitals Abroad (ASHA) Division to build a
Simulation Education and Research Centre for
Nursing Excellence in Bengaluru.
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Thank You!!!