Inclusive Hospital Policies, Nurse Burnout, and Job Turnover

Organizational turnover among nurses is associated with high levels of burnout, which may be exacerbated by workplace discrimination and exclusionary organizational policies. The theory of inclusive organizations suggests that fostering inclusive workplace environments can positively affect job retention.

This study examined the role of inclusive hospital policies in shaping nurses' intentions to leave employment. We hypothesized that inclusive policies would reduce turnover intentions among all nurses, with a stronger effect among those experiencing high burnout.

This cross-sectional study analyzed three survey data sets from 2021: the RN4CAST-NY/IL data collected from registered nurses in New York and Illinois; the Healthcare Equality Index data, which assesses and scores hospitals' inclusion efforts for lesbian, gay, bisexual, transgender, queer or questioning, and other sexual and gender-diverse individuals; and the American Hospital Association Annual Survey. The dependent variable was nurses' intent to leave their employer within a year. The independent variable was the Healthcare Equality Index score, with nurses' high burnout serving as the moderating variable. Multilevel logistic regression with cross-level interaction was employed for the analysis.

A total of 6,294 nurses from 111 hospitals were included in the study. An increase in the total Healthcare Equality Index score was associated with decreased odds of nurses intending to leave their employer. Nurses experiencing high burnout were more likely to intend to leave their employer compared to those without high burnout. Nurses' high-burnout status did not moderate the relationship between hospitals' Healthcare Equality Index scores and nurses' intent to leave.

Inclusive hospital policies positively affect job retention regardless of nurses' burnout status. Healthcare organizations should foster inclusive and supportive environments as one strategy to improve nurse retention and organizational stability.