title: Nurse Knowledge, Work Environment, and Turnover in Highly Specialized Pediatric End-of-Life Care.
abstract: OBJECTIVE
  To examine the relationship between nurse knowledge, work environment, and registered nurse (RN) turnover in perinatal hospice and palliative care organizations.
  
  
  METHODS
  Using nurse intellectual capital theory, a multivariate analysis was conducted with 2007 National Home and Hospice Care Survey data.
  
  
  RESULTS
  Perinatal hospice and palliative care organizations experienced a 5% turnover rate. The professional experience of advanced practice nurses (APNs) was significantly related to turnover among RNs (β = -.032, P < .05). Compared to organizations with no APNs professional experience, clinical nurse specialists and nurse practitioners significantly reduced RN turnover by 3 percentage points. No other nurse knowledge or work environment variables were associated with RN turnover. Several of the control variables were also associated with RN turnover in the study; Organizations serving micropolitan (β = -.041, P < .05) and rural areas (β = -.037, P < .05) had lower RN turnover compared to urban areas. Organizations with a technology climate where nurses used electronic medical records had a higher turnover rate than those without (β = .036, P < .05).
  
  
  CONCLUSIONS
  The findings revealed that advanced professional experience in the form of APNs was associated with reductions in RN turnover. This suggests that having a clinical nurse specialist or nurse practitioner on staff may provide knowledge and experience to other RNs, creating stability within the organization.
authors.affiliation: 1 College of Nursing, University of Tennessee, Knoxville, TN, USA.
authors.forename: Lisa C
authors.initials: LC
authors.lastname: Lindley
authors.affiliation: 2 Department of Health Services Policy and Management, Center for Effectiveness Research in Orthopedics, University of South Carolina, Columbia, SC, USA.
authors.forename: Melanie J
authors.initials: MJ
authors.lastname: Cozad
mesh_terms: D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D002648:Child; D002675:Child, Preschool; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009722:Nurse Practitioners / Q000523:psychology*; D009859:Oncology Nursing / Q000706:statistics & numerical data; D010166:Palliative Care / Q000523:psychology*; D010371:Pediatric Nursing / Q000706:statistics & numerical data; D018743:Perinatal Care / Q000706:statistics & numerical data; D010563:Personnel Turnover / Q000706:statistics & numerical data*; D013727:Terminal Care / Q000523:psychology*; D017132:Workplace / Q000523:psychology*
keywords: RN turnover; RN work environment; advanced practice nurses; nurse intellectual capital theory; perinatal hospice care; perinatal palliative care