The Impact of Nurse Turnover on Patient, Nurse, and System Outcomes: A Pilot Study and Focus for a Multicenter International Study (original) (raw)

Nurse turnover: A literature review

Ongoing instability in the nursing workforce is raising questions globally about the issue of nurse turnover. A comprehensive literature review was undertaken to examine the current state of knowledge about the scope of the nurse turnover problem, definitions of turnover, factors considered to be determinants of nurse turnover, turnover costs and the impact of turnover on patient, and nurse and system outcomes. Much of the research to date has focused on turnover determinants, and recent studies have provided cost estimations at the organizational level. Further research is needed to examine the impact of turnover on health system cost, and how nurse turnover influences patient and nurse outcomes. r

Nurse turnover: A literature review – An update

International Journal of Nursing Studies, 2012

Background: Concerns related to the complex issue of nursing turnover continue to challenge healthcare leaders in every sector of health care. Voluntary nurse turnover is shown to be influenced by a myriad of interrelated factors, and there is increasing evidence of its negative effects on nurses, patients and health care organizations. Objectives: The objectives were to conduct a comprehensive review of the related literature to examine recent findings related to the issue of nursing turnover and its causes and consequences, and to identify on methodological challenges and the implications of new evidence for future studies. Design: A comprehensive search of the recent literature related to nursing turnover was undertaken to summarize findings published in the past six years. Data sources: Electronic databases: MEDLINE, CINAHL and PubMed, reference lists of journal publications. Review methods: Keyword searches were conducted for publications published 2006 or later that examined turnover or turnover intention in employee populations of registered or practical/enrolled or assistant nurses working in the hospital, long-term or community care areas. Literature findings are presented using an integrative approach and a table format to report individual studies. Results: From about 330 citations or abstracts that were initially scanned for content relevance, 68 studies were included in this summary review. The predominance of studies continues to focus on determinants of nurse turnover in acute care settings. Recent studies offer insight into generational factors that should be considered in strategies to promote stable staffing in healthcare organizations. Conclusions: Nursing turnover continues to present serious challenges at all levels of health care. Longitudinal research is needed to produce new evidence of the relationships between nurse turnover and related costs, and the impact on patients and the health care team.

Cost of nursing turnover in a Teaching Hospital

Revista da Escola de Enfermagem da USP, 2016

OBJECTIVE To map the sub processes related to turnover of nursing staff and to investigate and measure the nursing turnover cost. METHOD This is a descriptive-exploratory study, classified as case study, conducted in a teaching hospital in the southeastern, Brazil, in the period from May to November 2013. The population was composed by the nursing staff, using Nursing Turnover Cost Calculation Methodology. RESULTS The total cost of turnover was R$314.605,62, and ranged from R$2.221,42 to R$3.073,23 per employee. The costs of pre-hire totaled R$101.004,60 (32,1%), and the hiring process consumed R$92.743,60 (91.8%) The costs of post-hire totaled R$213.601,02 (67,9%), for the sub process decreased productivity, R$199.982,40 (93.6%). CONCLUSION The study identified the importance of managing the cost of staff turnover and the financial impact of the cost of the employee termination, which represented three times the average salary of the nursing staff.

IMPACT OF NURSES TURNOVER ON ORGANIZATION PERFORMANCE

Afro Asian Journal of Social Sciences, 2013

This survey based descriptive research work has been undertaken with the objectives of analysing impact of turnover of nurses on organization performance and offering suitable suggestions to control and prevent turnover of nurses. The study has adopted both convenient and judgement sampling methods and sampled 30 administrators from 30 leading private multi speciality hospitals in Tirunelveli city, Tamilnadu, India. Primary data have been collected by a constructed questionnaire along with personal discussion. Percentage method has been administered to analyse profile of the respondents. Both Mean and Standard deviation have been employed to analyse impact of turnover of nurses on organization performance. The research has found excessive work load for remaining staff, delay in daily routine procedures (e.g. transfer of the patient to operation theatre, ICU and wards), poor patient satisfaction and complaints from patients (as newly joined staffs take long time to cope with routine procedures) are foremost impact of turnover of nurses in private hospitals. The study has given suitable suggestions to control and prevent turnover of nurses.

Related factors of actual turnover among nurses: a cross-sectional study

International Journal of Public Health Science (IJPHS), 2023

Turnover exacerbates the global nursing shortage; the loss of skilled and expert nurses has a negative impact on patient outcomes. The study examined the influence of job satisfaction, work environment, leadership styles, organizational commitment and work-family support on actual turnover among nurses working in the hospital of Indonesia. A cross-sectional survey was carried out in Jakarta, Indonesia. The sample in this study was nurses who leave the jobs from hospital during period of time October 2019 to October 2020. A total of 170 nurses responded to the survey. Nurses reported poor leadership style (2.84±0.82), organization commitment (2.99±0.76), as well as dissatisfaction with organization (2.76±0.80) and leadership support (2.89±0.89). Job satisfaction (p=0.007), work environment (p=0.032), leadership style (p=0.001), organizational commitment (p=0.010), and workfamily support (p=0.026) remained statistically significant affected turnover. The findings of this study emphasize the critical role of satisfaction, organizational commitment, work-family support, and leadership style in determining nurse intention to stay and provide employers with a road map for reducing turnover. Future studies may need to understand more deeper regarding the actual turnover experience and its associated factors using longitudinal or qualitative studies.

Nursing Turnover and Hospital Efficiency: An Organization-Level Analysis

Industrial Relations, 1994

This study tests the competing arguments that organizational turnover rates are positively associated with organizational inefficiency or, alternatively, that turnover rates are positively related to organizational inefficiency only in those organizations experiencing very high or very low rates of turnover. The findings strongly support the former argument: in a national sample of 407 hospitals, turnover among registered nurses was found to be positively and linearly associated with both operating and personnel costs per adjusted admission. However, subset analyses based on hospital size, location, and teaching status, suggest that the strength of the turnovercostrelationship is contingent upon the type of institution in which turnover occurs.

Nurse turnover in New Zealand: costs and relationships with staffing practises and patient outcomes

Journal of Nursing Management, 2013

Aims To determine the rates and costs of nurse turnover, the relationships with staffing practises, and the impacts on outcomes for nurses and patients. Background In the context of nursing shortages, information on the rates and costs of nursing turnover can improve nursing staff management and quality of care. Methods Quantitative and qualitative data were collected prospectively for 12 months. A re-analysis of these data used descriptive statistics and correlational analysis techniques. Results The cost per registered nurse turnover represents half an average salary. The highest costs were related to temporary cover, followed by productivity loss. Both are associated with adverse patient events. Flexible management of nursing resources (staffing below budgeted levels and reliance on temporary cover), and a reliance on new graduates and international recruitment to replace nurses who left, contributed to turnover and costs. Conclusions Nurse turnover is embedded in staffing levels and practises, with costs attributable to both. A culture of turnover was found that is inconsistent with nursing as a knowledge workforce. Implications for nursing management Nurse managers did not challenge flexible staffing practices and high turnover rates. Information on turnover and costs is needed to develop strategies that retain nurses as knowledge-based workers.

Impact of Nursing Unit Turnover on Patient Outcomes in Hospitals

Journal of Nursing Scholarship, 2010

The aim of this study was to examine how nursing unit turnover affects key workgroup processes and how these processes mediate the impact of nursing turnover on patient outcomes. A secondary data analysis was used to test the hypothesized model. This study used registered nurse and patient data from 268 nursing units at 141 hospitals collected as part of the Outcomes Research in Nursing Administration (ORNA II) project. Nursing units provided monthly nursing unit turnover rates for 6 consecutive months, and registered nurses completed questionnaires measuring workgroup processes (group cohesion, relational coordination, and workgroup learning). Patient outcome measures included unit-level average length of patient stay, patient falls, medication errors, and patient satisfaction scores. Nursing units with moderate levels of turnover were likely to have lower levels of workgroup learning compared to those with no turnover (p<.01). Nursing units with low levels of turnover were likely to have fewer patient falls than nursing units with no turnover (p<.05). Additionally, workgroup cohesion and relational coordination had a positive impact on patient satisfaction (p<.01), and increased workgroup learning led to fewer occurrences of severe medication errors (p<.05). The findings of this study provide specific information on the operational impact of turnover so as to better design, fund, and implement appropriate intervention strategies to prevent registered nurse exit from nursing units. Further investigation is needed to assess the turnover-outcomes relationship as well as the mediating effect of workgroup processes on this relationship. Managing nursing unit turnover within appropriate levels at the nursing unit is critical to delivering high-quality patient care.

Nursing turnover: literature review and methodological critique

Journal of Advanced Nursing, 1989

CAVANAGH S J (1989) Joumal of Advanced Nursing 14,587-596 Nursing turnover: research review and methodological critique Turnover represents a major problem for nursmg and health care in terms of cost, the ability to care for patients and the quabty of care given As a result, turnover has been the subject of a large number of lnveshgations, both in nursmg and non-nursmg fields However, many of the artides pubbshed report conflicting finelmgs A further compbcation is the vanety of methodologies researchers have used, there has been bttle agreement on definition, measurement or reportmg strategies This has led to considerable confusion when attemptmg to compare studies This artide reviews what is currently understood about nursmg turnover from an organizational perspective, and exammes some of the methodological considerahons surrounebng the study of nursmg turnover Histoncally, nursmg turnover research appears to have rehed heavily on studies conducted m nonnursmg areas for methodological guidance References to non-nursmg stuebes are therefore important and are reported where appropnate