Cheryl B. Jones

The nursing practice environment, staff retention, and quality of care

The effects of key factors in the nursing practice environment--management style, group cohesion, job stress, organizational job satisfaction, and professional job satisfaction--on staff nurse retention and process aspects of quality of care were examined. Hinshaw and Atwoods (1985) anticipated turnover model was modified and expanded to include relevant antecedent and outcome variables. The four-stage theoretical model was tested using data from 50 nursing units at four acute care hospitals in the southeast. The model explained 49% of the variance in staff nurse retention and 39% of the variance in process aspects of quality of nursing care. Study findings warrant careful consideration in light of recent practice environment changes: experience on the unit and professional job satisfaction were predictors of staff nurse retention; job stress and clinical service were predictors of quality of care. The variable contributing the most to indirect, and in turn, total model effects, was that of management style. These results substantiate the belief that aspects of the practice environment affect staff nurse retention, and most importantly, the quality of care delivered on hospital nursing units.

Nurse Staffing and Postsurgical Adverse Events: An Analysis of Administrative Data from a Sample of U.S. Hospitals, 1990–1996

OBJECTIVE To examine the impact of nurse staffing on selected adverse events hypothesized to be sensitive to nursing care between 1990 and 1996, after controlling for hospital characteristics. DATA SOURCES/STUDY SETTING The yearly cross-sectional samples of hospital discharges for states participating in the National Inpatient Sample (NIS) from 1990-1996 were combined to form the analytic sample. Six states were included for 1990-1992, four states were added for the period 1993-1994, and three additional states were added in 1995-1996. STUDY DESIGN The study design was cross-sectional descriptive. DATA COLLECTION/EXTRACTION METHODS Data for patients aged 18 years and older who were discharged between 1990 and 1996 were used to create hospital-level adverse event indicators. Hospital-level adverse event data were defined by quality indicators developed by the Health Care Utilization Project (HCUP). These data were matched to American Hospital Association (AHA) data on community hospital characteristics, including registered nurse (RN) and licensed practical/vocational nurse (LPN) staffing hours, to examine the relationship between nurse staffing and four postsurgical adverse events: venous thrombosis/pulmonary embolism, pulmonary compromise after surgery, urinary tract infection, and pneumonia. Multivariate modeling using Poisson regression techniques was used. PRINCIPAL FINDINGS An inverse relationship was found between RN hours per adjusted inpatient day and pneumonia (p < .05) for routine and emergency patient admissions. CONCLUSIONS The inverse relationship between pneumonia and nurse staffing are consistent with previous findings in the literature. The results provide additional evidence for health policy makers to consider when making decisions about required staffing levels to minimize adverse events.

Revisiting nurse turnover costs: adjusting for inflation.

Organizational knowledge of nurse turnover costs is important, but gathering these data frequently may not always be feasible in todays fast-paced and complex healthcare environment. The author presents a method to inflation adjust baseline nurse turnover costs using the Consumer Price Index. This approach allows nurse executives to gain current knowledge of organizational nurse turnover costs when primary data collection is not practical and to determine costs and potential savings if nurse retention investments are made.

The costs of nurse turnover, part 2: Application of the nursing turnover cost calculation methodology

This is the second article in a 2-part series focusing on nurse turnover and its costs. Part 1 (December 2004) described nurse turnover costs within the context of human capital theory, and using human resource accounting methods, presented the updated Nursing Turnover Cost Calculation Methodology. Part 2 presents an application of this method in an acute care setting and the estimated costs of nurse turnover that were derived. Administrators and researchers can use these methods and cost information to build a business case for nurse retention.

The costs of nurse turnover: part 1: an economic perspective.

Nurse turnover is costly for healthcare organizations. Administrators and nurse executives need a reliable estimate of nurse turnover costs and the origins of those costs if they are to develop effective measures of reducing nurse turnover and its costs. However, determining how to best capture and quantify nurse turnover costs can be challenging. Part 1 of this series conceptualizes nurse turnover via human capital theory and presents an update of a previously developed method for determining the costs of nurse turnover, the Nursing Turnover Cost Calculation Method. Part 2 (January 2005) presents a recent application of the methodology in an acute care hospital.

A literature review of nursing turnover costs

Aim  To report the findings of a literature review of studies examining nursing staff turnover costs published between 1990 and 2010. Background  Nurse turnover is a global concern that is both costly for health-care organizations and, in the context of the work environment, affects quality and safety. Evaluation  We reviewed past literature and describe the conceptualization of nurse turnover, evaluate the methodologies and calculation of costs, identify the reported range of turnover costs and provide suggestions for future study. Key issues  We report inconsistencies in past studies in terms of the conceptualization and measurement of nurse turnover and turnover rates, the methodologies for gathering data and the data sources used, the approaches for calculating turnover costs and the resulting nursing staff turnover costs estimated. Conclusion  Past studies reached different conclusions about nurse turnover. We still need to explore the actual costs and benefits of nurse turnover and retention. Implications for nursing management  This study should be helpful for nurse executives as they build a business case to address nurse turnover in their organizations, and for policy-makers as they develop policies about turnover.AIM To report the findings of a literature review of studies examining nursing staff turnover costs published between 1990 and 2010. BACKGROUND Nurse turnover is a global concern that is both costly for health-care organizations and, in the context of the work environment, affects quality and safety. EVALUATION We reviewed past literature and describe the conceptualization of nurse turnover, evaluate the methodologies and calculation of costs, identify the reported range of turnover costs and provide suggestions for future study. KEY ISSUES We report inconsistencies in past studies in terms of the conceptualization and measurement of nurse turnover and turnover rates, the methodologies for gathering data and the data sources used, the approaches for calculating turnover costs and the resulting nursing staff turnover costs estimated. CONCLUSION Past studies reached different conclusions about nurse turnover. We still need to explore the actual costs and benefits of nurse turnover and retention. IMPLICATIONS FOR NURSING MANAGEMENT This study should be helpful for nurse executives as they build a business case to address nurse turnover in their organizations, and for policy-makers as they develop policies about turnover.

Job satisfaction of new baccalaureate nurses.

Objective: The purpose of this study was to examine job satisfaction of recent RN graduates working in various specialty areas in outpatient and inpatient settings. The authors also examine job satisfaction for new graduates relative to intent to remain in their current position. Background: Retaining new nurses is one strategy for addressing the nursing shortage. By understanding aspects of their jobs that new nurses find satisfying, administrators can develop better retention and recruitment strategies. Methods: Participants completed the McCloskey-Mueller Satisfaction Scale (MMSS) rating their satisfaction with, and importance, of each item. Discrepancy scores were created by subtracting importance scores from satisfaction scores. Results: Nurses who intend to stay in their current position were significantly more satisfied than were those that did not intend to stay on 7 of the 8 MMSS subscales. There were no differences in their importance ratings. Inconsistent differences were found in the other comparisons. Conclusion: Administrators should give greater consideration to the role that satisfaction of new nurses plays in shaping future job intentions.

Staff nurse turnover costs: Part II, measurements and results

This study demonstrated that the costs of nursing turnover can be high (over +10,000 per RN turnover), and that the potential for adverse impact on the nursing department, the hospital environment, and the healthcare environment exists. The results of this study are important, particularly in the midst of a national nursing shortage, for several reasons. CNEs are responsible for obtaining, allocating, and managing nursing department resources; knowledge of nursing turnover costs will allow them to make more informed decisions about how best to allocate scarce resources. The findings of this study are also important to hospital administrators because they demonstrate the financial impact of high rates of nursing turnover on healthcare delivery. Finally, these findings provide nurse researchers direction for future research into the costs and benefits of nursing turnover and retention activities, so that cost-effective methods of minimizing organizational costs can be determined.

A retention strategy for newly graduated nurses: an integrative review of orientation programs.

To address nurse recruitment and retention issues, hospitals have increased the number of newly graduated nurses in their hiring pools and have simultaneously established orientation programs for those nurses. Structured orientation programs facilitate newly graduated nurse transition from novice to advanced beginner. The outcome of these programs is twofold: First, they promote the confidence and competency level of new nurses in providing patient care, and second, they increase nurse retention. This literature review presents the most useful interventions used in the programs that reported positive affects on new nurses.

Staff Nurse Turnover Costs: Part I, A conceptual Model

The impact of turnover is a major concern for the chief nurse executive. This study provides nurse administrators with information necessary to more fully understand the impact of turnover and assists them in developing and defending retention strategies. Part 1 addresses the conceptual model used to guide the study; Part 2 (May 1990) will discuss the application of the methodology to measure nursing turnover costs and the studys findings.