Frances Hughes

Nurse turnover: A literature review - An update

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 inter-related 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.

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

Research about the economic impact of nurse turnover has been compromised by a lack of consistent definitions and measurement. This article describes a study that was designed to refine a methodology to examine the costs associated with nurse turnover. Nursing unit managers responded to a survey that contained items relating to budgeted full-time equivalents, new hires, and turnover, as well as direct and indirect costs. The highest mean direct cost was incurred through temporary replacements, whereas the highest indirect cost was decreased initial productivity of the new hire. The study allowed the identification of the availability of data and where further refinement of data definition of variables is needed. The results provided significant evidence to justify increased emphasis on nurse retention strategies and the creation of healthy work environments for nurses.

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

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.

The nurse executive role in quality and high performing health services

AIMS To explore and identify the core elements of the nurse executive role and the contribution these posts make to health service organisations in terms of quality and performance. BACKGROUND With the ongoing global reform of health services and, in particular, currently in Australia, this commentary paper explores the available evidence that explains and describes the role that nursing leaders can and do play at executive level in enabling quality services in high performing health-care organisations. EVALUATION While the overall literature is limited in relation to the role and function of nurse executives, there are strong and recurrent themes indicating that nurses by virtue of their professional background and experience can provide effective and influential input to executive boards. Executive nurses are well positioned to influence and lead professional governance, quality improvement, service transformation and change and shared governance. CONCLUSION At a time when the role of nursing executives may be questioned, the evidence supports the positive impact of highly skilled nursing executives in contributing to the implementation of effective health services. Successful health services should be engaging nurse executives who have the high level of expertise, education, the best leadership and management attributes to bring the art and science of nursing to produce outcomes for organisations. IMPLICATIONS FOR NURSING MANAGEMENT Nurse executives must remain alert to the ongoing challenges and potential questioning on the value that nurses can bring to an executive board. The framework of nursing executive influence and leadership through professional governance, quality improvement, service transformation and change and shared governance is one possible approach that nurse executives may wish to apply to articulate their contribution and value in remaining at the executive board table.