James Buchan

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 migration of nurses: trends and policies

This paper examines the policy context of the rise in the international mobility and migration of nurses. It describes the profile of the migration of nurses and the policy context governing the international recruitment of nurses to five countries: Australia, Ireland, Norway, the United Kingdom, and the United States. We also examine the policy challenges for workforce planning and the design of health systems infrastructure. Data are derived from registries of professional nurses, censuses, interviews with key informants, case studies in source and destination countries, focus groups, and empirical modelling to examine the patterns and implications of the movement of nurses across borders. The flow of nurses to these destination countries has risen, in some cases quite substantially. Recruitment from lower-middle income countries and low-income countries, as defined by The World Bank, dominate trends in nurse migration to the United Kingdom, Ireland, and the United States, while Norway and Australia, primarily register nurses from other high-income countries. Inadequate data systems in many countries prevent effective monitoring of these workforce flows. Policy options to manage nurse migration include: improving working conditions in both source and destination countries, instituting multilateral agreements to manage the flow more effectively, and developing compensation arrangements between source and destination countries. Recommendations for enhancements to workforce data systems are provided.

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.

Developing evidence-based ethical policies on the migration of health workers: conceptual and practical challenges

It is estimated that in 2000 almost 175 million people, or 2.9% of the worlds population, were living outside their country of birth, compared to 100 million, or 1.8% of the total population, in 1995. As the global labour market strengthens, it is increasingly highly skilled professionals who are migrating. Medical practitioners and nurses represent a small proportion of highly skilled workers who migrate, but the loss of health human resources for developing countries can mean that the capacity of the health system to deliver health care equitably is compromised. However, data to support claims on both the extent and the impact of migration in developing countries is patchy and often anecdotal, based on limited databases with highly inconsistent categories of education and skills.The aim of this paper is to examine some key issues related to the international migration of health workers in order to better understand its impact and to find entry points to developing policy options with which migration can be managed.The paper is divided into six sections. In the first, the different types of migration are reviewed. Some global trends are depicted in the second section. Scarcity of data on health worker migration is one major challenge and this is addressed in section three, which reviews and discusses different data sources. The consequences of health worker migration and the financial flows associated with it are presented in section four and five, respectively. To illustrate the main issues addressed in the previous sections, a case study based mainly on the United Kingdom is presented in section six. This section includes a discussion on policies and ends by addressing the policy options from a broader perspective.

Global nursing shortages.

In October 2001 government chief nurses and other delegates from 66 countries met to discuss how best to deal with a common challenge—the global growth of nursing shortages.1 Nursing shortages in the United Kingdom and elsewhere have been a repetitive phenomenon, usually due to an increasing demand for nurses outstripping static or a more slowly growing supply.2 This time the situation is more serious. Demand continues to grow, while projections for supply point to actual reductions in the availability of nurses in some developed and developing countries. Some health systems are also coping with the legacy of ill conceived reform projects of the 1990s, which demotivated and disenfranchised nurses and other staff. Developed countries are facing a demographic double whammy. The United States, United Kingdom, Australia, Canada, and other countries have an ageing nursing workforce, caring for increasing numbers of elderly people.3–5 The challenge is how to replace the many nurses who will retire over the decade. Some countries also have to cope …

Human resources for health and universal health coverage: fostering equity and effective coverage

Achieving universal health coverage (UHC) involves distributing resources, especially human resources for health (HRH), to match population needs. This paper explores the policy lessons on HRH from four countries that have achieved sustained improvements in UHC: Brazil, Ghana, Mexico and Thailand. Its purpose is to inform global policy and financial commitments on HRH in support of UHC. The paper reports on country experiences using an analytical framework that examines effective coverage in relation to the availability, accessibility, acceptability and quality (AAAQ) of HRH. The AAAQ dimensions make it possible to perform tracing analysis on HRH policy actions since 1990 in the four countries of interest in relation to national trends in workforce numbers and population mortality rates. The findings inform key principles for evidence-based decision-making on HRH in support of UHC. First, HRH are critical to the expansion of health service coverage and the package of benefits; second, HRH strategies in each of the AAAQ dimensions collectively support achievements in effective coverage; and third, success is achieved through partnerships involving health and non-health actors. Facing the unprecedented health and development challenges that affect all countries and transforming HRH evidence into policy and practice must be at the heart of UHC and the post-2015 development agenda. It is a political imperative requiring national commitment and leadership to maximize the impact of available financial and human resources, and improve healthy life expectancy, with the recognition that improvements in health care are enabled by a health workforce that is fit for purpose.

Nursing numbers in Britain: the argument for workforce planning.

When the Labour government in Britain took office in 1997 it inherited a growing problem of nursing shortages, which finally hit the headlines in 1998. The shortages have been recurring ever since, particularly during the influenza “crisis” last winter. How has the government fared in dealing with nursing shortages, and has it put the worst behind it? #### Summary points Britain has a serious shortage of nurses, as well as problems in recruiting and retaining them It is not simply that there are too few nurses; some key skills shortages also exist, with increasing demand for more qualified staff in some areas Much better planning of the workforce is required, and this needs to be more integrated with the planning for other groups in healthcare A change in the pay system may help, but the creation of better work environments may be part of the solution The rapid pace of change in the nursing profession has produced a challenge that the NHS needs to address The roots of the recent nursing shortages lie in the early 1990s. As part of the NHS reforms and the introduction of the internal market, there was a move towards an employer led system to determine intakes to nurse training. The involvement of NHS trusts was to be welcomed, but the narrow focus, varying capacity of local training and education consortiums, and lack of a national overview meant that most trusts underestimated required staffing numbers. The system also underestimated non-NHS demand for nurses, particularly in the rapidly expanding nursing home sector. The effect of this new “planning” system was to reduce markedly the number of student nurses. In 1984 England had more than 75 000 nursing students and pupil nurses. By 1994 that number had more than halved. The register of the United Kingdom Central Council for Nursing, …

A comparative review of nurse turnover rates and costs across countries

AIMS To compare nurse turnover rates and costs from four studies in four countries (US, Canada, Australia, New Zealand) that have used the same costing methodology; the original Nursing Turnover Cost Calculation Methodology. BACKGROUND Measuring and comparing the costs and rates of turnover is difficult because of differences in definitions and methodologies. DESIGN Comparative review. DATA SOURCES Searches were carried out within CINAHL, Business Source Complete and Medline for studies that used the original Nursing Turnover Cost Calculation Methodology and reported on both costs and rates of nurse turnover, published from 2014 and prior. METHODS A comparative review of turnover data was conducted using four studies that employed the original Nursing Turnover Cost Calculation Methodology. Costing data items were converted to percentages, while total turnover costs were converted to US 2014 dollars and adjusted according to inflation rates, to permit cross-country comparisons. RESULTS Despite using the same methodology, Australia reported significantly higher turnover costs (

The impact of global nursing migration on health services delivery.

48,790) due to higher termination (~50% of indirect costs) and temporary replacement costs (~90% of direct costs). Costs were almost 50% lower in the US (

Internationally recruited nurses in London: a survey of career paths and plans

20,561), Canada (