Nurse turnover is widely used as a measure for healthcare system analysis and remains one of the most important determinants of firm output, especially for the health care industry. The turnover is either voluntary or involuntary. The rate at which nurses join and quit a hospital impacts healthcare providers directly and indirectly. The nursing profession demands effective and strategic retention programs to ensure a reduced turnover rate, especially from experienced nurses. It is prudent for nurse managers to investigate the causes of nurse turnover and contributing factors. The nurses decide to quit over a myriad of reasons, such as personal reasons, staffing ratio, general satisfaction, and career advancement. Nurse turnover is directly related to nursing satisfaction and leads to an impact on the quality of care and patient safety in health institutions.
Nurses turnover leads to a shortage of the nursing staff, thus adversely impacts on patient satisfaction. The short-staffed institutions increase the workload for the remaining staff in terms of extra shifts. The increase in nurses’ working shifts is directly proportional to the quality of healthcare and mortality rates (De Simone, Planta and Cicotto, 2018). Nurses working longer shifts are prone to stress and burnouts, which affects their ability to provide quality healthcare to patient safety strategies aimed at preventing risks and errors that may cause harm to patients during healthcare provision. One of the strategies to improve patient safety is increasing nurse staffing levels in emergency areas and requiring experienced nurses to perform complex procedures. With a high nurse turnover, patient’s safety guarantee is diminished due to the exit of experienced physicians charged with specific tasks, which may take longer for new hires to master. Patient safety in emergency rooms is also at risk due to the low number of nurses assigned. Understaffing in critical areas in health institutions increases the patients’ risks, thus hindering the application of quality care in the hospitals. The work environment is also a factor affecting the nurse’s turnover, which directly impacts the patient. Employee satisfaction is critical in healthcare as a conducive work environment increases patient rapports, and ultimately the quality of care. A satisfied workforce significantly reduces the margin of error, thus ensuring mortality rates are reduced.
Professional Standards of Practice
Professional standards of practice are paramount in ensuring nurse turnover is reduced through improving staff retention. The establishment of retention initiatives is an efficient strategy used to curb high turnover. Professional standards of practice require that healthcare providers set realistic goals by having a framework for implementing its plan to retain experienced staff and newly hired nurses. The framework sets the minimum number of years that new employees must work before resignation. The purpose of this strategy is to cultivate a culture that aligns with the permanency of the staff.
Salary and remunerations is a crucial factor in nurse’s turnover. The retention strategy should incorporate an upward mobility curve in terms of nurses’ pay with variables such as the level of hard work and dedication. Staff motivation is achieved through mentorship programs and job promotions. Personal reasons significantly contribute to nurse’s turnover due to the negligence of work-life balance by health institutions. This negligence is compounded by the increased overtime and double shifts, which negatively impact the physician’s personal life (Austin, Saylor and Finley, 2017). Elimination of mandatory overtime is achieved by adequate nurse staffing such that there is a balance between the hours spent on the job and personally a strategy that reduces burnouts. Retirement is a primary factor influencing turnover and a decrease in general staff experience. Health institutions should initiate programs where the new staff is mentored by the experienced nurses to fill their positions after retirement.
Roles of Managers and Leaders
Nurse leaders focus on setting and upholding standards regarding the organization’s mission and long term goals. The leaders ensure that all employees uphold standards that represent the whole organization and are actively involved in policy setting. Nurse managers act as a point of reference to the staff who work under them. They provide guidance and support to their staff by addressing the issues raised. The role of nurse managers regarding the turnover of their staff is engraved in their responsibilities of overseeing staff schedules and career advancement opportunities (Wei, Roberts, Strickler and Corbett, 2019). Nurse managers are responsible for assigning duties; thus, overtime and shifts are under their control. The nurse manager should strive to implement a flexible schedule where the new employees are not overworked at the expense of older staff. Nurse managers are involved in the day to day operations, thus oversee career opportunities for staff as they are aware of the contributions of the staff towards the team.
Nurse leaders ensure regulatory compliance, set policies, and discharge planning. The role of leaders regarding staff turnover is that of advocacy. The leader ensures that top-level management is aware of the staff discrepancy, making efforts to increase the employees to the standard ratio. The nurse leader is responsible for ensuring that the staff is adequately compensated in terms of salaries and overtime pay. For the retention strategy to work, the leader sets policies such as minimum working years for staff to reduce unexpected turnover. Nurse leaders formulate procedures in case of staff turnover, such as reviewing budgetary costs related to hiring and training new staff.
Additional Aspects in Relation to Professionalism
Professionalism in health care is bound to prevent harm to patients in the care of health professionals. In the event of understaffing due to high turnover, the nurse’s leaders and managers are required to guide the staff in upholding quality health care to patients. They coordinate the teams by delegating work to the staff as per the urgency of situations. Emergencies situations are accorded this privilege due to the high risks involved, and thus, more staff are put on standby for such situations. The facility’s overall organization is designed to cover for the inadequacies of the staff, thus running smoothly.
Another aspect is the hiring of competent new employees. The managers and leaders work together to ensure that the recruiting process is aimed at selecting staff who will uphold the health care facility’s values and mission. The nurse leaders and managers are charged with creating an employment committee that will be best equipped to bring the right personnel in the organization. Budgetary concerns are a top priority in this period due to the cost of hiring new nurses. The cost of hiring and training new employees is high; thus, they must allocate resources catering to the added expenses. The cost of replacing one nurse is equivalent to two months’ pay; thus, the management must come up with ways of maintaining the bill at a considerable amount. Motivation among the staff is prudent due to the loss of a team member. The leaders and managers show consideration by engaging other team members to chip in and assist the affected group, thus creating a collaborative environment.
Transformational Leadership Style
The most appropriate leadership style to address nurse turnover is the transformational leadership style. The transformational leadership style involves a leader setting a goal or vision for their followers and guiding the process through inspiration and motivation rather than issuing directives. The transformational leadership style is described using the four “ I’s; Individualized consideration, intellectual stimulation, inspirational motivation, and idealized influence. Individualized consideration identifies employees’ individual needs, while intellectual stimulation involves changing the status quo through new ideas. Inspirational motivation includes the organization’s goals and personal targets, while idealized influence looks at the norms of the role models.
Transformational leadership in nursing is associated with employee job satisfaction, improved patient care, and reduced turnover (Sfantou, Laliotis, Patelarou, Sifaki-Pistolla, Matalliotakis and Patelarou, 2017). Job satisfaction remains a critical factor in nurse’s turnover, and this type of leadership has contributed significantly to the retention of workers due to the positive environment created where everybody’s new ideas are valued. Transformational leadership improves patient care through effective communication among healthcare teams. Nurses who value their jobs are less likely to leave the institution as their aim to reach their set targets, thus reducing turnover.
