According to Haddad et al. (2023), nurses comprise a crucial component of a healthcare team, often making up the largest section of the health profession. However, the nursing profession is experiencing shortages due to various reasons, including high turnover. This paper explores the implications of nurse turnover on patient care, proposes a solution, discusses an appropriate leadership style, compares it to a personal leadership style, explores two leadership theories, and emphasizes the nurse’s role in an interdisciplinary team.
Issue Description:
Nurse turnover can be described as the situation when the nurse leaves an organization for a given reason, such as retirement or choosing to change a profession. The most common reasons for nurse turnover include physical labour, short staffing, and feeling underappreciated. Moreover, nurses may leave due to other reasons such as promotion, salary, burnout, little respect in the workplace, return to school, or lack of collegial nurse/physician relationships. Nurse turnover is a critical issue in healthcare settings that significantly impacts the quality of care provided to patients. The healthcare sector was ranked among the top three professions with a high turnover rate by Streamline Verify. These findings align with Dewanto & Wardhani (2018), who points out that globally, the nurse turnover rate ranges from 15% to 44%. The survey also demonstrated that about 43% of the newly licensed nurses working in the hospital leave their jobs within three years. In addition, after two years, approximately 33.5% of the nurses resigned, and about 17.5% worked for only one year. Despite intervention by the hospitals to address the issue, turnover continues to rise.
According to Peng et al. (2023), a higher rate of nurse turnover is associated with lower care quality. The author points out that, due to nesting turnover, there can be nursing shortages in the healthcare system, which increases the workload of the remaining nurses, and they will have to cover for the nurses who have quit. From the management perspective, the loss of highly skilled employees is considered a loss of human capital, which can impact the performance of an organization negatively. Peng et al. (2023) also point out that an increased nurse turnover can lower the morale of the remaining nurses in the hospital unit due to increased stress resulting from higher workload and burnout. Furthermore, nursing turnover can diminish nursing care and quality due to disruption of existing services and workflows.
Peng et al. (2023) illustrate the impact of nursing turnover on patient quality care by demonstrating using ICU nurses. The author points out that compared to their counterpart medical nurses, ICU nurses are hard to replace due to their higher level of training and specialization. In addition, it usually takes longer to adjust to a new ICU environment among nurses. Therefore, this dramatically impacts the ICU patients who require constant nursing care. Increased nursing turnover leads to a shortage of nurses, increasing the ICU nurses’ capacity to keep up with the pace of their workload and remain focused throughout their shifts. This can affect the levels of quality of patient care negatively, making the patients suffer, and their conditions deteriorate at a faster pace. For instance, ICU patients often spend in bed for much longer times than MedSUrg patients and cannot move on their own. As a result, these patients are more susceptible to developing pressure ulcers if a nurse cannot adjust their sleeping position regularly.
Higher nurse turnover was associated with worsened quality of care, especially the bedsores. In addition, their findings showed that a reduction in turnover was associated with a reduced mortality rate. They point out that a “10 percentage point increase in turnover results in a 9.4–17.4 per cent increase in the discharge death rate and increases the census death rate by 2.0 to 8.3 per cent” (p.26). They concluded that lowered nurse turnover is associated with overall improved quality of care.
Proposed Solution to Address Nursing Turnover:
Nurse retention in the nursing profession is urgent, especially following the growing nursing shortage caused by the coronavirus pandemic. According to the American Nurses Association (2023), more than 1 million nurses will be required by 2030. Additionally, the cost of hiring and training a registered person is higher, making their rental crucial. For instance, a hospital spends about $3.6 to $6.5 million annually in the process of hiring and training registered nurses. The Association proposed the elimination of mandatory overtime as a critical solution to staffing shortages.
Comparison to Personal Leadership Style:
Transformational leadership aligns with my personal leadership style. I believe in engaging and influencing others by paying attention to their needs. In addition, I believe in raising the motivation and morale of my followers to realize shared goals. Other characteristics of my leadership include challenging my followers to take greater responsibility for their work and understanding their strengths and weaknesses. This approach aligns with transformational leadership.
Comparison of leadership Theories:
The Situational Leadership Theory and Transactional leadership theories can be applied to eliminate mandatory overtime and hence reduce nurse staff turnover. Situational leadership will require the NURSE leader to adapt their leadership style based on the unique situation to meet the team member’s needs. This will be essential in enabling efficient and effective implementation of the new scheduling practices. On the other hand, the transactional leadership theory focuses on the rewards and punishments to achieve optimal job performance from the team members, who are usually their subordinates or juniors. Therefore, the nurse leader will be required to recognize and reward the nurses who have adapted to the new scheduling system to reinforce this positive behaviour, making the initiative a success.
Nurse’s Role in an Interdisciplinary Team:
The nurse plays a crucial role in an interdisciplinary team. For instance, they are tasked with assessing and determining the patient’s needs. They also administer medications within their scope of practice and collaborate with other professionals to provide quality patient care (American Nurses Association, 2016). In regard to addressing nurse turnover, the nurses are tasked with participating in retention programs and providing valuable insights into organizational policies.
Conclusion:
In sum, the nursing shortage is an urgent issue that needs to be addressed, affecting the healthcare system. The reasons why nurses leave their work include burnout, physical strain, changes in their professionalism, salary, or lack of respect. This issue can lead to reduced quality of patient care, which can increase mortality. To address this issue, proactive measures such as eliminating mandatory overtime should be implemented. To implement this initiative, a nurse manager needs to adopt a transformational leadership style. Lastly, nurses, members of an interdisciplinary team, are tasked with participating in retention programs.
References
American Nurses Association. (2023, May 5). Nurse Retention Strategies: How to Combat Nurse Turnover. ANA. https://www.nursingworld.org/practice-policy/nurse-staffing/nurse-retention-strategies/
Dewanto, A., & Wardhani, V. (2018). Nurse turnover and perceived causes and consequences: a preliminary study at private hospitals in Indonesia. BMC Nursing, 17(S2). https://doi.org/10.1186/s12912-018-0317-8
Haddad, L. M., Toney-Butler, T. J., & Annamaraju, P. (2023, February 13). Nursing shortage. National Library of Medicine; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK493175/
Peng, X. (David), Ye, Y., Ding, X. (David), & Chandrasekaran, A. (2023). The impact of nurse staffing on turnover and quality: An empirical examination of nursing care within hospital units. Journal of Operations Management, 69(7). https://doi.org/10.1002/joom.1245
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