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Change Strategy and Implementation: RN Turnover Rates


Recognizing the causes and solutions to nurse turnover is a significant challenge for healthcare administrators. This is known as turnover, when nurses leave their jobs for whatever reason, including retirement, career changes, or personal preferences. Research findings show a direct link between managing nursing turnover and high-quality patient care. It is important to keep that in mind as you calculate the direct costs of replacing a nurse and the indirect costs of poor care due to high turnover (Dechawatanapaisal, 2018). Common causes of turnover include nurses’ feelings of underappreciation, staffing shortages, and the mental and physical strains of the job. Constant turnover among nurses negatively impacts healthcare providers and their patients by eroding trust in one another and making it more difficult to communicate.

To conduct the largest study of its kind in the United States, NSI Nursing Solutions, Inc. contacted more than 3,000 institutions in January 2022. By 2030, the healthcare industry is expected to have grown by 16%, creating over 2.6 million new employment opportunities (US Bureau of Labor Statistics, 2022). The vacancy rate for registered nurses in hospitals has increased significantly. Now at 17%, up 7.1 percentage points from a year ago, with over 80% (81.3% to be exact) reporting a vacancy rate above 10%, this is an all-time high (Colosi, 2022). The results showed that hospitals still do not agree on which job functions should be included in the turnover rate. The vast majority (59.6%) of organizations disclose all forms of employment status change (full-time, part-time, per diem, PRN, casual, occasional, and much more) in their turnover statistics (Colosi, 2022). The remaining medical facilities only provide permanent and temporary positions.

Hospital & Staff RN Turnover

(Colosi, 2022).

The global healthcare industry is facing a rising human resource crisis due to high turnover rates among nurses. Many registered nurses (RNs) are abandoning the healthcare industry due to the COVID-19 pandemic, either by retiring early or leaving the field entirely to pursue other interests. This has led to astronomical turnover costs for hospitals. The survey found that to improve their bottom line, hospitals needed to increase their capacity to retain patients, reduce their vacancy rate, improve their recruitment efforts, and tighten their control over labor costs.

According to a report released by Illinois Northwestern Memorial Hospital Report Card ( 2018), Northwestern Memorial Hospital had an RN turnover rate of 18.84%. In this paper, I will collect data that fairly represents the existing and desired state of this problem, suggest a change strategy that will assist achieve the desirable state of this issue, provide supporting evidence for that strategy, take into account the perspectives of other professions, and present the results of my analysis and recommendations for moving forward. Retirement options are available at Northwestern Memorial Hospital. Employer-sponsored retirement plans are a great way to ensure a steady income in your golden years. Pension schemes with guaranteed benefits are available at Northwestern Memorial Hospital. Employees who retire from their job get a certain sum from their employer under a defined benefit retirement plan.

Employee retention at Northwestern Memorial Hospital

Employee retention at Northwestern Memorial Hospital

Change strategies

Northwestern Memorial Hospital needs to change methods to boost patient outcomes and decrease employee turnover. Other problems in the past that could have influenced the high turnover rates of the hospital’s nurses were medication errors and discrimination in admissions based on age or gender (Kwon et al., 2021). An effective technique for reducing medication errors and increasing the proportion of patients admitted based on age and gender may be to increase the retention of existing nurses. Strategies for keeping nurses in an organization can improve morale, broaden career advancement possibilities, and cut down on unnecessary overtime. Implementing a residency program for nurses has been shown to reduce burnout and boost job satisfaction (McNulty et al., 2022). However, there are concerns about the potential difficulties in establishing such a program, such as regulatory constraints, payment issues, and monitoring and evaluation concerns. One of the most common barriers to implementing nurse residency programs is the cost (McNulty et al., 2022). On the other hand, nurse residency programs save money by increasing the retention of new nurses (Cochran, 2017). Regulatory challenges can be overcome by complying with the relevant rules and regulations when establishing such programs. Monitoring and evaluation should be conducted regularly, at least once every three months (McNulty et al., 2022). Despite these obstacles, nurses at Northwestern Memorial Hospital should be optimistic about establishing a nursing residency program.

Patients lose out on having access to a qualified medical expert when hospitals are understaffed. Executives in the healthcare industry must realize how limited personnel negatively affects patient care. Nurses’ likelihood of staying in their jobs can be increased or decreased by several things. The turnover rate of nurses can be lowered, and staffing levels can be maintained if hospitals take steps to enhance the working conditions of their nurses (Kaddourah et al., 2018). If they are content where they work, they will be less likely to look for a new location. Nurse turnover can be reduced with strong leadership and adequate staffing. Administrators in the nursing field would do well to foster open communication amongst staff members to assess their leadership styles and figure out how to better care for their nurses. Nurses should talk to their managers about how they feel about their workload and what they need from them. The main barriers to effective leadership are the failure of organizational leaders to support nurses and the lack of a structured nurse leader pathway. To overcome these barriers, a nurse manager with the appropriate education is required to effectively manage the nursing turnover situation. If hospitals are to maintain their high standards of care, their leaders will need to collaborate to reduce the number of workplace conflicts that drive nurses away. Pay and bonuses for registered nurses have gone up recently because many people who become nurses are offered financial incentives to take the job. The hospital turnover rate might be lowered by offering bonuses to nurses who put in extra hours or take on more tasks.

Many of the systemic operational, procedural, coordination, and technology difficulties highlighted in the survey have been discussed previously. The COVID-19 pandemic was the final straw for the industry and raised awareness to new heights, although these issues have been growing for years and are already a major concern in the nursing profession. Northwestern Memorial Hospital’s administration has reached a tipping point where they must take immediate action to address the underlying operational issues causing widespread fatigue and attrition. It is common knowledge that bettering a hospital’s operational performance can boost productivity, morale, treatment quality, and patient outcomes. The administrative, manual, and tedious duties and processes that further strain already overworked nurses are usually a good place to begin. Nurses want hospitals and health systems to streamline and automate manual activities to improve communication, coordination, and staff scheduling. The potential barriers to streamlining patient care processes through technology to reduce strain on nurses include resistance to change and the need to comply with HIPAA regulations (Whitelaw et al., 2020). To overcome these barriers, the organization must train clinicians to trust a digital process and avoid breaching HIPAA regulations to maintain a positive patient experience.

Justification of Change Strategies

The annual revenue of Northwestern Memorial Hospital is $1.5 million. Thirty-five people work at Northwestern Memorial Hospital, each bringing in $42,857 in revenue (Northwestern Memorial Hospital Revenue: Annual, Historical, And Financials, 2022). In 2021, Northwestern Memorial Hospital earned a peak of $1.5 million. Northwestern Memorial is widely regarded as a leader in patient care and cutting-edge medical technology in cardiology, gynecology, oncology, neurology, neurosurgery, orthopedics, and solid and soft tissue transplants. Because of the scarcity of health care funding, this article seeks to guarantee that monies are being put toward activities that improve patient outcomes, such as providing the highest levels of safety and quality, rather than mere busy work—errors in drug administration and transcribing occurred due to decreased staffing and a shortage of nurses. Northwestern Memorial Hospital and its divisions can do more to help people by working together across disciplines to boost patient care and satisfaction. Northwestern Memorial Hospital’s interdisciplinary team will need to incorporate interprofessional considerations to implement this strategy successfully.

The implementation and planning process is crucial to improve quality treatment; thus, stakeholders, including doctors, nurses, managers, pharmacists, and members of the IT department, should all be involved. The PDSA model could be used to reduce the high number of RN departures from Northwestern Memorial Hospital. Together, these elements and the PDSA framework will help the hospital reduce its nurse turnover rate and improve patient outcomes. Nurses provide continuous care for patients in hospitals. Because of this, they are crucial in guaranteeing the health and well-being of their patients. Researchers have related many indicators of nurse staffing to better health outcomes for patients. How hospitals describe the level or complexity of care in each nursing unit may account for some discrepancies in reported staffing hours. Northwestern Memorial is doing better than its rivals in terms of keeping its employees.

Data Table

Current Outcomes Change Strategies Expected Outcomes
In 2018, Northwestern Memorial Hospital had an RN turnover rate of 18.84%, according to a report by Illinois Northwestern Memorial Hospital Report Card (2018).

a. Common causes of turnover include nurses’ feelings of underappreciation, staffing shortages, and the mental and physical strains of the job.

b. Constant turnover among nurses negatively impacts healthcare providers and their patients by eroding trust in one another and making it more difficult to communicate.

To ensure nursing turnover is minimized and prevented and that patient outcomes are improved, certain measures are necessary:

· Organizational leaders should implement a residency program for nurses to reduce burnout and boost job satisfaction, which will boost nurse retention.

· Leaders should provide adequate support for nurses, promote open communication, adopt a structured nurse leader pathway, and promote adequate staffing to reduce nurse turnover.

· The hospital needs to streamline patient care processes through technology to reduce the strain on nurses.

Nurses with turnover intentions will have adequate access to residency programs for hands-on experience, effective leadership, and technologies, increasing their intent to remain working with the hospital and provide high-quality patient care.

a. Nurse residency programs provide hands-on experience for nurses to deliver high-quality patient care and save money for the organization by increasing the retention of new nurses (Cochran, 2017).

b. Effective leadership fosters open communication, improving the organization’s staff’s well-being and increasing patient satisfaction (Kaddourah et al., 2018).

c. Nurses want hospitals and health systems to streamline and automate manual activities to improve communication, coordination, and staff scheduling (Whitelaw et al., 2020).


The high turnover rate of nurses affects healthcare systems worldwide. To lower turnover rates, managers and healthcare organizations must know what treatments work best. The majority of studies found that the intervention increased student retention. Job satisfaction and retention were improved through teamwork and individually tailored tactics like mentorship, leadership interest, and an in-depth orientation. Strong evidence suggests that retention strategies based on a preceptor program model centered on the NGN lasting between three and six months are most effective. Literature also supports a management approach adopted by nurse managers that emphasizes creating a pleasant working environment and treating each nurse as an individual within that setting. Despite the many potential causes of nurse turnover, there is still a lack of high-quality data for strategies to address these issues. Despite this setback, additional research is needed to build on the progress made thus far because many hospitals still struggle with retention and nurse shortages. This report recommends that nurses and research funders conduct controlled trials sufficiently powered to account for relevant concepts to evaluate further the efficacy of interventions proven to be successful in observational or quasi-experimental studies.


Cochran, C. (2017). Effectiveness and best practice of nurse residency programs: A literature review. MEDSURG Nursing, 26(1), 53–63.

Colosi, B. (2022). (2022). NSI National Health Care Retention & RN Staffing Report. East Petersburg: NSI Nursing Solutions, Inc. Retrieved from

Dechawatanapaisal, D. (2018). Nurses’ turnover intention: The impact of leader‐member exchange, organizational identification and job embeddedness. Journal of advanced nursing, 74(6), 1380-1391.

Illinois Hospital Report Card (2018). Northwestern Memorial Hospital.

Kaddourah, B., Abu-Shaheen, A. K., & Al-Tannir, M. (2018). Quality of nursing work life and turnover intention among nurses of tertiary care hospitals in Riyadh: A cross-sectional survey. BMC nursing, 17(1), 1–7.

Kwon, C.-Y., Lee, B., Kwon, O.-J., Kim, M.-S., Sim, K.-L., & Choi, Y.-H. (2021). Emotional Labor, Burnout, Medical Error, and Turnover Intention among South Korean Nursing Staff in a University Hospital Setting. International Journal of Environmental Research and Public Health, 18(19), 101-111. doi:10.3390/ijerph181910111

McNulty, D. S., LaMonica-Way, C., & Senneff, J.-A. (2022). The Impact of Mindfulness on Stress and Burnout of New Graduate Nurses as a Component of a Nurse Residency Program. The Journal of Nursing Administration, 52(4), E12-E18. doi:10.1097/NNA.0000000000001137

Northwestern Memorial Hospital Revenue: Annual, Historical, And Financials. (2022, September 30). Zippia – Find Jobs, Salaries, Companies, Resume Help, Career Paths, and More.

US Bureau of Labor Statistics. (2022, September 8). Healthcare Occupations. Retrieved from Occupational Outlook Handbook:

Whitelaw, S., Mamas, M.A., Topol, E.,Van Spall H.G.C. (2020). Applications of digital technology in COVID-19 pandemic planning and response. Lancet Digit Health, 2(1), e435–e440. DOI: 10.1016/S2589-7500(20)30142-4


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