Employee turnover remains one of the biggest challenges to many organizations’ success, and it is more calamitous in the healthcare sector. The quality of care and patient safety are affected, both directly and indirectly, by nurses entering and quitting their jobs at a high rate. Nurse leaders and managers have a major role to play in addressing this issue. Many factors have been associated with high nurse turnover. Some of them include staffing ratio, career advancement, working terms and conditions, and personal reasons (Dewanto & Wardhani, 2018). Nursing leadership and management need to develop effective retention strategies to help encourage nurses, both experienced and the newly hired, not to quit.
Nurse turnover impacts the quality of care and patient safety in many ways. According to Dewanto and Wardhani (2018), this issue adversely affects the delivery and effectiveness of care, and, consequently, patient safety and outcomes. Also, turnover in healthcare leads to a high patient-to-nurse ratio, leaving some patients unattended and reducing their dissatisfaction and unsafety (Antwi & Bowblis, 2018). The reason is reduced nurse morale due to increased workloads and responsibilities for the few remaining in the facility. According to Antwi and Bowblis (2018), nurse turnover negatively influences hospitals’ quality of care. For example, newly hired nurses may not have the requisite experience to handle such medical equipment as catheters. The low-quality care provided exposes patients to various hazards of improper use of these items, which affects their safety. They are also not conversant with a facility’s programs and schedules, thereby barring them from attaining the required care standards. For instance, a failure to use a proper protocol to prevent falls is likely to expose patients to hospital-acquired infections and injuries, thereby undermining their safety. Therefore, nurse turnover significantly impacts patient safety and the quality of care.
Professional standards of practice are vital as they help promote and guide nursing practice. They should be demonstrated in this situation to help rectify the issue. One way to do this is by aligning organizational performance goals with the vision and mission. This approach will ensure that nurses’ actual performance is measured against the desired performance standards (Davis, 2015). In doing so, nurses can get used to providing a safe and clinically competent level of care. Besides, these standards can be demonstrated in this situation by comparing nurses’ performance with a predetermined proficiency checklist. If a nurse can exceed the expectation of this evaluation, they can be rewarded to encourage them. This way, they can be motivated and can stay in the facility for a long time, thereby reducing turnover.
Another way to do this is by adopting nurse retention strategies to encourage them to stay longer. The administration can use these practice standards to develop safe staffing practices to ensure quality care and patient safety. For example, a nurse manager can ensure adequate documentation, delegate tasks appropriately, and create other policies aimed at retaining nurses. Healthcare organizations can make it an organizational practice standard for all nurses to air their complaints through their chosen channels. Antwi and Bowblis (2018) emphasize the need for a facility to ensure a strong support system to address nurse staffing and working issues as they arise. This standard of practice can help arrest a turnover crisis beforehand. This strategy will help identify the challenges nurses meet in their daily practice and initiate the formulation of solutions to address them because they are the root causes of turnover.
Moreover, the health sector can establish mentorship and counseling programs to empower nurses to adequately embrace their profession. For example, a module can be included in the nursing education curriculum to ensure they are well-prepared to face practice challenges. If a nurse can handle a stressful situation in a clinical simulation in college, then they are better positioned to translate that attitude to their practice. This can help reduce nurse turnover and improve the quality of care and patient safety.
Through their different roles, nurse leaders and managers have a significant role to play in alleviating nurse turnover. Nurse managers are responsible for ensuring staff and patient satisfaction (Ellis, 2018). They are better positioned to detect early signs of the possibility of a nurse quitting. This will help them approach those nurses and listen to their grievances, then decide how best to improve their welfare, thereby encouraging them to stay. This is also possible because nurse managers are also in charge of maintaining a safe environment for staff, as Ellis (2018) notes. Thus, nurse managers can help address the issue of nurse turnover.
On the other hand, nurse leaders can also help reduce nurse turnover in many ways. One of them is appropriately planning day-offs and work shifts since they are responsible for scheduling. Some of the most common reasons for nurse turnover are increased workload and poor working conditions (Dewanto & Wardhani, 2018). A nurse leader can ensure every staff member is comfortable with the workload by ensuring appropriate day-offs and shift hours. This will prevent nurses from burnout, which lowers their morale and performance. The other role of nurse leaders that Ellis (2018) identifies is to recruit and mentor newly hired nursing staff. They are responsible for ensuring that mentees are comfortable and get the necessary support to encourage and maintain professional competence. Therefore, a nurse leader can also help reduce or alleviate nurse turnover.
Moreover, managers and leaders can model professionalism to encourage other nurses to emulate them. One way to do this is by using a transformational leadership approach. This strategy will make nurses feel more engaged and valued in pursuing organizational goals. With this leadership style, the staff will develop a sense of belonging (Lin et al., 2015). This will encourage them to stay longer, thereby decreasing turnover. They can also initiate and maintain support and welfare programs aimed at ensuring the working conditions are favorable for nurses (Lin et al., 2015). A conducive working environment will be achieved with a proper channel for receiving and responding to staff complaints and demands. Thus, nursing leaders and managers can promote nurse retention and reduce their turnover.
The most appropriate leadership style to address nurse turnover in the healthcare setting is the transformational approach, for many reasons. First, it gives all nurses a chance to participate in the decision-making process (Lin et al., 2015). This will make them feel like a valuable piece of the organization. Second, this style allows the leader to understand and address their subordinates’ needs and demands, which ultimately leads to job satisfaction, a significant predictor of nurses’ work lives (Lin et al., 2015). If nurses are satisfied with their job, they are likely not to quit, which reduces turnover. Lastly, transformational leadership promotes open organizational communication, making it easier for nurses to raise their concerns. As Lin et al. (2015) argue, these leaders are excellent communicators, and they can cultivate the same trait in their subordinates. This open communication increases staff morale, thereby reducing the likelihood of turnover. Therefore, a healthcare organization can adopt the transformational leadership approach to reduce nurse turnover.
References
Antwi, Y. A., & Bowblis, J. R. (2018). The impact of nurse turnover on quality of care and mortality in nursing homes: Evidence from the Great Recession. American Journal of Health Economics, 4(2), 131-163.
Davis, C. (2015). The importance of professional standards. Nursing Made Incredibly Easy, 12(5), 4-5. Web.
Dewanto, A., & Wardhani, V. (2018). Nurse turnover and perceived causes and consequences: a preliminary study at private hospitals in Indonesia. BMC Nursing, 17(Suppl 2), 52. Web.
Ellis, P. (2018). Leadership, management and team working in nursing. Learning Matters.
Lin, P. Y., MacLennan, S., Hunt, N., & Cox, T. (2015). The influences of nursing transformational leadership style on the quality of nurses’ working lives in Taiwan: A cross-sectional quantitative study. BMC Nursing, 14, 33. Web.