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Nursing Turnover: Effective Approaches in Leadership and Management


The success of organizations usually depends on a variety of factors. According to Kurnat-Thoma et al. (2017), the necessity to evaluate the facility’s operational effectiveness by means of employee turnover enhances the creation of a supportive work environment and quality improvement. Managers and leaders have to recognize the needs of nurses, and their approaches and styles play a crucial role. In this paper, professional standards of nursing practice, nursing turnover, and the transformational leadership style will be discussed to promote patient safety and quality care.

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Nursing Turnover

Nursing turnover is a problematic issue in modern healthcare systems around the globe. It is a tendency when nurses leave their jobs or even professions because of burnout, the lack of benefits, and the rise of demands (Halter et al., 2017). Organizations suffer because of the necessity to find new people, check their skills, and understand the requirements of a positive environment. Employees are not able to grow and increase their salaries due to regular experiences and well-developed abilities. The hospital turnover rate is approximately 19%, and managers aim to reduce it by 3.2% on average (Nursing Solutions, 2019). It happens because of poorly chosen leadership styles, inexperienced management approaches, and unstable cooperation.

Impact on Quality of Care

Nursing turnover occurs suddenly and has to be solved in a short period. Its impact on care is important because the absence of experienced and skilled nurses decreases the quality of services (Kurnat-Thoma et al., 2017). New employees are not aware of hospital standards and misunderstand their responsibilities (Halter et al., 2017). Cooperation between the staff is poor, which leads to care retardation. When nurses know each other, they can support, motivate, and exchange information about patients quickly. Turnover means that nurses should not only spend additional time studying their working opportunities but also investigate their patients, resources, and clinical guidelines. The quality of care is not as high as expected, and medical workers focus on the development of effective interventions.

Impact on Patient Safety

As soon as care quality is decreased, other challenges may occur, and patient safety is one of them. Turnover means that new nurses have poor knowledge about scheduling, orientation, and communication in a particular healthcare facility. These factors put patients and the conditions under which they receive treatment and care at risk (Kurnat-Thoma et al., 2017). If a hospital has enough nurses and resources, there are no questions about the quality of services.

However, turnover proves the growth of problems among the staff and increased safety risks. Nursing workload provokes care delivery and the promotion of negative outcomes. Nurses make mistakes, confuse their duties, and fail to help patients and their families. Researchers frequently discuss associated cost consequences to prove the impact of turnover on patient safety (Halter et al., 2017). Instead of cooperating with patients, nurses correct their mistakes and investigate the ways of improvement and required standards of care in nursing practice.

Professional Standards of Practice

One of the ways to reduce the impact of nursing turnover on patient safety and care quality is to pay close attention to understanding professional standards of nursing practice. For example, a nursing home that has been challenged by turnover during the last year requires improvements. Nurses poorly know their obligations to explain to their managers and leaders what is going wrong in a facility. The American Association of Nurse Practitioners (2019) developed a guide with standards where licensed and independent practitioners recognize their roles in providing specialized and medical care in various settings.

Professional conduct is maintained when nurses realize that performing assessments and the development of comprehensive care plans are not their only duties. To rectify the problem of turnover and improve care quality, interprofessional and collaborative responsibilities, patient advocacy, and continued competence should never be ignored (American Association of Nurse Practitioners, 2019). Nurses become care providers, mentors for patients, researchers, and team partners, and their leaders must support them by any means.

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Roles of Leaders and Managers

Leaders and managers of healthcare facilities deal with a number of issues to provide employees with appropriate working conditions and patients with the highest level of care. Their main role is supportive leadership and equal distribution of benefits among nurses (Naseer et al., 2017). Retention of nurses is also their responsibility, and managers should follow professional standards. Turnover is a complex process that includes psychological factors, financial aspects, and organizational issues.

The establishment of trustful and loyal relationships is a skill privilege for any healthcare setting. Leaders must comprehend that the accomplishment of their missions and goals is not only about them but about all team members. Their approach focuses on the principles of support and equity to inspire nurses (Naseer et al., 2017). Following the complexity leadership theory and trait theory, the difference between leaders and managers should be identified (Tal & Gordon, 2016).

Managers become the main sources of information about nurses and their decisions to stay or leave a facility (Kurnat-Thoma et al., 2017). They advise, guide, teach, and cooperate with nurses, whereas leaders are less task-oriented but involved in the formulation of organizational missions and visions.

Professionalism in Healthcare Settings

To ensure professionalism in healthcare settings and reduce the impact of nursing turnover on care quality and patient safety, additional recommendations may be given. Kurnat-Thoma et al. (2017) develop an onboarding-structured approach to encourage and orient new employees by means of communication and evaluation of every new employee. Naseer et al. (2017) analyze several leadership styles to use the shortages of one and prove the worthiness of another approach. All these options are available to many hospitals due to their low costs and short preparation.

Leadership Style

The choice of the way of how nursing turnover is reduced depends on leaders and managers. Transformational leadership is a frequent recommendation that is based on motivation offered by a leader to his or her subordinates (Naseer et al., 2017). This style is characterized by effective self-management because transformational leaders know and love what they do and try to motivate followers to do the same. Using their strong moral values, charisma, and confidence, the supporters of this style demonstrate interaction and high-level analysis of the working environment (Tal & Gordon, 2016).

They are ready to make difficult decisions, identify risks, and share consciousness, which reduces the possibility of turnover (Naseer et al., 2017). In nursing homes, this style of leadership is effective because it may either include new ideas and approaches or follow the same standards without causing a negative influence on the quality of care and patient safety.


In general, turnover is a frequently discussed topic in modern nursing practice. Despite the intention to use trait or complexity leadership theories, many hospitals, and nursing homes experience problems with staff retention. Therefore, transformational leadership is recommended to understand the needs of nurses and reduce their desire to quit jobs but contribute to the development of one facility for a long theory. When leaders, managers, and nurses cooperate and share the same principles, there are enough chances to predict complications and choose the best alternatives to promote patient safety and care quality.

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American Association of Nurse Practitioners. (2019). Standards of practice for nurse practitioners. Web.

Halter, M., Pelone, F., Boiko, O., Beighton, C., Harris, R., Gale, J., Gourlay, S., & Drennan, V. (2017). Interventions to reduce adult nursing turnover: a systematic review of systematic reviews. The Open Nursing Journal, 11, 108-123. Web.

Kurnat-Thoma, E., Ganger, M., Peterson, K., & Channell, L. (2017). Reducing annual hospital and registered nurse staff turnover –A10-element onboarding program intervention. SAGE Open Nursing, 3, 1-13. Web.

Naseer, A., Perveen, K., Afzal, M., Waqas, A., & Gillani, S. A. (2017). The impact of leadership styles on staff nurses’ turnover intentions. Saudi Journal of Medical and Pharmaceutical Sciences, 7(12), 665-673. Web.

Nursing Solutions. (2019). 2019 NSI national health care retention & RN staffing report. Web.

Tal, D., & Gordon, A. (2016). Leadership of the present, current theories of multiple involvements: A bibliometric analysis. Scientometrics 107, 259–269. Web.

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