Reducing the Level and Cost of Nursing Turnover

Nursing shortages and high nurse turnover are very common issues faced in the health care industry. This instability of workforce in the health care industry in many countries is raising questions about performance of the nurses and quality of the patient care.

Gray & Phillips (1996) pointed out that nursing turnover has a negative impact on the organization’s ability to meet the needs of the patients and provide them quality care. Tai et al., (1998) also considered nursing shortage and turn over as an important factor responsible for the poor performance of the health care centers. This is due to the reason that the high turnover affects the morale and productivity of the nurses who are left behind to take care of the patients while the health care unit hires the new staff members (Sofer, 1995; Cavanagh and Coffin, 1992; Shields and Ward, 2001)

Aiken et al., (2001) pointed out that the common reasons behind the turnover of nurses in Canada, America, Germany and Scotland were problems in the work design and emotional exhaustion. Some of the other reasons include other career options for nurses, low wages, leaving the profession and older ages of nurses.

Nursing shortage and turnover is not only impacting the performance but also the profitability of the health care units. This is due to the fact that patients prefer to go to only those health care units that have a stable, well trained and active nursing staff who provides high quality care. Constant turnover of nurses at a healthcare unit distracts the attention of nurses, forces them to do extra work that causes frustration resulting the low quality care of patients. Therefore, losing a single nurse gives a financial cost of double’ the nurse’s annual salary. In addition to these, healthcare unit is affected in a variety of ways like low quality care, decrease in number of patients, increase in absenteeism, increase in accidents, increase in medical staff turnover, increase in temporary staff costs and contingent staff costs.

Role of Manager Nurse vs. Leader Nurse in a Health Care Unit

The terms nurse leader or nurse manager are used interchangeably but in actual there is significant difference between these two terms. A nurse leader can be an effective manager but it is not necessary that every nurse manager becomes a good nurse leader. The responsibility of the nurse manager is to fulfill the duties that are assigned to him or her and managing the nursing staff who reports to the manager. A nurse leader however, has a very different role as he has to inspire and motivate others to perform their duties keeping in mind the framework. Leaders can never be made; they are born and they possess the ability to motivate, inspire and drive other staff members to achieve the vision and mission of the health care unit.

A nurse leader should have effective communication and interpersonal skills. He should be the risk taker and should have ability to think beyond the issue, travel extra mile in order to achieve the desired results. He shouldn’t compromise on the destiny which is to provide high quality patient care. He should collaborate with the management to design strategies that help achieving the health care unit nursing staff goals. A nurse leader is considered as a role model by all the nurse staff members, so he should take the excessive responsibility on his shoulders and serve as an example for the other nurse staff members and managers. The leadership approach in a health care unit can be formal as well as informal. An effective nurse leader should take the responsibility of streamlining the workforce and allocating the resources.

Methods for Reducing the Level and Cost of Nursing Turnover by Nurse Managers and Nurse Leaders

There are several methods that help nurse managers and leaders to reduce the nursing turnover

1. Increase Wages/Salary

This is the direct way of retaining the current nursing staff as well as attracting more aspiring and experienced nurses towards the hospital employment. This helps reducing nurse shortage and enables hospitals in providing improved patient care. In addition, high pay scale for nurses also allows enhancing and expanding the nurse education due to the constant supply of nurses in present as well as future. Therefore, nurse manager should discuss the issue with senior management if he/she observes nurse staff members resigning due to salary issue.

2. Nurse Unionization

Allowing nurses to make a union and disclose their concerns helps nurse managers and leaders knowing the issues of nurses through collective voice. This helps in solving their issues and lowering the nurse shortage and high turnover. Leaders and managers should welcome the concerns of nurse staff members and try to resolve them.

3. Health care Unit Wage Setting

Management must make fair wage setting practices and should avoid unlawful agreements. Management should enforce the antitrust laws where required and make the data collection of wages as transparent as possible.

4. Staffing Ratio

Staffing ratio plays a critical role in providing quality patient care and controlling nurse shortage and turnover. When managers give nursing staff the responsibility to take care of too many patients at a time, the quality of care is badly affected and the staff also gets exhausted.

5. Research and Public Education

Hospitals, especially the nurse leaders and managers should research and educate themselves about the policies and strategies that how nurse pay scale and work pressure affects the performance of the staff and high turnover.

Approach that best fits Professional Philosophy of Nursing

In my opinion, low pay scale is the main issue behind nurse shortage and high turnover. Students who wish to become a nurse avoid going into this profession due to the low pay scale and tough duties. Therefore, the health care units suffering from nurse shortage and high turnover should revise their pay scale. This change will not only retain their current nursing staff but will also attract more educated and well experienced nursing staff who look for a better place to work. However, they should not shrink the number of staff members to balance their pay structure. This will make the nurse staff over burdened; they will be exhausted and will quit despite of getting better salary.

The nurse leaders should use the democratic style of leadership and allow their subordinates to participate and take active part in the decisions of the health care unit. The final decision should be of the nurse managers and nurse leaders but they should give freedom to all nurse members to give ideas, suggestions and input so that staff members feel their value and importance in the health care unit.


Aiken, L.H., Clarke, S.P., Sloane, D.M., Sochalski, J.A., Busse, R., Clarke, H., Giovannetti, P.,

Hunt, J., Rafferty, A.M and Shamian, J., 2001. Nurses’ reports on hospital care in five countries. Health Affairs 20 (3), 43 — 53.

Cavanagh, S.J and Coffin, D.A., 1992. Staff turnover among hospital nurses. Journal of Advanced Nursing 17 (11), 1369 — 1376.

Gray, A.M. And Phillips, V.L. (1996). Labor turnover in the British National Health Service: a local labor market analysis. Health Policy 36 (3), 273 — 289.

Shields, M.A and Ward, M., 2001. Improving nurse retention in the National Health Service in England: the impact of job satisfaction on intentions to quit. Journal of Health Economics

20 (5), 677 — 701.

Sofer, S., 1995. Determinants of nursing turnover. Dissertation Abstract International: Section B:

The Sciences and Engineering 55 (9-B), U.S.: University Microfilm International.

Tai, T.W.C., Bame, S.I and Robinson, C.D. (1998). Review of nursing turnover research, 1977

1996. Social Science and Medicine 47 (12), 1905 — 1924.

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