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Saturday, March 8, 2014

Turnover in Nursing Staff at the Unit Level: The Single Best Indicator of Manager Performance?

Recently I had lunch with a former student who was passing through town. Lisa graduated a little over two years ago and was one of the lucky ones who found a job fairly quickly.

What was most interesting about our conversation was the turnover rate on her unit. In 15 months, 15 nurses have left. The most recent was a group of five experienced night shift nurses, the kind any manager is loathe to lose. They left, according to the student, because they were tired of how they were treated.  Lisa is now the most experienced person on night shift at two years out of school. The loss of 15 nurses on one unit has also cost the organization nearly a million dollars. In an era of cost tightening, that is a steep price.

Acknowledging that this is only a report from one person, there is still something that rings true in her story: Well managed patient care units do not have high turnover rates of staff. So let's think about what constitutes turnover in nursing staff and it's causes.

Gilmartin provides an excellent review of the literature on nurse turnover in a 2012 study published in Medical Care Research and Review. If we consider turnover as a measure of manager performance, however, it needs categorization. Positive turnover might be staff who leave because they completed a higher degree and are moving into a new job that reflects their new level of education. It could also be termination of poor performing personnel who are likely toxic for unit culture and whose firing would likely improve retention overall. Internal transfers are a gray area because they could reflect poor management and a nurse "voting with her feet" to get away from it. Negative turnover, of course, is a situation like what Lisa described with the night staff.
Research by Kovner and Brewer on new graduate nurses adds another later of complexity to the performance equation because early career nurses may be more likely to leave due to life changes like marriage and child bearing. Rural locations may have high retention rates because there are fewer job options, but a proxy measure there could be staff burnout levels. Unhappy nurses make for unhappy patients as recent research out of the University of Pennsylvania shows.

If we move beyond borders to low and middle income countries, turnover grows still more complex. Poorly managed systems, for example, where staff do not get paid on time or as much as promised certainly drive people away and frontline managers do not always have control over those circumstances.

The take away message here is that turnover is complex, but it may be time to quantify it as a measure of manager performance. Turnover costs organizations too much to ignore any more. A million dollars in single unit turnover costs could be spent in much better ways.

Tuesday, January 14, 2014

Research Rankings - US Nursing Schools

The 2013 results are in!  Which US universities with research intensive nursing programs made the top ten in US National Institutes for Health Funding?  Here's the list:

1. UNIVERSITY OF CALIFORNIA SAN FRANCISCO
2. UNIVERSITY OF ILLINOIS
3. UNIVERSITY OF WASHINGTON
4. JOHNS HOPKINS UNIVERSITY
5. UNIVERSITY OF PITTSBURGH AT PITTSBURGH
6. NEW YORK UNIVERSITY
7. UNIVERSITY OF CALIFORNIA LOS ANGELES
8. UNIVERSITY OF PENNSYLVANIA
9. UNIVERSITY OF MARYLAND BALTIMORE
10. EMORY UNIVERSITY

So what does this mean? If you are a newly minted PhD or Post-Doc and you want to get your research career off the ground, applying for a job at one of those institutions will give you a good shot at developing your career.

If you are looking for a PhD program or a Post-Doctoral Fellowship, one of those schools would probably be the best place to look for opportunities and mentoring.  Nursing schools in universities that can consistently obtain funding mean that they have good research infrastructure overall to support a budding research career.

And yes, you better believe I'm proud as heck to be affiliated with the #6 ranked NYU College of Nursing!


Thursday, January 2, 2014

Welcome to 2014, Most Trusted Professionals in the US!

Welcome to 2014!  What does the new year have in store for you?  As you've figured out about US nursing by now, there are so many possibilities.  Maybe it's time for a career change?  To go back to school?  To move on from your current job into something else?  Hopefully a little mentoring can help you get there.

Meanwhile, pat yourselves on the back again nurses.  In 2013, the US public voted nurses the most trusted of all the service professionals in the country, with 85% indicating high levels of trustworthiness and dedication to ethics.  This was our highest ranking ever!  So if you've had one of those days at work, take a moment to pat yourselves on the back.

In the US, nurses are lucky enough to be held in such high esteem.  That's not the case in every country.  In fact, nursing is undergoing a transition around the world. Nurses are doing more in many countries due to personnel shortages.  You know what its like to work with too few nurses on staff in your facility, imagine doing that every single day?!  It affects everything from patient outcomes to health system costs.  Fortunately, more and more international policy making organizations are realizing that investments in the health workforce are critical for long term sustainability.  Nurses are central to those investments.  Imagine how much more effective those investments could be if nurses were held in equal esteem in other countries.