Skip to main content

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.

Comments

Popular posts from this blog

To Post-Doc or Not to Post-Doc, That is a Very Good Question - Part 1

Happy 2019!

Much to my surprise, I realized I went all of 2018 without posting anything. I got tenure in 2018 so technically, I should have had more time with that monkey off my back. Yet as a wise colleague told me, tenure usually means more work. Sure enough.

Nonetheless, let's start 2019 off fresh with a burning question I get from many of my PhD students: To post-doc or not to post-doc. For those of you not in academia, I post-doctoral fellowship (post-doc) involves additional training. You see, science has evolved so much these days that despite doing a PhD for 4 to 7 years, you might need more training.

I went into my post-doc reluctantly. After 5 years of PhD study, I was really hoping to have a just one job and a regular salary that might actually allow me to travel and start paying down my student loans. A post-doc just seemed like more years being poor.

It was, however, the best decision I ever made. I was lucky to have a great mentor who passed along many wonderful oppo…

There Are Other Masters Degrees Besides a Nurse Practitioner - Part I

It strikes me that many students and nurses do not seem to know about the "other" masters degree options for nurses.  Everyone seems to want to be a nurse practitioner these days.  Now, that's great news for the primary care provider shortage, but we need nurses with masters degrees who can work in other positions and have other skill sets.
Let's review the other masters degrees in nursing.  Nearest and dearest to my own heart is Nursing Education.  Remember that really cool clinical instructor you had in your entry-level nursing program --that could be you!  Do you like precepting new hires?  Are you the person on your unit who unofficially keeps everyone up-to-date on the latest evidence?  Do you really enjoy patient teaching, whether in the hospital or community setting?  Do you just like to teach?  Nursing education is the right masters for you.  Skills learned in a nursing education masters cannot be learned on the job.  Curriculum writing and program developmen…

Here's a Great Study Highlighting the Impact of Racism on Nurses

“I Can Never Be Too Comfortable”: Race, Gender, and Emotion at the Hospital Bedside
That's the title of a new study that just came out in Qualitative Health Research. The study of bedside nurses' diaries of their experiences reveals how nurses experience racism on the job. It comes not just from patients, but also from peers and management.
We have to talk about this more folks. It's time we deal with it better, in every setting.

Translate