Introduction:
Nurse turnover is defined as “the number of nurses changing jobs within an organization or leaving an organization within a given year” (Baumann 2010). Retaining nurses is one of the most important issues in health care as its effects range from challenges in human resource planning, to high costs in financial and organizational productivity (Beecroft et al, 2008), to workgroup processes and morale, to patient safety and quality of care (i.e. patient satisfaction, length of patient stay, patient falls, and medication errors) (Bae et al, 2010). Nursing Solutions Inc (NSI) reported the national average turnover rate for hospitals increased from 13.5% in 2012 to 14.7% last year. Nurses working in Med/Surg had more turnover than any other specialty with a rate of 16.8%. Other specialties that exceeded the national average were ER, Behavior Health, Step Down, and Telemetry. The cost of this high turnover ranges from $36,000 to $88,000 to lose a bedside RN, resulting in an average hospital losing $3.74M to $6.98M (NSI, 2014). The NSI 2013 “National Healthcare Retention Survey” found that almost 90% of organizations view retention strategies as imperative for success, however less than half of them have a retention strategy in place. With a large population of nurses approaching retirement and a growing economy that historically supports higher turnover rates, hospitals cannot afford to not invest in a nurse retention strategy, since a high nurse turnover results in nurse burnout and job dissatisfaction which in turn results in more turnover, forever feeding the cycle.
Literature Review:
Extensive research on impacts and determinants of nursing turnover has been done for decades resulting in numerous causative theories,...
... middle of paper ...
...n, D., Barton, D., Davis, C., and G. Rook. 2012. Tripping over the welcome mat: Why new nurses don’t stay and what the evidence says we can do about it. American Nurse Today.
O’Brien-Pallas, L., Murphy, G., Shamian, J., Li, X., and L. Hayes. 2010. Impact and determinants of nurse turnover: a pan-Canadian study. Journal of Nursing Management. 18: 1073-1086.
PricewaterhouseCoopers Health Research Institute. 2007. What Works: Healing the Healthcare Staffing Shortage. New York: PricewaterhouseCoopers.
Smith, J., and L. Crawford. 2003. Medication errors and difficulty in first patient assignments of newly licensed nurses. JONAS Healthcare Law Ethics Regulation. 5(3):65-67.
The University Healthsystem Consortium/American Association of Colleges of Nursing. 2009. Nurse Residency Program. http://www.aacn.nche.edu/education-resources/nurse-residency-program.
Newly graduated nurses lack clinical skills necessary to evolve professionally and carefully from academics to bedside practice (Kim, Lee, Eudey, Lounsbury & Wede, 2015). How scary is that not only for the patient but also for the new nurse himself or herself? While being faced with new challenges, an increasing amount of newly graduated RNs felt overcome and unqualified. Twibell and Pierre explain how new nurses express “disillusionment” about practice, scheduling, and being rewarded. Frustration and anger between employees play a huge part in NGNs resigning because of the lack of experience and knowledge of what to do in high stress situations (2012). Nursing residency programs have proven to directly improve patient care, develop critical
As the forthcoming nursing shortage threatens the United States, organizations must be knowledgeable in the recruitment and retention of nurses. The challenge facing health care organizations will be to retain sufficient numbers of nurses to provide safe, efficient, quality care to patients. Organizations will look to recruit and attract quality nurses to fill vacancies. As turnover in nursing is a recurring problem, health care organizations will look for strategies to reduce turnover. The rate of turnover for bedside nurses in 2013 ranged from 4.4 to 44.6% (American Nurses Association, 2013). Nurse retention focuses on keeping nurses in the organization and preventing turnover. The purpose of this paper is to discuss the significance of recruitment and retention of nurses, review the literature, and explore how recruitment and retention apply to nursing.
Mbemba, Gisèle, Gagnon, Marie-Pierre., Paré, Guy. & Côté, Jose (2013.) Interventions for supporting nurse retention in rural and remote areas: an umbrella review. Human resources for health. doi:10.1186/1478-4491-11-44. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3847170/pdf/1478-4491
Stevens, S. (2002, September-October). Nursing workforce retention: Challenging a bullying culture. Health Affairs, 21 (5), 189–193. http://dx.doi.org/10.1377/hlthaff.21.5.189
"What Works: Healing the Healthcare Staffing Shortage." Modern Healthcare 37.29 (July 2007). ABI/INFORM. ProQuest. Ithaca Coll. Lib., Ithaca, NY. 2 Dec. 2007
Sovie, M. D., & Jawad, A. F. (2001, December). Hospital restructuring and its impact on outcomes. nursing staff regulations are premature. Journal of Nursing Administration, 31(12), 588-600. Retrieved from http://journals.lww.com
U.S. Department of Health and Human Services. (2013, April). The U.S. nursing workforce: Trends in supply and education. Retrieved March 10, 2014, from http://bhpr.hrsa.gov/healthworkforce/reports/nursingworkforce/nursingworkforcefullreport.pdf
Zerwekh, J., Claborn, J. (2006). Nursing today: Transitions and trends (pp. 343-346). St. Louis, Missouri:
The number of patients assigned per nurse has been directly linked to nurse job satisfaction and patient outcomes; with a ratio of four patients to one nurse being the ideal ratio (7). Research has shown that the addition of just one patient per nurse has been associated with a higher risk of death for patients and an increase in nurse job dissatisfaction and burnout (2). This is significant because nurses wish to provide the best quality of care for patients and with increased patient to nurse ratios, nurses are unable to maintain their ideal quality of care; which leads to job dissatisfaction and nurse burnout. Originally, after the passage of the California nurse staffing act, which set mandated nurse-patient rations, overall job satisfaction appeared to increase (1). However, several longitudinal studies have suggested that direct care nurses are still dissatisfied despite increased nurse to patient ratios (1). From the results of these longitudinal studies, it has been found that there is still some shortcomings with staffing systems based solely on nurse-patient ratios. Therefore, even though the ratios staffing system accounts for appropriate patient care, it does not take into consideration different patient complexities and needs for nursing care (10). Staffing by acuity is the third and final staffing system that is considered when looking at nurse burnout and job
Tzeng, H., Yin, C., & Schneider, T. E. (2013). Medication Error-Related Issues In Nursing Practice. MEDSURG Nursing, 22(1), 13-50.
However, upon securing a job, they find that things on the ground are not as they had expected them to be and this results in some of them deciding to leave the profession early. Research shows that turnovers within the nursing fraternity target person below the age of 30 (Erickson & Grove, 2011). The high turnover within the nursing fraternity results in a massive nurse shortage. This means that the nurses who decide to stay have to work for many hours resulting in exhaustion. A significant percent of nurses quitting their job sites exhaustion and discouragement as the reason that contributed to their decision. In one of the studies conducted on the issue of nurse turnover, 50% of the nurses leaving the profession argued that they felt saddened and discouraged by what they were unable to do for their patients (Erickson & Grove, 2011). When a nurse witness his/her patients suffering but cannot do anything because of the prevailing conditions he/she feels as if he/she is not realizing the reason that prompted him/her to join the nursing profession. The higher rate of nursing turnover is also affecting the quality of care nurses provide to
In addition to concerns about the adequacy of the supply of nurses the financial impact of high turnover was startling. According to Jones (2005) Using the updated Nursing Turnover Cost Calculation Methodology, the per RN true cost of nurse turnover is calculated to be 1.2–1.3 times the RN annual salary. That estimate is derived from a retrospective, descriptive study of external RN turnover cost data at an acute care hospital with over 600 beds. The findings indicate that the three highest cost categories were vacancy, orientation and training and newly hired RN productivity. (as cited in Kooker & Kamikawa, C. 2011). For example, At the Queen’s Medical Center, the annual salary of an experienced RN is currently $91,520. Therefore, using the
The prolonged shortage of skilled nursing personnel has been a serious concern to the healthcare industry, and this shortage has impacted the quality of care delivery. In addition, nursing turnover has also exacerbated the problem of nursing shortage. Nursing shortage has been blamed on many nurses retiring and less younger nurses joining the occupation. There is also an increase in life expectancy (baby boomers) leading an increase in both physical and mental ailment with subsequent demand in nursing care. Nurses are also leaving nursing profession because of inadequate staffing, tense work environment, negative press about the profession, and inflexible work schedules. Even though nursing is a promising career and offers job security, the
This article is a comprehensive look at staffing on hospital units. It used a survey to look at characteristics of how the units were staffed – not just ratio, but the experience and education level of the nurses. It evaluated several different categories of hospital facilities – public versus private, academic medical centers versus HMO-affiliated medical centers, and city versus rural. It is a good source because it shows what some of the staffing levels were before the status quo of the ratio legislation passed in California. It’s main limitation as a source is that it doesn’t supply any information about patient outcomes.
Recent literature reports that there is a nursing shortage and it is continually increasing. Data released by the American Association of Colleges of Nursing (2011) projects that the shortage, would increase to 260,000 by the year 2025. AACN (2011) also reported that 13% of newly registered nurses changed jobs and 37% were ready to change within a year. A study conducted reports that there is a correlation between higher nursing workloads and nurse burnout, retention rates, job dissatisfaction and adverse patient outcomes (Vahey & Aiken, 2004). Among the nurses surveyed in the study, over 40% stated that they were suffering from burnout while 1 in 5 nurses intended