Problem Background
Employee turnover bothers leaders in any sphere, and nursing is no exception. Nurses leave their organizations because of poor role clarity, burnout, a lack of communication, and no supervisory support (van der Heijden et al., 2019). Thus, nurse turnover is an issue that needs analysis to clarify how it affects care quality, patient safety, and leadership or management approaches. Nurses are important in gathering personal data, monitoring, and connecting patients with other healthcare providers.
Turnover means that the offered working conditions could be better, and it is obligatory to investigate the sector and offer improvements. Transformational leaders strengthen commitment, motivate the staff, and promote organizational changes. This paper discusses how nursing leaders and managers apply various approaches to minimize nurse turnover, improve care quality, enhance patient safety, and ensure professionalism in healthcare settings, proving the worth of a transformational leadership style.
Nurse Turnover and Its Impact on Care Quality and Patient Safety
Nurse turnover means that a person is no longer interested in working at the same place or chooses to leave for some personal or professional issues. Some nurses need more time to maintain career identity and define the critical sources of motivation, while others demonstrate low job satisfaction levels, increased stress, and a lack of hope (Hu et al., 2022). Still, despite the reasons people introduce to change their working environments, many hospitals experience a shortage of nurses because about 35-60% leave within the first year of their practice (Hu et al., 2022). As a result, nursing quality is reduced, recruitment costs increase and new strategies are required.
The quality of care depends on the work of nurses, and nurse turnover might have adverse outcomes on nursing quality. According to Bae (2023), nurse turnover creates poor work conditions, which are detrimental to care quality and, in turn, harmful to patients. For example, when the same nurses cooperate with patients, they rely on their past experiences, observations, and knowledge and exchange the necessary information. However, when a nurse leaves, the system has to be changed, and the quality of care is hard to maintain on the same level.
Patient safety is threatened when new nurses have to replace those who decide to leave as time is needed to learn organizational standards, protocols, and other procedures. Although nursing care is always different and depends on patients, their needs, levels of support, and disease severity, a hospital continues working under the same principles, identifying nurse roles, responsibilities, and obligations. Not all employees are ready to accept changes quickly, leading to increased medical errors, miscommunication, and even deaths. In addition, Lasater et al. (2021) show that nurse turnover has high financial burdens: replacing one bedside nurse can cost from $20000 to $80000. This inability to stabilize the healthcare economy brings various consequences: cheap or a lack of patient equipment, understaffing, inconsistent nurse-patient ratios, etc.
Influence of Professional Standards of Practice
In 2021, the American Nurses Association (ANA) improved the standards of nursing practice, but the main idea remains the same. Nurses are expected to collect and assess primary patient data, identify expected outcomes, develop and implement plans, coordinate care, promote health, and evaluate progress (Dickerson & Durkin, 2022). In other words, the offered professional standards of nursing practice indicate the roles and responsibilities of any registered nurse, which systematize care and cooperation within a healthcare facility. Implementing ANA ideas can effectively rectify adverse outcomes in nurse turnover and even predict a turnover process.
One of the main goals for healthcare facilities is to hire the best employees and maintain professional conduct. Nurses find it possible to change the workplace because of poor role identifications and explanations (Hu et al., 2022). Following the standards allows nurses to delegate their duties and enhance supervision. For example, the fourth standard underlines the worth of collaboration and promotion of innovative initiatives (Dickerson & Durkin, 2022). When nurses consider the impact of diversity, interdependence, and support, they can work well and be satisfied with the condition, leading to decreased turnover.
Roles and Approaches of Nursing Leaders and Managers
Nursing leaders and managers have to fulfill a number of roles related to the policies and standards of their settings. One of the major goals of their work is to promote patient safety and quality care, but despite a list of common characteristics, leaders and managers are not the same (van der Heijden et al., 2019). Leaders build a vision through motivation, guidance, and decision-making, while managers are interested in processes: the goals are achieved, and the work is well-coordinated.
The differing roles and approaches of leaders and managers can be better understood through the prism of several theories. Following the situational leadership theory developed by Hersey and Blanchard, leaders and managers have to adapt their leadership styles to meet organizational needs and promote maturity levels among their followers (Castillo et al., 2021). On the one hand, effective leadership and management depend on the steps people take to predict nurse turnover, to keep order, and not to deteriorate care quality and patient safety. On the other hand, leaders should be ready to impose change, and managers must implement it, using such skills as shared decision-making, problem-solving, and communication.
Another approach that might help leaders solve the problem of nurse turnover is based on the conservation of resources theory. Its principle is to retain and protect resources for responding to stress in the workplace, which is the managers’ responsibility (Iqbal et al., 2019). Leaders offer resources and define the boundaries within which the work should be done. If resources and tasks are reasonably distributed, nurse turnover can be decreased.
Additional Aspects to Ensure Professionalism in Diverse Healthcare Settings
In addition to the mentioned skills and aspects, leaders and managers can ensure professionalism by strengthening cooperation, commitment, and training among nurses to reduce nurse turnover. First, all employees should be eager to cooperate and delegate their duties through the prism of long-term sustainable development (Castillo et al., 2021). Working together, they help nurses identify and solve organizational problems and strengthen their commitment to stay at the same facility (Hu et al., 2022). Finally, professional training and emotional support enhance professionalism because nurses can learn and apply new information in practice. All these aspects improve nursing care, promote patient safety, and address nurse turnover as the primary source of current problems.
Leadership Style
A transformational leadership style is one of the best options for healthcare settings to address nurse turnover. According to Iqbal et al. (2019), transformational leaders foster high levels of commitment among employees. Nurses need to feel respect and recognition in the workplace, and this type of leadership raises morale and motivation levels (Iqbal et al., 2019). Despite the imposed changes and requirements, transformational leaders know how to support nurses and underline the worth of team-building and shared decision-making. Although this choice may not directly eliminate nurse turnover, it can successfully remove its possible causes.
Analyzing different nursing leadership and management approaches is an excellent opportunity to understand how modern healthcare facilities can deal with nurse turnover. It is not enough for nurses to stop leaving their workplaces; they need to know why they do this and how to prevent losses. Transformational leaders have an impressive list of qualities that help effectively contribute to solving the nurse turnover issue by enhancing motivation, training, employee commitment, and job satisfaction.
References
Bae, S. H. (2023). Comprehensive assessment of factors contributing to the actual turnover of newly licensed registered nurses working in acute care hospitals: A systematic review. BMC Nursing, 22(1). Web.
Castillo, A. L. R., Padilla, M. E. R., & Hernández, D. G. (2021). Self-evaluation and evaluation of nursing leaders: Leadership styles. Revista Latino-Americana de Enfermagem, 29. Web.
Dickerson, P. S., & Durkin, G. J. (2022). Nursing professional development standards of practice: Standards 1–6. Journal for Nurses in Professional Development, 38(4), 248-250. Web.
van der Heijden, B., Brown Mahoney, C., & Xu, Y. (2019). Impact of job demands and resources on nurses’ burnout and occupational turnover intention towards an age-moderated mediation model for the nursing profession. International Journal of Environmental Research and Public Health, 16(11). Web.
Hu, H., Wang, C., Lan, Y., & Wu, X. (2022). Nurses’ turnover intention, hope and career identity: The mediating role of job satisfaction. BMC Nursing, 21(1). Web.
Iqbal, K., Fatima, T., & Naveed, M. (2019). The impact of transformational leadership on nurses’ organizational commitment: A multiple mediation model. European Journal of Investigation in Health, Psychology and Education, 10(1), 262-275. Web.