Introduction
The challenging workplace conditions of nurses inevitably affect their decision to leave work or change the employer for the sake of a better working environment. Nurse turnover, which stands for the process of nurses either leaving their workplace or transferring to a different position within a unit, is a significant issue for health care due to its implications on the quality and costs of care. Thus, according to the NSI National Health Care Retention & RN Staffing Report (2021), the turnover rate of registered nurses in the US constituted 18.7% in 2020 (NSI Nursing Solutions, Inc., 2021). Such an indicator is the highest in the past five years, and the increase is correlated with the outbreak of the COVID-19 pandemic. According to Shaffer and Curtin (2020), some of the primary antecedents of nurse turnover include personal matters, salary, retirement, burnout, and promotion, with additional reasons tackling little autonomy, lack of respect in the team, and little consideration for their needs when creating shift schedules. Hence, it becomes evident that the precedents to nurse turnover are explicitly correlated with poor management and nurse dismissal in the professional team.
Nurse turnover is a considerably costly endeavor for the healthcare sector. According to NSI Nursing Solutions, Inc. (2021), the average turnover cost of one average RN constitutes nearly $40,000, with the average hospital losing nearly $5 million because of the turnover (p. 6). However, the consequences of turnover are not only significant for the medical establishment, as it also impacts other nurses in the team, doctors, and patients. According to Dewanto and Wardhani (2018), nurse turnover consequences on patients include increasing rates of mistrust and dissatisfaction, poor appraisal of the nurses’ skills, and more complaints about services. Nurses, for their part, have a higher risk of burnout due to shortage and senior nurses’ need to educate new nurses and help them adapt to the workplace (Dewanto & Wardhani, 2018). Finally, the doctors feel the pressure of readapting to cooperate with new nurses while subconsciously undermining the nurses’ skills due to turnover and shortage. For this reason, there is a need to address this issue to re-establish the nurses’ role in the work environment and secure higher retention rates.
Professional Standards of Practice
To define the procedures that ought to take place in the workplace, it is necessary to define the aspects that affect the nurse turnover rates. Thus, one of the primary antecedents to turnover is burnout and lack of autonomy in the workplace. Hence, as far as burnout is concerned, the American Nurses Association (ANA, 2021) emphasized the significance of fatigue reduction and optimal staffing policy implementation. Hence, to be alert and efficient during the shift, nurses are to be well-rested, encouraged to eat properly, and pay attention to their mental health.
To ensure fatigue risk reduction, nurse managers and employers are to follow the guidelines of proper staffing, which includes both the account for workload per nurse and the securement of efficient collaboration among the professional team (ANA, 2021). According to the ANA’s Principles of Nurse Staffing, employers must develop an exhaustive nursing framework with well-defined roles and measurable outcomes for every position in the workplace, promoting meaningful participation in decision-making for every team member (ANA, 2019). Hence, while the dismissal of nurses’ personal needs is sometimes perceived as the most beneficial way to address the measurable nursing outcomes within the team, managers fail to pay proper attention to low-efficiency rates and poor patient outcomes deriving from nurse exploitation.
Roles of Nurse Managers and Leaders
There is a fundamental difference between a manager and a leader. While the latter aims at empowering and directing followers towards achieving a certain goal, the former is an authorized worker obligated to develop a tangible framework with measurable steps on how this goal can and should be achieved to meet the organizational expectations (Grand Canyon University, 2018). Hence, as far as the turnover is concerned, the primary role of the manager is to adhere to the practice guidelines outlined above, ensure proper work-to-rest ratio for nurses, collaboration within the team, and distribute well-defined roles among nurses.
A leader, on the other hand, is expected to empower practitioners to collaborate in the team while listening to the staff’s concerns and acknowledging their expectations and ideas in terms of improving the workflow. Hence, while the manager takes a pragmatic approach to defining measurable outcomes of teamwork, the leader emphasizes empathy and dialogue, and such a distribution of roles makes them highly interdependent. Indeed, once either leadership or management aspects are overlooked, nurse turnover rates are not likely to reduce.
Additional Aspects of Leadership and Management
As far as nurse turnover is concerned, it would be reasonable to assume that the additional aspects of nurse management would include the reconsideration of the staffing practices and directing the employees. Thus, according to Grand Canyon University (2018), nurse managers are responsible for hiring and retaining nurses in the position. Hence, when speaking of reducing turnover rates, nurse managers are to re-evaluate their practices of recruiting and hiring nurses to ensure that the job candidates and professionals are dedicated to committing to the designated workplace, thus increasing the retention potential of each employee (Ayanwale, 2019). Leadership aspects, for their part, are to shift the focus from empowering others through role-modeling to empowering followers through meaningful participation in the decision-making process. Thus, the participative aspect of leadership will help collect feedback on the current pitfalls in the workflow, assisting managers in presenting efficient changes to the working environment (Magbity et al., 2020). Hence, both leadership and management in the context of turnover elimination are concerned with establishing a dialogue regarding nurses’ expectations and vision of a productive work environment.
Leadership Style
Evidence demonstrates that the choice of leadership styles has a tremendous impact on the nurses’ job satisfaction, turnover, and, consequently, the quality of patient care (Saleh et al., 2018). Hence, when addressing turnover, the team’s feedback is essential, as it has been defined that one of the primary reasons behind nurse turnover is the lack of autonomy and respect in the team. For this reason, the application of authoritative models of leadership is not productive in addressing and resolving the issue. In the given scenario, two beneficial options would be to adopt either participative or servant leadership. The latter presupposes paying special attention to the followers’ emotive response to the environment, where the leader becomes a role model through serving others (Neubert et al., 2016). As a result, embracing such an approach would be an asset for a nurse manager willing to increase the team’s efficiency, as collecting feedback and ideas provides them with ideas about the compromise that would eventually result in higher job satisfaction rates, better retention rates, and, naturally, proper patient outcomes.
References
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American Nurses Association [ANA]. (2021). Nursing: Scope and standards of practice (4th ed.). ANA.
Ayanwale, A. M. (2019). Strategies nurse managers use to reduce voluntary turnover of new registered nurses (Doctoral dissertation, Walden University).
Dewanto, A., & Wardhani, V. (2018). Nurse turnover and perceived causes and consequences: a preliminary study at private hospitals in Indonesia. BMC Nursing, 17(2), 1-7. Web.
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NSI Nursing Solutions, Inc. (2021). 2021 NSI national health care retention & RN staffing report [PDF document]. Web.
Saleh, U., O’Connor, T., Al-Subhi, H., Alkattan, R., Al-Harbi, S., & Patton, D. (2018). The impact of nurse managers’ leadership styles on ward staff. British Journal of Nursing, 27(4), 197-203. Web.
Shaffer, F. A., & Curtin, L. (2020). Nurse turnover: Understand it, reduce it. My American Nurse, 15(8), 57-59.