Effective Approaches in Leadership and Management for Tackling Nurse Turnover

Effective Approaches in Leadership and Management for Tackling Nurse Turnover

Registered Nurse turnover remains one of the biggest problems facing healthcare systems globally. Despite this fact, a consensus on the definition of nurse turnover is still lacking. Nursing turnover can broadly be defined as the number or percentage of nurses that leave an organization and have to be replaced. Some researchers include any nurse that goes to an organization for whatever reason in the turnover metric. Some only include those that leave voluntarily, while others include those that leave voluntarily and involuntarily but distinguish the two categories. However, researchers agree on the impact of leadership and management on nurse turnover. Specific leadership and management styles and practices both reduce turnovers and mitigate their effect on an organization.

The Problem

Nursing turnover is a severe problem for health systems worldwide. Researchers estimate that nurse turnovers occur at a rate between 15% and 44% across the nations of the world, with the United States rate being about 17% per year (Dewanto & Wardhani, 2018). Nurse turnovers can have significant adverse effects on hospitals. The impact of a turnover on a hospital is directly tied to the rate of turnover. Studies indicate that the harmful effects of nurse turnovers become significant at speeds of over 10%, and there is a substantial increase in the detrimental impact for every percentage rise in turnover (Dewanto & Wardhani, 2018). Nurse turnovers affect many aspects of the healthcare system, but, ultimately, it is the patients who suffer.

Nurse turnovers incur significant financial burdens on hospitals. The difficulty arises directly through an increase in costs because of replacement and training expenditure or indirectly by affecting revenues. Scientists estimate that the average U.S. hospital loses about 300,000 dollars annually for every percentage rise in nurse turnover (Dewanto & Wardhani, 2018). Financial losses by hospitals affect standards of care and patient safety, as hospitals are less likely to invest in improving quality while under financial strain.

Nurse turnover also impacts the quality of patient care and patient safety by affecting the skill levels of staff and affecting the relationship between staff members and between staff and patients. Nurse turnovers can cause nurse shortages or result in the loss of experienced nurses (Roche, Duffield, Dimitrelis & Frew, 2015). New nurses may lack the level of skill of departing nurses and may need time and training to catch up. There is also the possibility of a communication barrier and a lack of trust between new and existing nurses and doctors. These problems are likely to impact the quality of care for patients negatively. Patients may also feel frequent nursing changes lower the quality of care they receive, resulting in lower satisfaction levels.

Leadership and Management Styles

Many factors affect nurse turnover, and not all of them are under the control of hospitals. However, factors such as poor job satisfaction, high workload due to high turnover, low role clarity among nursing staff, poor communication between staff and management, poor recognition for good work, lack of opportunities to advance, and lack of trust, which significantly impact turnover, are under the direct control of hospital leaders and managers. Studies have shown that it is possible to reduce turnovers or smoothen transitions through strong and appropriate leadership and management (Xu, 2017). There are individual leadership styles and practices that have been associated with employee retention and low turnover. Leadership styles that value staff as fully functioning human beings have been found to reduce nurse turnover and increase withholding. Transformational leadership and participative (democratic) leadership styles are particularly good at reducing turnover.

Transformational leadership establishes a relationship between the leader and the nurse, where they work to inspire each other to work towards higher standards. Transformational leadership is underpinned by four fundamental tenets: The ability to affect intellectual stimulation, positive impact, ability to motivate, and consideration for individual differences (Xu, 2017). The transformational leadership style reduces turnover by making staff feel valued and creating strong bonds between staff and the leader. Roles are clearly defined, and staff members are given a chance to grow and advance. These features of transformational leadership make it ideal for reducing turnover and ensuring a smooth transition when turnovers cannot be prevented. In transformational leadership, the leader and the follower also help each other to maintain high moral standards by creating a positive ethical climate in the work environment and holding each other to high moral standards (Xu, 2017). The majority of nurses join the profession to help patients and are conscientious by nature.

Participative leadership is democratic, and team members are encouraged to take part in the decision-making process. Participative leadership theory holds that the leader is merely an enabler and not a dictator (Xu, 2017). The leader should strive to build trust with the followers and encourage them to air their views during decision-making processes. This leadership style reduces turnover by making staff feel valued, unlike the transactional leadership style, where nurses are required to do as they are told (Xu, 2017). Transformational and participative leadership techniques both result in higher staff retention, although transformational leadership has been identified as a better style for job satisfaction and staff retention.

Specific Practices and Professional Standards

The nursing leader is responsible for creating a work environment that is conducive to work. Motivation is a critical factor in employee retention. The nursing leader has to come up with motivational strategies that inspire nurses to work hard. Hard-working nurses are unlikely to quit because they feel they have invested their time and energy into the job. Hard work also provides a measure of job satisfaction as the nurses feel they are making an actual difference (Portoghese, Galletta, Battistelli & Leiter, 2015). Nurse managers also play an essential role in employee retention. Managers primarily deal with nurses’ schedules and day to day work of nurses. Managers also evaluate nurses, return feedback on work, offer mentorship, and come up with professional development strategies. They are also responsible for maintaining high professional standards. High standards encourage nurse retention as it motivates staff.

Motivated workers are also less likely to make mistakes or neglect their work. Hence, motivated workers are less likely to face disciplinary action or be sacked, reducing involuntary turnover. Strategies to motivate employees include giving employees purpose, setting small weekly goals, being transparent when dealing with employees, ensuring adequate compensation, promoting a healthy work-life balance, promoting teamwork and staff bonding, encouraging communication, and leading by example (Portoghese, Galletta, Battistelli & Leiter, 2015). Ideally, motivational strategies should be geared towards an individual rather than a team.

Conclusion

Nurse turnover is a significant problem for healthcare systems worldwide. This problem is likely to grow unless action is taken to mitigate it. While there are many causes of nurse turnovers, a good portion of the factors falls under the control of leaders and managers. Some styles and practices have been associated with employee retention. Specifically, techniques and methods that make employees feel valued and those that motivate employees result in less turnove

References

Dewanto, A., & Wardhani, V. (2018). Nurse turnover and perceived causes and consequences: a preliminary study at private hospitals in Indonesia. BMC nursing, 17(2), 52. Retrieved from https://bmcnurs.biomedcentral.com/articles/10.1186/s12912-018-0317-8

Portoghese, I., Galletta, M., Battistelli, A., & Leiter, M. P. (2015). A multilevel investigation on nursing turnover intention: the cross‐level role of leader-member exchange. Journal of nursing management, 23(6), 754-764. Retrieved from https://onlinelibrary.wiley.com/doi/abs/10.1111/jonm.12205

Roche, M. R., Duffield, C. M., Dimitrelis, S., & Frew, B. (2015). Leadership skills for nursing unit managers to decrease the intention to leave. Dove Medical Press Ltd, 5 (3). Retrieved from http://ro.ecu.edu.au/cgi/viewcontent.cgi?article=2877&context=ecuworkspost2013

Xu, J. H. (2017). Leadership theory in clinical practice. Chinese Nursing Research, 4(4), 155-157. Retrieved from https://www.sciencedirect.com/science/article/pii/S2095771817300944