Dysfunctional Turnover In The Nursing Profession

Registered Nurse turnover is a continuous problem in the nursing profession. Turnover in this context is simply defined as “someone leaving a job” (Kovner, Brewer, Fatehi, & Jun, 2014). Some aspects of nurse turnover can be viewed as positive, however, most circumstances of turnover are seen negatively and can be referred to as functional versus dysfunctional. The difference between the two is a “functional turnover, a poorly functioning employee leaves, as opposed to a dysfunctional turnover, when well-performing employees leave” (“One in Five nurses leave First job within a year,” 2014). The nursing profession’s recommendation for improvement focuses on dysfunctional turnover of Registered Nurses. Nurses choose to leave their jobs to explore

positions in other hospitals, other specialties, to return to school to achieve a higher level degree, and sometimes to take a completely different career path. High nurse turnover rates affect the hospital, the patients, and other employed nurses. There are discrepancies regarding actual statistics related to nurse turnover rates; however, one source states “nearly one in five new nurses leaves first job within a year” (“One in Five nurses leave First job within a year,” 2014). Another source suggests that “In 2015, the turnover rate for bedside RN’s increased to 17.2%” (NSI Nursing Solutions, Inc., 2016). Regardless of the exact number or percentage, it can be agreed that nurse turnover is both a common occurrence and a noteworthy issue because it negatively affects patient care and safety.
Nurses have different motives for choosing to leave a job. The most common includes problems with inter-professional relationships, nurse burn-out, and overall dissatisfaction with their current job. Inter-professional relationships can include physician to nurse relationships and nurse to management relationships. “Abuse (verbal or physical) and intimidating or disrespectful behavior by doctors toward nurses impacts the healthcare practice environment in a negative way, affecting both nurse retention and patient outcomes” (Siedlecki & Hixson, 2015). If nurses are constantly or continuously disrespected or belittled by physicians, they will lose respect for the physician, the hospital administration when they do not take action to protect and defend the nurse, and eventually even themselves. This inappropriate behavior by physicians causes nurses to question themselves and increases stress levels at work. Likewise, a positive relationship between the nurse and their management team is also vital to a nurses overall satisfaction. Nurses experiencing “burn-out” or mental, physical, and emotional exhaustion from their job, is another reason nurses choose to leave.
Burn-out can stem from many other common issues in the nursing profession such as short-staffing, nurse-patient ratios, mandatory overtime, and floating to other units.

Finally, a more obvious and direct cause of nurse turnover is overall dissatisfaction with the current job. This can be for numerous reasons related to pay, benefits, job growth availability, lack of autonomy, or simply feeling unappreciated. According to one source, “a 2014 survey of more than 3,300 nurses found that they were stressed, overworked, underappreciated, and underutilized” (Fischer, 2016). No matter the reason a nurse chooses to leave their job, the negative outcomes remain the same. The most common of these outcomes are that hospitals lose money, it decreases patient quality of care, and it continues the cycle of more turnover in the nursing profession. “It is predicted that there will be a shortage of nearly 1 million nurses in the United States by 2020” (Hunt, 2009). Hospitals are impacted financially by the high nurse turnover rates. “The financial costs of losing a single nurse has been calculated to equal about twice the nurse’s annual salary” (Hunt, 2009). With these numbers in mind, the hospital spending more money to retain nurses could be a smart and beneficial action for them to

take.
The most important issue caused by nurse turnover is a decrease in the quality of care patients are receiving. The patients should always remain the center of focus and top priority. “Staff shortages caused by nursing turnover are associated with significant decreases in the general quality of patient care, increases in the length of patients stays within hospitals, and greater number of hospital-acquired patient illnesses and conditions” (Hunt, 2009). When nurses are constantly leaving their jobs, hospitals are remaining in a state of staff shortages because there is only weeks’ notice required to leave a job and months of training to replace the nurse who left. Staff shortages result in higher nurse to patient ratios, an increased number of nurses being floated to cover the shortages, higher stress situations, and ultimately more nurses leaving; therefore further increasing nurse turnover rates. One source summarizes this outcome as “nurse turnover creates staffing shortages that increase the work demands placed on the organization’s remaining nurses.” They go on to say “This heightens the risk of the remaining nurses quitting due to excess workload” and that it results in a “vicious cycle of constantly increasing nurse turnover within an organization” (Hunt, 2009).
The nursing profession recommends implementing a Retention Rewards Program as one way to reduce overall job dissatisfaction among nurses associated with high nurse turnover rates.

This program would not just reward senior staff but all staff for every year they stay beginning after their first year. It would create a ladder effect, where every year or so that a nurse stays, they climb the ladder and unearth new benefits and reasons to stay longer. A new nurses “one year mark” is an important and monumental goal to reach. To them, it is everything. They survived that first year. However, besides their first annual evaluation, this often goes unnoticed and unrecognized by management or the hospital itself. The benefits would have to be hospital or unit specific because all organizations have different policies and ways to reward their staff. One incentive could include more flexibility with scheduling such as less weekend shifts, less Fridays, and first dibs on holiday shifts. Another Incentive could be becoming a charge nurse and a preceptor/mentor at a certain stage in your career. Although these require more responsibility, it also allows for growth, confidence, and a sense of authority and autonomy. Other incentives could be reimbursement or scholarships for furthering education, raises for performance, length of stay, and certifications obtained, and increased PTO and vacation time. Most nurses are task-oriented, goal-focused individuals. Employers who give them a goal to

obtain and reward those goals should see an increase in satisfaction. Managerial staff should take the time to briefly survey their employees so that they can personalize their Retention Rewards Program to their specific unit and staff. Find out what encourages each staff member to stay and implement that in the benefits program. The Retention Rewards Program should be the first to implement because it is the simplest to put into effect and it not only reduces nurse’s job dissatisfaction but it also improves other aspects that may cause a nurse to leave their job by improving inter-professional relationships between nurses and management and reducing burn-out. When a job is rewarding their employees for length of stay, that employee has more to lose when deciding to start over at another job. For example, a nurse that works day-shift, few weekends, gets more PTO and has more respect and autonomy in their position, will be less likely to change to a job where they have to work night shift, several weekends, holidays, and do not accrue as much PTO.
The turnover rate of bedside Registered Nurses in the hospital setting is an issue that must be addressed as it affects the quality of patient care and safety, it is a financial burden to hospitals, and it is a compounding issue that continues to contribute to more nurse turnover. The Retention Rewards Program recommended by the nursing profession would decrease the percentage of nurses leaving the hospital and reward nurses for staying at the bedside. The key to nurse retention is giving the employees a reason to stay. The program would be hospital or unit specific but would include benefits such as pay raises or bonuses, flexible scheduling, earning more vacation time, and educational assistance scholarships. Not only will this Retention Rewards Program decrease nurse turnover but it will also directly increase patient satisfaction by employing nurses who are content and feel appreciated in their career.