3 Biggest Causes of Nurse Turnover

Nurses play a vital role in patient care at any hospital, especially in today's healthcare environment. "Hospitals are under the gun for patient satisfaction, and nurses often have the most interaction with patients during their hospital stay, greatly affecting satisfaction," says Karlene Kerfoot, PhD, RN, NEA-BC, FAAN, vice president of nursing for API Healthcare, a healthcare workforce technology company that delivers data driven staffing and talent solutions as well as business analytics. Additionally, having long-term, experienced nurses helps hospitals provide higher quality care.

However, recruiting the right nurse and training him or her is a time consuming and expensive task. That's why retaining nurses should be a major concern for hospital leaders. "When you have nurse turnover, that's a lot of knowledge that walks out your front door," says Dr. Kerfoot. "It's expensive, and a major quality problem. You want to prevent turnover as much as you possibly can."Kerfoot

Here, Dr. Kerfoot shares the three main reasons nurses leave a hospital job and gives suggestions for hospitals to keep their nurses long term.

1. Relationships. If the relationships among nurses in a unit or between nurses and their manager or physicians, are strained, the nurses are more likely to leave that hospital. "People like to work in happy places where everyone gets along," says Dr. Kerfoot.

There are several reasons these relationships might turn sour. For instance, some nurse managers are promoted without being properly competency trained for their new positions, according to Dr. Kerfoot. Additionally, some units may have nurses who fight among themselves or are simply not supportive of one another.

How to avoid the problem: Dr. Kerfoot says hospitals can monitor these relationships and help fix problems when they arise through surveys and data. Frequent employee satisfaction surveys can help reveal if nurses in individual units are satisfied or not. If satisfaction is low, the data from surveys can help pinpoint the problem. Then, hospitals can begin to take steps to fix the issues and prevent nurse turnover.

2. Staffing. There are several issues related to staffing that can lead to nurse turnover in a hospital. Many nurses are prone to leave hospitals that they feel do not have proper staffing levels. Additionally, a hospital may have adequate staffing levels but unorganized units. Further, some nurses may leave a job if they feel they are receiving inequitable assignments, or believe they are taking care of difficult patients more often than their colleagues, according to Dr. Kerfoot.

How to avoid the problem: Having a software-based staffing system can help prevent these staffing snafus. "Unfortunately, half of hospitals do not have software for staffing and scheduling, they are doing it on spreadsheets or paper," says Dr. Kerfoot. "You have to have data." She says this is the biggest nurse staffing mistake that hospitals are making — not having and using data to drive decisions.

For instance, systems can keep track of what types of patients each nurse is assigned to, virtually preventing inequitable assignments, according to Dr. Kerfoot. The data can also help hospitals evaluate their staffing practices. "Do analysis retrospectively to make sure things are done correctly," she urges. That way, nurses are more likely to feel the staffing is adequate and fair, and the hospital has data to back up its staffing practices — or make changes if necessary.

3. Personal reasons. When a nurse leaves a hospital for personal reasons, it may seem out of a hospital's control. However, there are some personal problems a nurse may be having that a hospital can help mitigate.

One common reason nurses leave a hospital is compassion fatigue, according to Dr. Kerfoot. When nurses take care of many high-risk patients, "over time they will get burned out and can't really connect with patients as [they] would like," she says.

Another issue is when nurses feel they have hit a "glass ceiling." "Nurses become comfortable with their clinical skills and look for an expanded role," says Dr. Kerfoot. "If there are no expanded roles, they will oftentimes move to new settings."

How to avoid the problem: Some personal reasons nurses have for leaving a position are unavoidable, but there are some things hospitals can do to make sure their nurses are content. For instance, hospitals can try to prevent compassion fatigue by making sure nurses are not working with high-risk, extremely sick patients on every shift, every day.

Steering clear of these three main drivers of nurse turnover will help hospitals keep nurses long-term, ultimately saving money and keeping quality and patient satisfaction high.

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