Across 8,584 U.S. acute care hospital units, higher nurse turnover is significantly associated with increased patient falls, according to a study published Dec. 29 in JAMA.
Previous research has detected this association, but there is limited evidence exploring the trend from a multidimensional lens, including practice environment and job satisfaction, according to researchers from Boston College in Chestnut Hill, Mass.
The study utilized the Practice Environment Scale of the Nursing Work Index to assess nurse practice environments and the National Database of Nursing Quality Indicators to analyze job satisfaction and patient falls. Practice environment components included staffing adequacy, nurse-physician collaboration and nurse manager ability.
Between 2022 and 2023, surgical units in the study recorded 5,285 falls, medical units saw 15,094 and medical-surgical units recorded 22,550. The percentage of patients at risk for falls was 45% in medical units, 37.1% in surgical units and 42.5% in medical-surgical units.
After adjusting for patient risk, staffing levels and unit characteristics, the study found that “a turnover increase of 10 percentage points is associated with approximately 36 additional patient falls per year in a hospital with 1000 inpatients per day.”
Aside from a nurse’s intent to stay, no other practice environment factors were significantly associated with patient falls.
“These findings suggest that interventions to reduce inpatient falls should focus not only on patient-level risk factors but also on broader organizational context and workforce stability,” the researchers concluded. “Efforts to reduce nurse turnover, particularly in medical units, could have downstream effects on patient safety.”
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