Introduction – Nurse Turnover
All the professions in the world have to face multiple issues with various dimensions. With time, these issues are addressed in various ways to seek appropriate solutions. Similarly, several issues are associated with the nursing profession and practice that leave lasting impacts in this regard. The list of these issues may include compensation and monetary-based aspects, departmental promotions and the workplace environment, etc. For example, the nurses and medical staff may have the viewpoint that the environment at work is a hurdle in the way of their success. Such a situation in the nursing paradigm depicts the abuse of power on the part of authorities. Similarly, a further thought may lead towards compensation that monetary benefits are not in alignment with the capability and services of medical staff. In addition, it may happen that the training and boasting of skill patterns do not suit the trainees and only for the satisfaction of upper authorities. These or other associated problems precede the situation towards non-satisfaction, especially in terms of high nurse turnover. This paper will explore the nurse turnover in alliance with the managerial role of authorities regarding patient safety and arrangements in the vicinity of reduced staffing.
Impacts of Nurse Turnover Regarding Health Care Quality and Patient Safety:
In hospitals, various entities may have negative impacts on the quality of patient care. One of them is nurse turnover in terms of healthcare settings. This is due to the fact that a nurse is the only healthcare practitioner who acts as the two ends of a string. First is responsible for delivering the final product to the healthcare institutions to which they belong, and the second most important aspect is to always remain in contact with the patient. In other words, the negative impacts of nurse turnover revolve around both the quality and consistency of healthcare phenomenon.
Besides that, the research showed that nurse turnover has an impact on workgroup learning which ultimately leaves harsh effects on patient outcomes. In this context, it is clear that the low levelled quality of nursing care is directly associated with high nurse turnover. Moreover, such turnover directly lowers the effectiveness because the new staffing in this cadre creates immense problems especially relating to procedures and standards of the concerned organization. In other words, such high turnover may lead to increase cost and lower quality, which ultimately results in diminished efficiency, especially in terms of fiscal and budgeting aspects (Antwi & Bowblis, 2018).
Demonstration of Nursing Professional Standards concerning the Practice:
Schmidt & McArthur (2018) concluded that the standards of practice are obvious and clearly stated by the American Nurses Association’s Standards of Professional Nursing Practice. In this context, standard number 3 of the said association make the registered nurse responsible for the outcomes of each individual patient. Such a notion elaborates that the care planning of each patient is the sole responsibility of a registered nurse in the nursing care plan and works with her team. The registered nurse chalks out the patient expectations and outcomes. In such circumstances, in a typical healthcare setting, the respective team comprises various members, including other registered nurses, enrolled nurses, and nursing assistants. In this way, the registered nurse has to assume the role of a clinical nurse leader to achieve the results and outcomes for patients. As far as the unit’s administrative management is concerned, the registered nurse may or may not be a part of these specific situations. While at the same time, to achieve and maintain professional standards, it becomes challenging for a clinical nurse leader to work with a deficiency of nurses. This deficiency rises due to significant staff turnover in any healthcare unit. But as a lead nurse, these difficulties must be addressed in the best way.
Multiple Roles of the Nurse Manager during Nursing Shortage Due to Turnover:
During the deficiency of nursing staff, the role of the nurse leader or clinical manager becomes critical. In such situations, patient safety cannot be compromised at any cost. So the leadership slot should overcome the negative impacts in such specific situations. Such practice needs the leadership role of the respective leaders adorned with resourcefulness, decision power, teamwork, and sharpness under the blanket of experience. The leader nurse has to chalk out strategic planning in three dimensions in such situations. First is the prioritized safety of the patient, second is motivating and boosting the morale of the team members, and finally, fulfilling the standards and expectations of the respective organization. However, various nurse leaders may adopt multiple approaches in this aspect. In this context, the authoritarian approach can be adapted to execute all the plans, even by using forceful delegation of powers. But this approach may prove fatal that most nurses may leave the organization at a time of existing deficiency of nurses.
Similarly, another approach may be teamwork, by which the nurse leader consults the team members for their cooperation and assistance. For this approach, the clinical manager should be an expert in the respective field to execute the plans. Meanwhile, the other nurse leaders may adopt the approach to facilitate staffing with a good working environment. In such approaches, the leaders succeed to overcome the deficiency and shortage of nurses in their leading roles. Moreover, they apply the management principles where authority vests with great responsibility in the hour of crisis or challenging situation. The approaches other than authoritative prove fruitful in countering the negative impacts of high nurse turnover.
Adoption of Additional Measures: Rectification of Nurse Turnover Impacts:
Maintaining and ensuring professionalism, standards of practice and especially patient safety are challenging for nurse leaders. But they also have some additional measures that can be helpful in this aspect. The foremost surety is regarding the skill mix in the team, which a nurse leader must keep under strict observation. In this context, the nurse leader or clinical manager must ensure skill mix in all the subunits of the team, even in a shortage of nurses. Such team units may include various registered nurses, enrolled staffing, and nurse assistants. Cheng et al. (2016) quoted that a nurse leader or manager keenly monitors her remaining staffing, especially for signs of burnout. This is because of the fact that burnouts are responsible for high panic and irritability. Other than the emotional and psychological impacts, these burnouts become a source of danger for patients and other team members. More often, in this concern, these burnouts need medication, and the nursing community may commit mistakes. In this way, both the patients and team members may get impacted.
As far as the leadership style to address the issue of nurse turnover is concerned, the transformational leadership style is most appropriate and appealing. Wang et al. (2021) deduced that such a leadership style might lead to motivating the staffing, and team members, providing a facilitated working environment to the nursing members and also helping to understand the ongoing situation. However, it is considered the best available to counter challenging situations. Meanwhile, the transformational leadership style involves multiple features and characteristics, due to which no other style replicates this specific leadership style.
In a nutshell, we can say that almost all healthcare units face the menace of high nursing staff turnover. The standards of healthcare services, quality of services and safety of the patients have got negative impacts due to this challenge. In addition, the remaining staffing has to bear the workload manifold. However, the transformational leadership style can effectively tackle the said menace by managing the crisis circumstances with accelerated devotion and integrity.
Antwi, Y.A. & Bowblis, J.R. (2018). The impact of nurse turnover on quality of care and mortality in nursing homes: Evidence from the great recession. American Journal of Health Economics, 4(2), 131–163. https://doi.org/10.17848/wp15-249
Cheng, C., Bartram, T., Karimi, L., & Leggat, S. (2016). Transformational leadership and social identity as predictors of team climate, perceived quality of care, burnout and turnover intention among nurses. Personnel Review, 45(6), 1200–1216. Doi:10.1108/pr-05-2015-0118
Schmidt, B. J., & McArthur, E. C. (2018, January). Professional nursing values: A concept analysis. In Nursing forum (Vol. 53, No. 1, pp. 69-75).
Wang, H. F., Chen, Y. C., Yang, F. H., & Juan, C. W. (2021). Relationship between transformational leadership and nurses’ job performance: The mediating effect of psychological safety. Social Behavior and Personality: an international journal, 49(5), 1-12.