Effective Approaches in Leadership and Management Turnovers
Nurse Turnover and Its Impacts on Quality of Care and Patient Safety
The healthcare job market has experienced a demand for healthcare professionals, especially in the nursing field. However, despite growing demand, the nursing field is faced with the challenge of increasing nurse turnover. According to Karlsson et al. (2019), the current healthcare problem of nurse turnover is predicted by factors present in the nursing work environment. Workplace challenges that lead to job dissatisfaction and burnout, such as insufficient staffing levels, technologies, leadership, and work-life balance, among others, are the leading causes of increased nurse turnover (Putra et al., 2020).
Increasing nurse turnover rates have an impact on the quality of care and patient safety. Nurse turnovers are associated with short staffing, longer work shifts, and more work for the available nurses, which leads to work burnout and fatigue (Wei et al., 2018). Work burnout and fatigue increase the risk of nurses committing medical errors that compromise patient safety. The lack of enough staffing also leads to a high patient-to-nurse ratio. This reduces the attention a single patient gets and the quality of care delivered.
Professional Standards of Practice in Solving Nurse Turnovers
Nurses in all care settings dedicate their careers and lives to caring for the sick and suffering. The demands of the current health care need have pushed nurses to pay less attention to themselves professionally in their private lives and needs. The mounting career pressure has resulted in high turnover rates, increased workloads for the remaining nurses, and a reduced supply of new nurses to the healthcare market. The focus today is to employ professional standards of practice that help retain the currently experienced nurses and attract others to join the nursing profession. As concluded by Putra et al. (2020), the level of job satisfaction and organizational commitment have an influence on the intentions of nurses to leave or remain in their current work. It is important for nurse leaders and healthcare managers to adopt strategies that effectively improve nurses’ job satisfaction in order to achieve commitment to healthcare organizations and retain the experienced nursing workforce.
Incentives for nurses have been identified as one of the most effective strategies to reduce nurse turnover rates and turnover intentions and retain nurses, especially for early-career nurses with higher expectations in the nursing field (Brook et al., 2019). Incentives also make the nursing profession an attractive field in the job markets, leading to a sufficient supply of new nursing professionals. Incentives to retain and attract nurses may include competitive salaries, rewards and bonuses for performance, career benefits, good over-time compensation, and good payments for time off work. Incentives can motivate and improve the nurses’ morale to provide quality care services and forego their intentions to leave. Professionalism in healthcare settings facilitates interdisciplinary teamwork and a conducive work environment that meets the needs of nurses. Such a collaborative work environment determines the ability of nurses to provide quality care, assure patient safety, and their intention to stay (Karlsson et al., 2019). Therefore, improving the workplace conditions for nurses in terms of wages, work benefits, and other bonuses promotes their intentions to stay and improves the quality of care for patients.
Differing Roles of Nursing Leaders and Nursing Managers in Solving Nursing Turnovers
Nursing leaders and nursing managers play different roles within healthcare settings and, therefore, apply different approaches when solving the challenge of nurse turnovers. Nursing leaders provide leadership within the healthcare organization. They provide guidance, support, and motivation to nurses to ensure that quality care is provided and that nurses understand their accountability for the patient’s health and safety. Nurse Managers are tasked with ensuring that nurses in practice adhere to the required standards of care, laws, and nursing regulations. They, therefore, tend to be authoritative in carrying out their managerial roles.
Nursing managers apply evidence-based practices such as financial compensations, allowing nurse autonomy, developing recognition and rewards systems, use of communication to retain specialized nurses and reduce turnover and turnover intentions (Brook et al., 2019). On the other hand, nurse leaders solve nursing turnover issues by applying leadership styles and skills that create a work environment that enables inter-professional collaborations, motivation, and job satisfaction. Nursing leaders tend to be more successful in retaining nurses than nursing managers. This difference can be explained by applying the Transformational Leadership Theory in relating leadership to positive employee and work outcomes.
Transformational Leadership Theory holds the view that leaders should be at the forefront of promoting individual improvement and achievement (Hansbrough & Schyns, 2018). While managers assume a position of authority, transformational leaders connect with their subjects at a personal level to promote work motivation and morale. Through transformational leadership, nurses are able to enhance nursing citizenship behaviors, create a collective identity among diverse healthcare professional teams, and gain more ownership of the responsibilities of the nurses’ care settings. The results achieved through a transformational leadership style are much better in reducing nurse turnover rates than assuming a managerial position of authority.
Other Initiatives to Ensure Professionalism and Reduce Nurse Turnover
Both nurse leaders and managers have a role in ensuring professionalism and reducing nurse turnover across the healthcare systems. The roles of nursing leaders and nursing managers can be interlinked to create a work environment that helps meet the needs of the nurses. Other initiatives that nursing managers and leaders can employ to reduce nurse turnovers and professionalism in nursing practice can include the provision of coaching services to improve the skills of nurses to provide quality and safer care services. Other approaches that can improve nurse job satisfaction levels and reduce turnover rates and intentions in the nursing field include the elimination of mandatory working overtime, improvement in the safety of the workplace, development of platforms for shared governance, and programs that improve the transition of nurses from class to practice. Nurse leaders and managers also need to promote respectful collaboration and reduce cases of bullying in the workplace.
Participative Style of Leadership in Solving Nursing Turnover
The participative leadership style is the most suitable approach that nurse leaders and managers can adopt to reduce and solve the challenge of nurse turnover. The Participative leadership style promotes inclusiveness and ensures that all members of a team or an organization work in unison and all member inputs are considered during decision-making (Busse & Regenberg, 2019). The participative style of leadership creates an environment suitable for shared governance. When applied in nursing, the participative style of leadership can help identify and recognize the needs of the nurses and develop a satisfying work-life balance. The shared governance created by participative leadership gives nurses a platform to share their ideas on work plans and other roles and responsibilities within the care settings. It also redefines collaborations within the workplace and recognition of the nurses’ input during such collaborations. Therefore, the participative leadership style is ideal for creating a work environment that promotes job satisfaction and work commitments and reduces turnovers and turnover intentions.
Brook, J., Aitken, L., Webb, R., MacLaren, J., & Salmon, D. (2019). Characteristics of successful interventions to reduce turnover and increase retention of early career nurses: A systematic review. International journal of nursing studies, 91, 47-59.
Busse, R., & Regenberg, S. (2019). Revisiting the “authoritarian versus participative” leadership style legacy: A new model of the impact of leadership inclusiveness on employee engagement. Journal of Leadership & Organizational Studies, 26(4), 510-525.
Hansbrough, T. K., & Schyns, B. (2018). The appeal of transformational leadership. Journal of Leadership Studies, 12(3), 19-32.
Karlsson, A. C., Gunningberg, L., Bäckström, J., & Pöder, U. (2019). Registered nurses’ perspectives of work satisfaction, patient safety and intention to stay–A double‐edged sword. Journal of Nursing Management, 27(7), 1359-1365.
Putra, A. P., Kusnanto, K., & Yuwono, S. R. (2020). Effects of job satisfaction and organizational commitment on nurse retention: A systematic review. Indonesian Nursing Journal of Education and Clinic (INJEC), 5(2), 197-205.
Tang, J. H., & Hudson, P. (2019). Evidence-based practice guideline: Nurse retention for nurse managers. Journal of Gerontological Nursing, 45(11), 11-19.
Wei, H., Sewell, K. A., Woody, G., & Rose, M. A. (2018). The state of the science of nurse work environments in the United States: A systematic review. International Journal of Nursing Sciences, 5(3), 287-300.
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