Effective Approach in Leadership and Management

Nurse Turnover – Effective Approach in Leadership and Management

Grand Canyon University: NRS-451VN

Nurse Turnover – Effective Approach in Leadership and Management

Professional nurses’ roles and duties continue to grow and elaborate with the continual change of the U.S. healthcare system. Many healthcare organizations now have to work hard to retain their nurses and reduce turnover rates as it is costly, disrupts patient care, and has a negative effect on healthcare outcomes. Causes are most often work-related stress, dissatisfaction with their job, and physical and mental exhaustion and burnout and turnover rates are a significant consequence and cost. Leadership and managers carry a strong role in creating an environment, that promotes the health and well-being of their nurses This requires great listening skills, advocacy and staying connected with their nurses’ needs.

Quality of Care and Patient Safety

The current turnover rate of 19.1% for nurses has been published by NSI, with an increase from the 2017 statistic of 16.8%. The review of numerous studies present the high expense of a nurse turnover, with an average of $40K-$60K for a bedside nurse, and the negative effect of the quality of care for patients (NSI Nursing Solutions, Inc., 2019). Among hospital nurses, job dissatisfaction is four times greater than an average U.S. worker. As one out of 5 nurses report, their intend to leave their current job within the next year due to insufficient orientation, scheduling concerns, heavy workloads, and the inability to work at their unit of choice. Issues with management and lack of career progression are listed as other factors considered (Aiken, Clarke, Sloane, Sochalski & Silber, 2002). As increased workload and stress accounts for the rise in burnout and eventually to nurse turnovers, which leads to nursing staff shortage and adversely influences mortality rates, patients’ outcome and satisfaction.

Professional Standards of Practice

Professional standards of practice aim to create a foundation of nurse decision-making processes and to assist in guiding and maintaining a safe and competent nursing practice. Nurses are a critical component of todays’ comprehensive healthcare system, which are impacted by inadequate staffing and turnover rates. This hinders the ability to deliver safe and high-quality patient care, as this is fundamental to attain the goals of patient satisfaction and quality care. Nurses are professionally obligated to report conditions that are unsafe and inappropriate staffing without any retaliation. Regular monitoring should be accounted for factors such as nursing satisfaction, burnout and turnover, retention rate, nursing students and new hires, technology skills, the use of contract or travel agency staff, requirements in competency, as well as staff development to ensure adequate staffing outcome and adjustments (ANA, 2012).

Nursing Manger and Leadership Roles

A critical part of a healthy workplace, is strong relationship between nurses and management. It not only impacts nurses’ intention to keep their current job, it is also a major determinant influencing effective leadership and supportive work environment with job and career (Lee, Chiang, & Kuo, 2018). A healthy work environment allows nurses to provide a high level of standards of care, compassionate patient care, while fulfilling the needed duties. Statistics proof units with an implemented healthy work environment standard, outperform others dramatically due to higher motivation and satisfaction of their nurses. Communication by management and leadership style directly correlates to nurses’ job satisfactions and overall retention (Whitney, 2018). Successful leaders acknowledge quality of work that is done, offer help through stressors, appoint a reward system with positive feedback and employee recognition. A continuous professional growth and development opportunity needs to be ensured, for employees to continue working towards a goal and higher achievements. Nursing management should be able to acknowledge staffing issues, encourage feedback on issues around the workplace, and offer guidance in resolutions. Strong leadership is important and valuable in the current multifaceted and rapid changing health care environment. It introduces the opportunity to lead, challenge, integrate, and implement changes. A genuine leader can touch an employees’ heart, inspire their team members, provide a safe environment, prevent burnout, and decrease the intent to leave. Negative perceptions related to work environment and stressors for nurses should be explored and effective strategies for a positive and safe work environment provide (Lee, Chiang, & Kuo, 2018). The importance of successful leadership is associated with job satisfactions and retention of nurses, as their role is vital in creating teams to improve the system and (Whitney, 2018). Organizations have discovered with lessen overall workload, staff is more relaxed, lesser chances of errors, able to provide safe and quality care to patients. As the focus of leadership and management is at variance, a well-maintained balance of the two is necessary.

Successful Leadership Style

Transformational leadership in relationship to nursing turnover is continuously researched, as studies most often show this as a key factor in minimizing nursing turnover rats and intention to leave (Choi & Lee, 2011). This leadership style can be motivational to satisfy a higher level of need, such as self-esteem and self-actualization. Most often employees that are guided through this leadership style, find the importance and significance in their work done, are of value of morals and ethical principles, contribute to their institution, and voice a higher level of satisfaction with their job. Transformational leadership guides, encourages, and motivates to achieve higher goals with their supported environment and is linked to the nurses well-being and greater commitment to their organization.


Strong leadership allows a positive and supportive work environment, that provides a professional to grow and improve their job satisfaction with consistency, honesty, willingness. The abundance of retention strategies available will be difficult to implement in any work environment, without a strong and influential nursing manager and leader. Institutions and leadership need to successfully recognize unhealthy work environments, address those issues, and provide support, in order to decrease staff turnover due to dissatisfaction, distress, and burnout within the workplace.


Aiken, L. H., Clarke, S. P., Sloane, D. M., Sochalski, J., & Silber, J. H. (2002). Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. Jama288(16), 1987-1993. Retrieved from https://jamanetwork.com/journals/jama/article-abstract/195438

American Nurses Association. Nursing World. Org. (2012). ANA’s Principles of Practice: ANA’s Principles for Nurse Staffing 2nd Edition. Retrieved from https://www.nursingworld.org/~4af4f2/globalassets/docs/ana/ethics/principles-of-nurse–staffing–2nd-edition.pdf

Choi S. L., and Lee Y. T. (2011). Relationship Between Leadership Style, Job Satisfaction and Employees’ Turnover Intention: A Literature Review. Research Journal of Business Management, 5: 91-100. Retrieved from https://scialert.net/fulltextmobile/?doi=rjbm.2011.91.100

Lee, H‐F, Chiang, H‐Y, Kuo, H‐T. (2018). Relationship between authentic leadership and nurses’ intent to leave: The mediating role of work environment and burnout. J Nursing Management. 2019; 27: 52– 65. https://doi.org/10.1111/jonm.12648

NSI Nursing Solutions, Inc. (2019). 2019 National Health Care Retention & RN Staffing Report. Retrieved from http://www.nsinursingsolutions.com/Files/assets/library/retention-institute/2019%20National%20Health%20Care%20Retention%20Report.pdf

Whitney, S. (2018). Nursing Leadership & Management: Leading and Serving. 1st Edition. Theories and Concepts in Leadership and Management. Retrieved from https://lc.gcumedia.com/nrs451vn/nursing-leadership-and-management-leading-and-serving/v1.1/#/chapter/2https://lc.gcumedia.com/nrs451vn/nursing-leadership-and-management-leading-and-serving/v1.1/#/chapter/2