RUNNING HEAD: Nurse Retention and Shortages

Nurse Retention and Shortages

The Costs and Impact on Patient Care

Ruby Sabina

Frostburg University

Spring 2017
Nurse Retention and Shortages 2

Abstract

Nursing shortages and lack of nurse retention is a huge problem in acute care facilities all

over the World. Whether or not these problems are causing financial issues and poor

patient care is an important question. Performing a qualitative analysis of literature will

help to further understand the effect these shortages and retention are having in these

facilities. All of the research studied show that lack of staffing with more experienced

nurses is having a bad effect of patient outcomes. Studies also showed that higher nurse

to patient ratios have worse outcomes for patients as well.

Keywords: nursing, retention, patient, outcomes

Nurse Retention and Shortages 3

Nurse retention is a real problem throughout the World. One survey found that

the national average turnover rate was estimated to be approximately 14% for bedside

registered nurses, and almost 28% for registered nurses (RNs) in their first year of

employment nurse turnover rates have been re-ported as approximately 10% in England,

ranging between 12 and 21% across 10 European countries and approximately 20% in

Canada (Jones, 405). Although it may seem unimportant at first glance, recent studies

suggest the cost is roughly $22,000 to over $64,000 per nurse turnover for acute care

facilities. This doesnt even begin to quantify the benefits to patient care when nurses are

available on hospital floors that have previous experience. This problem is not only one

that incurs large financial deficits; it is also one that results in patient death and decreased

positive outcomes. It is believed that having RNs on staff with more experience and

increasing nurse retention can create better outcomes for patients. This can be achieved at

a lower overall cost of care in acute care settings than the current model, which involves

high nurse turnover and frequent staffing of new graduate registered nurses.

In order to research this problem several databases were used. These include

EBSCO, Catalog USMAI, Healthsource: Nursing, MEDLINE, and Nursing and Allied

Health Source. These databases were found using the Frostburg Library system.

Originally these were accessed on March 18, 2017. They were accessed several times

from March 18, 2017-March 28, 2017. When performing this research several search

terms were used such as nursing, retention, patient, and outcomes.

One study conducted in Pennsylvania in several hospitals found very explicit

results that coincided with the hypothesis. This was done in 210 adult hospitals
Nurse Retention and Shortages 4

throughout the state. They used surveys, discharge data, chart reviews, and patient

outcomes data from these hospitals. The results of this study found that each additional

patient per nurse was associated with a 7% increase in the likelihood of dying within 30

days of admission and a 7% increase in the odds of failure-to-rescueeach additional

patient per nurse was associated with a 23% increase in the odds of burnout and a 15%

increase in the odds of job satisfaction (Aiken, 1987). Another study reviewed was

performed in New Zealand in 2012. This study found that the cost of this turnover

represents half an average salary. The highest costs were related to temporary cover,

followed by productivity loss (North, 419). This is not a small cost to any degree. This

means that for most facilities the cost of two nurses leaving could be the equivalent of

one extra nurse on staff, decreasing nurse to patient ratios. Another study done in Hawaii

initiated a training program funded by the US Health Resources and Services

Administration. This study initiated support for new nurses, giving them additional

training and clinical coaches beyond simple nursing orientation. They also tried to instill

further leadership skills into management that aided in retention. At the end of this study,

nurse vacancy rates decreased from 11.26% to 2.19%. Patient satisfaction increased from

84.6% to 87.8%. Nursing satisfaction went from 41.13% to 47.97%.

One recommendation that is very important to the nursing profession is

addressing nurse retention rates and not solely nursing shortages. This is pivotal to

providing excellent, patient centered care. Many studies have shown that high nurse

retention and staffing improves patient outcomes. In an age where reimbursement is

measured in patient satisfaction and numbers of sentinel events, these are statistics every

organization must focus on. Although addressing the nursing shortage will aide in
Nurse Retention and Shortages 5

improving many of these statistics, finding ways to keep nurses at the bedside and not

burnt out is key to ensuring good patient care.

One study reported, Nurses nationwide consistently report that hospital nurse

staffing levels are inadequate to provide safe and effective care. Physicians agree, citing

inadequate nurse staffing as a major impediment to the provision of high-quality hospital

care. (Aiken, 1987) This is an issue that is agreed upon by all providers caring for

patients on a daily basis.

Second, the way in which acute care providers address nurse retention will prove

to be very important. Increased wages is a quick solution, but it is not the sole source of

employee happiness (Heinz, 49). If hospitals and acute care centers rely solely on small

hourly wage increases to keep nurses when they have already found new employment,

they will continuously find themselves short-staffed. One way to address retention is to

ensure that your hospital is instilling a sense of empowerment amongst all nurses on the

floor. Interdisciplinary care involves all staff, but especially nurses. Studies have shown

that retention is higher when nurses are afforded the opportunity for decision making,

participation, and input into the work (Heinz, 49). According to one article, another

innovative way to increase nurse satisfaction and retention is to allow self-scheduling.

This allows nurses control over their shifts and may result in greater positive outlooks

for balancing work, family, and social demands (Heinz, 50).

Finally, in order to ensure all acute care providers understand the importance of

nurse retention and satisfaction, it will be important to continue to quantify the effects

nursing turnover has on patient care and satisfaction. This involves finding out more

specific and detailed information about the real time costs involved with current
Nurse Retention and Shortages 6

practices. One study found that the cost per registered nurse turnover represents half an

average salary(and is) associated with adverse patient events (North, 1). But the

reality is that facilities need more studies and specifics. Each acute care unit should be

encouraged to find out the effects the lack of retention has on their patient care. Until we

devote more time to finding out the exact costs we incur every day, establishments may

not truly know the effects this has on patient care. These costs do not just equate to

dollars, they equate to lives. Until this is understood, real solutions will not be put into

place.

Nursing may be the oldest known profession, as some nurses were paid for their

services from the beginning (Weatherford, 2010). Yet still, nurses constantly feel the

need to fight for their worth and their rights as caregivers. Until more studies are done to

show medical facilities the worth of nurses in dollar amounts, nothing will be done to

address these shortages. It is also incredibly important that we quantify the effects

nursing shortages and retention are having on reimbursement and patient care in the

changing landscape of healthcare.

Nurse Retention and Shortages 7

Appendix

Individual Evidence Summary

Databases Used: Search Terms Used: nursing and retention Filters Used:
EBSCO, Catalog and patient and outcomes None
USMAI,
HealthSource:
Nursing,
MEDLINE,
Nursing and Allied
Health Source
# Author Yea Evidence Sample Size Results Limitatio Strengt
r Type Recommendat ns h/
ion Quality
1 Aiken, 200 Statistical, 10,184 staff Each Limited Level
Clarke, 2 Nurse nurses additional to III/ A,
Sloane surveys, 232,342 patient general High
data patients increases and
measureme likelihood of orthopedi
nt death by 7%. c surgery
Each patients
additional
patient adds a
23% increase
in risk of
burnout.
2 North, 201 New 12 months of Temporary Limited Level
Leung, 3 quantitative data from 22 cover and new to New I/ A,
Ashton, study and nursing units employee Zealand High
Rasmusse reexaminati losses are Hospitals
n, on of old associated
Finlayson studies with adverse
patient events
3 Kooker, 201 Data 1 hospital Improving Only one Level
Kamikaw 1 measureme from years nurse retention hospital III/ B,
a nt and 2005-2009 while Good
analysis improving
outcomes had
significant
financial
benefit
4 Jones, 200 Data Multiple We need to Only Level
Gates 7 measureme Articles/Sour make more used IV/ B,
nt, survey, ces effort to articles, Good
analysis quantify the no
Nurse Retention and Shortages 8

cost of nurse separate

turnover and research
quantifying conducte
the cost and d
benefits of
retention
5 Heinz 200 Review of Review The bottom Only Level
4 literature current line is that based on IV/B,
literature and staffing makes critical Good
research better patient care
studies outcomes nurses
6 MacDavit 200 Secondary 705 surveys High levels of Not first Level
t 8 analysis of from 78 units dissatisfaction hand III/ A,
data and burnout data, High
related to poor previous
long term study
quality of looked at
care, not just again
the last shift
completed

Overall Evidence Summation

Level of Number of Summary of Findings Overall

Evidence Studies Quality
I- JAMA: 3 In hospitals that have higher nursing ratios, High
Hospital patients experienced high mortality rates and Quality- A
Nurse nurses reported more dissatisfaction in their
Staffing and workplace.
Patient
Burnout
II- Nurse 1- There is a very high cost associated with nurse High
turnover in qualitative turnover. About half a years salary for each Quality- A
New and nurse turnover that occurs. There is actually a
Zealand: quantitative culture surrounding nurse turnover that is
costs and embedded in the system.
relationships
with staffing
practises
and patient
outcomes
III- 1- By implementing a state funded nurse High- A
Successful qualitative retention program for four years nurse
Nurse Retention and Shortages 9

strategies to retention declined, vacancies decreased,

improve RN patient satisfaction increased, and decubitus
retention ulcer rates dropped.
IV- The Review of We need even more efforts to quantify how Good- B
Costs and 9 studies much nurse turnover costs businesses. At the
Benefits of same time, we need to quantify the savings in
Nurse nurse retention.
Turnover: A
Business
Case for
Nurse
Retention
V- Hospital Review of Increase nurse retention and nurse recruitment Good- B
nurse 8 studies in order to decrease nursing shortage. Allow
staffing and nurses to find empowerment in the workplace
patient using things like self scheduling and tuition
outcomes: reimbursement.
Heinz
Nurse Retention and Shortages 10

References

Aiken, L. H., Clarke, S. P., & Sloane, D. M. (2002). Hospital Nurse Staffing and Patient
Mortality, Nurse Burnout, and Job Dissatisfaction. Jama,288(16), 1987.
doi:10.1001/jama.288.16.1987

Heinz, D. (2004). Hospital nurse staffing and patient outcomes. Dimensions of Critical
Care Nursing,23(1), 44-50.

Jones, C., Gates, M., (September 30, 2007) "The Costs and Benefits of Nurse Turnover:
A Business Case for Nurse Retention" OJIN: The Online Journal of Issues in
Nursing. Vol. 12 No. 3, Manuscript 4.

Kooker, B. M., & Kamikawa, C. (2010). Successful strategies to improve RN retention

and patient outcomes in a large medical centre in Hawaii. Journal of Clinical
Nursing,20(1-2), 34-39. doi:10.1111/j.1365-2702.2010.03476.x

MacDavitt, K. C. (2008). An examination of the relationships between nurse outcomes

and patient outcomes (Doctoral dissertation, Columbia University) [Abstract].

North, N., Leung, W., Ashton, T., Rasmussen, E., Hughes, F., & Finlayson, M. (2012).
Nurse turnover in New Zealand: costs and relationships with staffing practises
and patient outcomes. Journal of Nursing Management,21(3), 419-428.
doi:10.1111/j.1365-2834.2012.01371.x

Weatherford, D. (2010, February 05). National Women's History Museum. Retrieved

May 05, 2017, from https://www.nwhm.org/blog/the-evolution-of-nursing/.