Nurse turnover rates affect patient safety.
(Compensation and benefits)
Nursing care (Economic aspects)
Patients (Care and treatment)
Patients (Safety and security measures)
|Publication:||Name: Kai Tiaki: Nursing New Zealand Publisher: New Zealand Nurses' Organisation Audience: Trade Format: Magazine/Journal Subject: Health; Health care industry Copyright: COPYRIGHT 2012 New Zealand Nurses' Organisation ISSN: 1173-2032|
|Issue:||Date: July, 2012 Source Volume: 18 Source Issue: 6|
|Topic:||Event Code: 280 Personnel administration; 260 General services; 200 Management dynamics|
|Product:||Product Code: 8043100 Nurses NAICS Code: 621399 Offices of All Other Miscellaneous Health Practitioners|
|Geographic:||Geographic Scope: New Zealand Geographic Code: 8NEWZ New Zealand|
Evidence of a "culture of turnover" in New Zealand, more
commonly associated with industries staffed by low-skilled workers, is
the unsettling conclusion of a study into nurse turnover rates,
published in the Journal of Nursing Management this year. (1)
Led by five Auckland researchers, the study re-examines a national study into costs of nurse turnover in New Zealand conducted in 20042006. The aim was to determine the impact of turnover costs on outcomes for nurses and patients. Registered nurses (RNs) in 22 genera[ medical and surgical units in 11 public hospitals were included in the study. The researchers concluded a culture of turnover was inconsistent with nursing as a "knowledge workforce"
Nurse turnover rates of 44.3 per cent were more than double that of Canada and the United States, the study found. (1) Nurse managers displayed an indifference to turnover, conveying an acceptance and tolerance of high turnover rates.
The cost per RN turnover represented half an average salary, with the highest costs related to temporary cover, followed by productivity loss. Both are associated with adverse patient events. Flexible management of nursing resources, and a reliance on new graduates and international recruitment to replace nurses who left, contributed to turnover and costs. Flexible staffing was used strategically by organisations to manage nurse shortages and to reduce fixed labour costs, the study found.
The highest cost, $4804, was for taking on a new graduate, with overseas-trained nurses nearly as expensive at $4467. New Zealand-trained nurses (recruited by the hospital from elsewhere) were next at $3019. The least expensive options were a nurse returning to a unit, at $941, and internal transfer, at $1711.
Costs of temporary cover
The main contributor to turnover costs was temporary cover, incorporating costs of temporary staff, overtime, clerical time and time of experienced staff to arrange cover, and productivity loss related to permanent staff assisting temporary staff. Nurse managers did not challenge flexible staffing practices and high turnover rates, the study said. It appeared they lacked information on turnover rates and costs, and so did not challenge the position of trying to deliver patient care safely by covering vacancies, shortages and sick leave with temporary cover, and continually recruiting new staff.
Of particular concern was that experienced nurses who left the participating units were being replaced largely by nurses with least experience in nursing (new graduates) or who were unfamiliar with the New Zealand nursing context (overseas-trained nurses). Combined, these two categories made up nearly two-thirds of all new employees. In addition, these two categories cost organisations the most in lost productivity. Costs of productivity loss were significantly associated with adverse patient events, an added cost to hospitals.
"A culture of turnover, and staffing less than budgeted levels, reflects an accepted view of a nurse as a replaceable unit of labour," the researchers said. The results challenge nurse managers' beliefs that efficient budget management involves intentional understaffing to reduce fixed costs, and using temporary cover to increase flexibility. "Moreover, while filling vacancies with lower-salaried new graduates may be cheaper, we have shown that the practise actually costs more ... Leadership is needed to refocus strategies from cost savings to investing in staff, and to nurture cultures and working environments that retain nurses, as workers whose knowledge is an asset to the organisation."
The study is part of an international project examining costs of nursing turnover and its impact on patient safety and nurse health.
(1) North, N., Leung, W., Ashton, T. et al. (2012) Nurse turnover in New Zealand: costs and relationships with staffing practises and patient outcomes. Journal of Nursing Management. DOI: 10.1111/j.1365-2834.2012.01371.x.
|Gale Copyright:||Copyright 2012 Gale, Cengage Learning. All rights reserved.|