High turnover of nurses compromises patient care and adds to the cost of healthcare. To determine why nurses changed positions or left a midwestern health system, the authors surveyed registered nurses who voluntarily terminated or changed their employment status to as-needed (PRN) within a 9-month period. They discuss the most frequent reasons given for these changes and suggest solutions for retention.

Study purpose was to describe facial fracture frequency, demography, injury characteristics, and diagnostic modalities at a Midwestern level I trauma center. A retrospective review was conducted on a Midwestern trauma center registry for years 2008 and 2009. Patient and injury data were collected along with diagnostic modality for facial fracture patients. Comparative statistics were conducted on the basis of the number of facial fractures, route of admission, presence of traumatic brain injury, and gender. There were 154 patients diagnosed with 443 facial fractures, representing 5% of the trauma population. Median patient age was 45 years. Median number of fractures was 2. Fractures were frequently present in orbit (32%), malar bone and maxilla (26%), and the nasal bones (19%). Motor vehicle crash was the most common mechanism (47%). Most fractures were diagnosed with maxillofacial computed tomography (78%). Males had an odds ratio of 2.5 (95% confidence interval, 1.15-5.43) for multiple facial fractures and composed 67% of the sample. Traumatic brain injury was diagnosed in 71% of patients. This study of a medium-sized city and its surrounding rural areas revealed differences from studies in large urban centers. Differences included lower gender ratio, older average age, and mechanism of injury. While urban trauma centers report assault as a leading cause of facial fracture, this study noted higher frequencies of motor vehicle crash and falls and fewer assaults.