Noneconomic and economic impacts of nurse turnover in hospitals: A systematic review

Abstract

Aim To examine and synthesize the noneconomic and economic impacts of nurse turnover in acute hospitals. Background Nurse turnover occurs when nurses leave their jobs or the profession and is a major concern for the healthcare industry. Many studies have investigated the determinants of nurse turnover. Methods The Preferred Reporting Items for Systematic Reviews and Meta‐Analyses checklist was utilized in the current review. Article search was conducted in June 2021. Research articles published since January 2000 were included. Eight databases (e.g., CINAHL, PubMed, PsycINFO, and Web of Science) were used. The following eligibility criteria were applied for inclusion: Articles that (1) were nonexperimental quantitative studies, (2) examined the impact of actual nurse turnover in acute hospitals, (3) were a peer‐reviewed original research article, and (4) were written in English or Korean. Results Among 9,041 searched articles, 16 were included in the review. Seven studies investigated the association of nurse turnover with processes and outcomes (workgroup processes, nurse staffing, nurse outcomes, and patient outcomes), and partially supported the negative impact of turnover. Nine studies found that nurse turnover is very costly. Conclusion Most studies investigated the turnover cost, which is costly. The negative noneconomic impact of nurse turnover was partially supported. Implications for nursing practice and nursing policy To prevent the adverse noneconomic and economic impacts of nurse turnover and retain nurses, healthcare organizations, nurse managers, and hospital staff nurses need to develop and implement prevention strategies and policies to address nurse turnover. Efforts to address nurse turnover can increase hospital competency to improve the quality of nursing care services and patient safety.

A Conceptual Model of Nurses’ Turnover Intention

“…The economic impact of nurses leaving the healthcare system cannot be fully represented due to a lack of consistent definitions and measurements. However, it is estimated that the cost is four to five times higher as productivity decreases with new hires [44]. When employees leave their jobs, valuable financial and social capital is lost, affecting the morale of other employees and the reputation of the organisation, as well affecting teamwork and work processes [1].…”

The nursing profession circa 2030

“…Most nurses reported difficulty sleeping, overeating, difficulty in relationships, and increased suicidal ideation over two surveys completed within 6 months in 2021 and 2022 9. Decades ago, it was believed that Florence Nightingale engaged in self-imposed seclusion to protest and to protect herself from a “less than nurturing society” while managing moral injury from treating soldiers 10. The compounding of traumatic events, the whiplash of stressors from COVID-19 infection and hospitalization surges, and abuse over a protracted and lengthy crisis has undoubtedly led to maladaptation for nurses, particularly those in the US 11.…”

“…9 Decades ago, it was believed that Florence Nightingale engaged in self-imposed seclusion to protest and to protect herself from a "less than nurturing society" while managing moral injury from treating soldiers. 10 The compounding of traumatic events, the whiplash of stressors from COVID-19 infection and hospitalization surges, and abuse over a protracted and lengthy crisis has undoubtedly led to maladaptation for nurses, particularly those in the US. 11 Maladaptation is also due to the lack of a systemic and sustained approach to address nurses' mental health along with organizations' inabilities to address the main evil root cause of nurses' feeling burned out-the lack of staffing.…”

Retention of ethnic minority staff is critical to resolving the NHS workforce crisis

“…Staff gaps lead to poorer patient outcomes, and replacing doctors and nurses with other clinical staff may affect patient satisfaction 34. High turnover is also costly 5…”