Top Reason for Nurse Turnover: Managers

Understanding nurse turnover is critical for nurse leaders and hospitals, but they don't always have a great grasp of it.

Here's a startling statistic: An estimated 17.3% of newly licensed RNs leave their first nursing job within the first year and 33.5% leave within two years, according to a new study conducted by the RN Work Project and published in the journal Policy, Politics & Nursing Practice.

Moreover, "When we asked new nurses what the primary reason for them leaving was, they consistently said the managers," one of the study authors, Christine Tassone Kovner, PhD, RN Professor, College of Nursing New York University and Faculty, New York University Langone Medical Center, said via email.

Clearly, understanding nurse turnover is critical for nurse leaders. It can negatively affect everything operational performance, to patient outcomes, to a hospital's bottom line; the latter to the tune of up to $6.4 million per year for a large acute care hospital, research says.

Yet hospitals don't always have a great grasp of nurse turnover.

"There is a lack of consistency in definitions of nurse turnover. These inconsistencies result in various turnover rates," Kovner said. "In addition, turnover rates vary depending on the method used to get data, response rates to surveys, and the geographical area included."

Kovner says she and the other study authors believe that their newly published turnover rates for new nurses are the most reliable and valid rates currently in the literature. I asked Kovner via email to run down some of the most important results of the study for nurse leaders.

HLM: Why are new nurses leaving?

Christine Tassone Kovner: There are several groups of turnover determinants. They include other job opportunities, the work environment, characteristics of the individual (e.g. their partner has taken a job in a distant city and the nurses decide to move with their partners), and broad concepts such as satisfaction and organizational commitment.

HLM: When they don't leave their jobs, why do they stay?

CTK: We know less about why they stay. One reason may be embeddedness—they have a lot invested in the people with whom they work and they like the geographical location of their jobs (e.g. in a rural area there may be only one hospital and the nurse can work there or travel 40 miles to a hospital in another town). 

HLM: What's are the most important and/or surprising of the study findings?

CTK: We were surprised that so many rates in the literature do not carefully define the definition, methods, and response rates. We were surprised how often rates from a few hospitals in a relatively small geographic are used to discuss turnover rates of nurses in all settings as well as measures of nurses leaving the profession.

Nurses change jobs, but few new nurses leave nursing. Turnover is not inherently bad. It is usually best if poor performers leave the organization.

HLM: What are the "good" versus "bad" kinds of turnover?

CTK: Good turnover occurs when someone is fired. Thus, if the unit manager cares enough to want the nurse gone one can suppose that is good turnover. Another example is someone who has bad work habits (comes in late, calls in sick), but not bad enough to fire. If that person leaves, that is probably good turnover.

Bad turnover is when a wonderful nurse who exemplifies all the characteristics that managers want in a nurse leaves. The manager didn't want that person to leave. 

HLM: What are the most important take-aways from the study for nurse leaders?

CTK: Before you start quoting turnover rates from other places to your board and/or CEO be sure that the group of nurses and organizations are comparable to your organization. Look at the response rate. I would not have a lot a confidence in findings when the response rate is below 30%. Some of my colleagues might say when it is below 50%. 

HLM: How can nurse leaders improve turnover among new nurses?

CTK: Nurse leaders should look at the work environments in their organizations and find out from nurses in their organizations what the nurses find satisfying and what they don't like.

It is important to get to the nurse before he or she makes the decision to leave. When we asked new nurses what the primary reason for them leaving was, they consistently said the managers.

Nurse[s] who are good or even great clinicians are not necessarily good managers. Nurses need to know what management research findings are and then use the research. There is a reason why so many CEOs have management education, often at the master's level. People can learn to be managers at universities.