The Cost of Nurse Leader Turnover - Emerging Nurse Leader

By Rose O. Sherman, EdD, RN, FAAN

I was recently talking with an international nurse leader who told me about the high rate of what he described as “leadership churn” in his country’s national health system. He feels that based on his recent research, it is coming at a significant cost relative to the work environment, nurse perceptions of leadership support and care outcomes. We often talk about the challenges of staff turnover and the impact on units and departments. Rarely do we discuss the impact of a high rate of leadership turnover and the failure to do smooth leadership transitions. In my own work, I am concerned about this because I am beginning to see (and hear from other leaders) a trend among our younger nurse leaders to leave positions within a the first one to two years of accepting the role. This is sometimes related to dissatisfaction with the role but often it is to further advance their careers. While this trend is not all bad, it can create a level of instability that diminishes staff confidence in their leadership, impacts patient outcomes and ultimately increases staff turnover.

Surprisingly, we know very little about nurse leader turnover below the level of the Chief Nursing Officer where it has been studied. Turnover at this level is often not voluntary and directly related to working relationships with the CEO. Jones, Havens & Thompson conducted research in 2009 that indicated that while almost 75% of nurses saw their CNOs as a critical voice for staff and patients, the majority did not see a change in quality of care, patient efficiency or staff satisfaction. No similar research has been conducted at the unit level of management. Yet, we do know from evidence-based work that the most important predictor of staff satisfaction is the relationship with one’s manager. Without continued nurturing of this relationship, it has been found that staff:

Become disengaged on the job
Often don’t do their best work
Don’t grow in their positions
Describe their units as having unhealthy work environments
Don’t provide the highest level of customer service
Leave when they have better opportunities

We also know that the recruitment costs to fill a leadership vacancy can often be very high. In my research with Perioperative Nurse leaders which is being published this month in Nursing Economics, I learned that the total cost of replacement for a perioperative director can run $132,000 to $228,000 or more if the process takes longer. At this time, there is much discussion about the need for good succession planning. This is critical to our future but we must also focus our efforts on retaining nurse leaders in these roles for a reasonable period of time once they are selected. Leadership is a journey. There are few leaders who do not express that they seriously considered leaving their role in their first or second year on the job. Instead when they stay, they often find that they grow into the role and it becomes deeply satisfying. This is a message that we need to convey. There is an undeniable cost to nurse leader turnover —some of which is known but much of which we have not studied.

Read to Lead

Jones, C.B. Havens, D.S. & Thompson, P.A. (2009). Chief nursing officer turnover and the crisis brewing: Views from the front line. Journal of Nursing Administration 39(6), 285-291.

Sherman, R.O., Patterson, P., Schmidt, T. & Dahl, J. (in press). Perioperative nurse leader perspectives on succession planning. Nursing Economics.

Evidence-Based Effective Nursing Leadership. Nursing Spectrum CE Program. (2012). Available at http://ce.nurse.com/ce620/evidence-based-effective nursing-leadership/