The Impact of High Turnover on Nurse Managers

By Rose O. Sherman, EdD, RN, NEA-BC, FAAN

For years, leaders have been told that nurses don’t leave their organizations but rather the leaders they work for. Today, that adage is not true in many settings. Nurses leave leaders for many reasons, including:

• Higher Pay
• Childcare Challenges
• A Desire to Travel
• The Inability of the Leader to Provide the Schedule the Nurse Wants
• A Belief that the Grass May be Greener in another Organization
• A Desire to Leave the Acute Care Environment

A nurse manager shared the following story that many leaders can relate to today.

I was entirely caught off guard. Just the week before, I spoke with this nurse about her career plans, and she said she was pleased with our team. A week later, she brought in her resignation. She begins the conversation by saying – I love working for you, but I have a much better offer and want to pursue this opportunity. There was no talking her out of it. She has been with us just a year. I liked this young nurse a lot and even thought about her as a future leader in our organization. After she left, I felt myself feeling depressed and defeated. She assured me I could have done anything differently, but I still felt guilty. Every time this happens – I lose a little bit of my soul. 

Recently, I participated in an AONL subgroup that looked at the impact of high turnover on nurse managers. We held three focus groups during the summer, with 87 nurse managers participating in the research. Most were leaders with three or more years of experience. Our criteria were that they were leaders of units with an overall yearly turnover rate exceeding 22% (the 2022 national average). We asked the leaders the following questions:

1. What factors are contributing to high turnover in your specialty area?
2. How has high turnover impacted the quality/safety of care your team can deliver (or not)?
3. What aspects of patient care are most missed?
4. How has high staff turnover impacted your role and practice as a manager?
5. How has high turnover impacted your leadership style?
6. What changes have you made to respond to the high turnover in your unit?
7. What leadership competencies/skills are necessary when managers face high turnover?

The results of our work were published this week in an  AONL Nurse Managers In High Turnover Areas. We learned some interesting things from these managers. As a group, they had a large span of control, with 25% supervising over 100 staff members. Many cited factors in their organizations that were outside their control contributed to staff turnover, such as shortened onboarding, an inexperienced candidate pool, a very competitive local job market, and changing patient demographics with higher acuity and less civility in the environment.

Leading teams with high turnover impacted nurse leaders’ well-being and leadership style. Many felt a loss of joy in their roles. They were not the leaders they wanted to be because of the high demands on their time. Despite everything, they remained committed, and few indicated an intent to leave the role. Our team observed that the leaders in these focus groups seemed to gain energy and support from their peers in feeling like they were not alone.

As we end 2023 and begin a new year, let us not forget our frontline leaders. In many ways, they are unsung heroes and warriors in our turbulent healthcare environment. They deserve our gratitude and thanks as they are the shock absorbers for staff emotions and the sounding boards for patient/family frustration in navigating the complexities of healthcare.

© emergingrnleader.com 2023

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