7 Ways How High Nurse Turnover Impacts Patient Care
Written By:
Darby Faubion
Darby Faubion RN, BSN, MBA
Darby Faubion is a nurse and allied health instructor with over 20 years of clinical experience. Darby lives in Louisiana and loves exploring the state’s rich culture and history. Darby has a passion for caring for veterans and a special interest in those affected by post-traumatic stress disorder. In her quest to make a difference for veterans, she founded a non-profit called “Operation Battle Buddy.” Read Full Bio »» RN, BSN, MBA
If you have been a nurse for any time, you know that, although it is a very rewarding job, nursing can also be quite stressful. Because of the stress that comes with the job, many hospitals and other healthcare organizations experience high rates of nurse turnover.
Having been a nurse and worked in leadership for many years, I have seen firsthand the effects of high nurse turnover on patient care. To be proactive in our jobs as clinical nurses, leaders, or administrators, we must ask, “How does nurse turnover impact patient care?” Then, we must find ways to help combat the problem. In this article, I am going to share 7 ways how high nurse turnover impacts patient care that I have experienced in my nursing career.
How Does High Nurse Turnover Impact Patient Care?
(The following are the 7 ways how high nurse turnover impacts patient care.)
WAY #1: Nurse Become Fatigued, Which Leads to Increased Safety Risks
When there is a high nurse turnover, the nurses who remain are often
overworked and fatigued. As a result, the risk of safety incidents occurring becomes higher. Nurses may overlook an order, administer the wrong medication, or fail to document the care they provide. In either of these cases, it could lead to patient injury, which is a serious issue.
Several years ago, I worked for a corporation that owned several nursing homes, assisted living facilities, and hospice agencies. After reviewing safety and incident reports, I was asked to visit one of the facilities to determine why there was an increase in safety incidents so we could determine a course of action to improve the situation. My in-person review of charts and incident reports and interviews with administration and staff revealed that there had been an increase in the number of nursing staff who had left the facility, leading to other nurses working overtime to cover shifts. Many nurses expressed frustration and stated they felt overwhelmed and often exhausted by the long hours they worked. When I reviewed the dates and times of the safety incidents with administrators, we found that most of them occurred during shifts when nurses working overtime or extended shifts were on duty.
The findings of my review are not meant to infer that all nurses who work overtime will commit errors that put patient safety at risk, but it is certainly a factor to consider when thinking of the ways high nurse turnover impacts patient care.
WAY #2: Increased Risk of Poor Patient Outcomes
One significant way that high nurse turnover impacts patient care is that it often leads to increased patient-to-nurse ratios, which means nurses have less time to spend with patients than they would when proper ratios are enforced. Unfortunately, when nurse/patient ratios are not stable, it can result in higher chances of medication errors, patient risks or injuries, and overall poorer patient outcomes.
Each state is responsible for setting its own standards for safe nurse-to-patient ratios. However, as a nurse and healthcare leader, I believe it is important to know your limits as far as what you can handle when it comes to accepting extra patient assignments. At the end of the day, if you take on more patients than you know you can handle, and if errors occur because of something you do, the responsibility for those errors and the patient's outcomes falls on you.
WAY #3: Continuity of Care is Compromised
Compromised continuity of care often results when there is a high rate of nurse turnover, especially in settings where patients are treated long-term, such as nursing homes, assisted living facilities, in-patient rehabilitation centers, or long-term substance abuse and recovery centers. Continuity of care deals with the quality-of-care patients receive over time, typically by the same care team. This does not mean that nurses do not alternate shifts, but, for the most part, the same nurses work with the same patients. When there is a high nurse turnover, however, a disruption in continuity of care occurs. New nurses need time to learn patient histories, treatment plans, preferences, and facility protocol, which can lead to gaps in care.
I witnessed this type of decline in continuity of care at a nursing home years ago. Although it was not intentional, the facility came under new ownership who tried to implement a new scheduling routine, which disrupted what the residents and nurses were accustomed to. At first, the disruption was more of an inconvenience as nurses tried to learn new patients and rotated from one hall to another from week to week. When that became overwhelming, though, some nurses began to seek employment elsewhere, which ended up causing a big turnover. As a result, continuity of care was compromised. The nursing staff that remained was able to work together and train new nurses well, which helped improve the state of things, but for a time, it was a frustrating experience.
WAY #4: Healthcare Facilities May Be Forced to Limit Available Services
Another unfortunate way high nurse turnover impacts patient care is that, when there is a decrease in the number of available nurses, some healthcare facilities may be forced to limit the type of services they can provide to patients. In some cases, this may lead to patients being turned away or having to seek healthcare services elsewhere.
For example, I used to live in a very rural area that had only one small hospital. Years ago, the hospital had a maternity ward and a few obstetricians who worked there. However, over time, the physicians moved away. Because the area was so rural, it was difficult to find obstetricians willing to take positions at the hospital. Eventually, the hospital closed the maternity ward, and as a result, expectant mothers were forced to seek maternity care and deliver their babies at hospitals over an hour away from our small hospital.
WAY #5: Decline in the Quality of Patient Care
High nurse turnover often leaves the nurses who remain employed stressed, overwhelmed, and dissatisfied with their work, which all leads to burnout. Unfortunately, nurse burnout can lead to decreased concentration, impaired memory, increased absences, and poor decision-making, all of which negatively impact the quality of patient care. Therefore, it is easy to see that decreased quality of patient care is one of the ways high nurse turnover impacts patient care.
While I realize the circumstances of high nurse turnover can make you feel overwhelmed, I encourage you to keep in mind that your patients count on you to be there for them and to advocate on their behalf. As much as possible, work together with your team members and leaders, and
practice self-care to help reduce your risk of burnout. Doing these things can help you be a better are provider and allow you to be instrumental in improving patient outcomes.
WAY #6: Nurse Turnover Impacts Healthcare Costs, Which Could Limit Access to Healthcare
One of the largest expenses related to high nurse turnover is the cost of hiring and training new nurses, and who do you think that cost is passed off onto? You guessed it... the consumer! One source suggests it can cost an average of
$82,000 to onboard and train one new nurse. That cost does not include the cost of paying overtime to other nurses who work to cover shifts while new nurses are in training.
The reality is that the expense of hiring and training new nurses is usually passed onto patients through the increased cost of healthcare services. An unfortunate result of how high nurse turnover impacts patient care is that as healthcare costs rise, many patients are unable to afford necessary treatment or care, which means they may do without important medications or treatments.
There have been many times that I have seen patients who walked away from hospitals or physicians' offices who declined treatment because they did not have the money to pay for services and did not feel they could commit to a payment plan. It is a challenge when you want to help patients and ensure they have the best care possible, but you are limited by what you can do legally and within the scope of your role at work based on their ability to pay.
WAY #7: High Nurse Turnover May Lead to Even Higher Rates of Nurses Leaving Their Jobs
Another way high nurse turnover impacts patient care is that when turnover rates are extreme, it leads to burnout, compassion fatigue, and other symptoms in the nurses who remain working that, when left unresolved, can lead to more nurses leaving their jobs or the profession. When this happens, it creates a snowball effect of negative consequences for patients. Fewer nurses mean harder workloads for those remaining, less time and attention for patients, increased safety risks, and poor patient outcomes.
My Final Thoughts
Having a steady, dependable nursing staff is paramount to providing quality patient care and improving patient outcomes. One of the things that hinders our ability to do so is high nurse turnover. With that in mind, it is crucial for nurses at all levels to consider, “How does nurse turnover impact patient care?”
In this article, I shared 7 ways how high nurse turnover impacts patient care that I have witnessed in my nursing career. Although there are some situations leading to turnover that seem inevitable, when nursing teams work together to promote teamwork and an atmosphere conducive to collaborative decision-making, it helps reduce the stress that often leads to turnover. While it takes a collective effort to reduce turnover rates, the benefits are well worth it!
List Of Sources Used For This Article
1. “Nurse Fatigue Creates a Dangerous Environment” (
Nurses Service Organization)
2. “Self-Care for Nurses – 25 Proven Strategies to Take Better Care of Yourself” (
nursingprocess.org)
3. “Nurse Turnover: Understand It, Reduce It” (
American Nurse, Official Journal of the American Nurses Association)
Darby Faubion, RN, BSN, MBA
Darby Faubion is a nurse and allied health instructor with over 20 years of clinical experience. Her work history includes clinical experience in pediatrics, mental health, addiction and behavioral disorders, geriatrics, wound management, and communicable disease. Darby has worked in hospitals, long-term care facilities, and home health and hospice agencies. Darby also has experience as a nursing and allied health educator at both community college and university levels. Her love for nursing and nursing education led to her becoming a test-taking strategist and NCLEX prep coach.