Nursing Unit Turnover, Workgroup processes, and Unit-level Patient Outcomes

Nursing turnover has reached critical levels and recent research suggests that turnover may have a significant impact on healthcare quality. This is especially troublesome given increased acuity and lower staffing. Anecdotal evidence suggests that turnover is associated with lower quality; however, empirical evidence is lacking. This study examines the relationship between nursing turnover and quality at the nursing unit level. By examining the mediating effect of work process variables, I seek to identify nursing units where turnover likely has its most deleterious impacts.

Registered nurse and patient data from 286 nursing units at 146 hospitals were collected as part of the Outcomes Research in Nursing Administration (ORNA-II). With the nursing unit as the unit of analysis, dependent variables include patient satisfaction, length of stay, patient falls, nosocomial infection, and medication errors. The independent variable is the crude nursing unit turnover rate. Mediating the impact of turnover are group cohesion, relational coordination, and group learning. Using a spline functional form, I estimate separate coefficients that capture the effects of turnover on workgroup processes. Path analysis is used to analyze the mediating effect of workgroup processes on the turnover-outcome relationship.

Unit turnover rates ranged from 0 to 1.03 (mean=0.1263). Medication errors ranged from 0 to 49 (mean=3.7). Continued analyses explore relationships among turnover, unit processes, and patient outcomes.

Although we believe turnover is associated with outcomes, this study will provide insight into the turnover-outcome relationship. It will contribute to our understanding of nursing turnover, and provide managers with information about turnover-quality relationship.