Hospital and unit characteristics associated with nursing turnover include skill mix but not staffing level: An observational cross-sectional study

Background and aimNurse staffing levels are associated with patient mortality, but little is known regarding the association between nurse turnover rate and patient mortality. This study investigated the combined effect of the bed-to-nurse ratio and the nurse turnover rate on in-hospital mortality in patients admitted to Korean acute care hospitals using national administrative data.MethodsThis study analyzed data from the National Health Insurance Service (NHIS) on 459,113 admitted patients and 111,342 employed nurses in 403 hospitals in South Korea from January to December 2016. Differences in in-hospital mortality and nurse turnover among hospital characteristics, including the bed-to-nurse ratio, were explored using the chi-square test. Multilevel, multivariate GEE logistic regression analyses were used to examine the combined effect of the bed-to-nurse ratio and the nurse turnover rate on in-hospital mortality.ResultsDuring the study period, 13,675 (3.0%) patients died during hospitalization, and 13,349 (12.0%) nurses left their jobs. The risk of death among patients admitted to hospitals with a bed-to-nurse ratio of < 2.5 and a nurse turnover rate of ≥ 12% was lower than among patients admitted to hospitals with a bed-to-nurse ratio of ≥ 4.5 and a nurse turnover rate of ≥ 12% (odds ratio [OR] = 0.63; 95% confidence interval [CI], 0.48–0.82). The risk of in-hospital mortality decreased further when the nurse turnover rate was < 12% (OR = 0.59; 95% CI, 0.44–0.79).ConclusionThe bed-to-nurse ratio and nurse turnover rate were jointly associated with patient mortality. When hospitals with a low bed-to-nurse ratio also experienced high nurse turnover, the risk of in-hospital mortality was even greater. The finding of this study will help health policy makers to better understand the importance of both nursing staffing levels and nurse turnover rates. It is necessary to create a comprehensive improvement plan that integrates policies aiming to improve nurse staffing levels and reduce turnover rates into a single strategy.

The aim of the present study was to determine whether there are differences in hospital characteristics, nursing unit characteristics, the nurse work environment, job satisfaction and turnover rates in rural and urban nursing units. Research in urban hospitals has found an association between the nurse work environment and job satisfaction and turnover rates, but this association has not been examined in rural hospitals. Rural and urban nursing units were compared in a national random sample of 97 United States hospitals (194 nursing units) with between 99 and 450 beds. Significant differences were found between hospital and nursing unit characteristics and the nurse work environment in rural and urban nursing units. Both nursing unit characteristics and the work environment were found to have a significant influence on nurse job satisfaction and turnover rates. Job satisfaction and turnover rates in rural and urban nursing units are associated with both nursing unit characteristics and the work environment. Both rural and urban hospitals can improve nurse job satisfaction and turnover rates by changing unit characteristics, such as creating better support services and a work environment that supports autonomous nursing practice. Rural hospitals can also improve the work environment by providing nurses with more educational opportunities.

ObjectiveTo investigate the association between monthly turnover rates of hospital nurses and senior doctors and patient health outcomes (mortality and unplanned hospital readmissions).DesignRetrospective longitudinal study.SettingAll 148 NHS acute trusts in...

본 연구는 병원에 근무하는 간호사의 이직률과 병원의 구조적 특성 간 관련성을 확인하기 위하여 시행하였다. 자료는 한국보건산업진흥원에서 매년 조사하는 병원경영분석자료를 이용하였으며, 2008년에 전국에서 자기기입식으로 입력한 병원은 247개였다. 2008년 우리나라 간호사의 평균 이직률은 32.0%(공공병원 15.5%; ...

Background: Demand for nurses is increasing in various fields of health care services. Despite the increase in the number of nurses, the shortage of nurses has not been solved. The leading cause of the lack of nursing staff is the high turnover rate. This study aims to examine the characteristics of the hospitals and working environment related to nurse turnover and identify the differences by age group. Methods: In this study, the data reported to the Health Insurance Review and Assessment Service were used. The subjects were nurses who worked in hospitals from 2017 to 2019. Nurse turnover, a dependent variable determined by a continuous work episode, was constructed in consideration of the date of employment and resignation. A total of 194,343 nurse staff in 1,316 hospitals and 245,004 work episodes were examined. Results: Among the work episodes analyzed, the turnover rate was 40.3%. The turnover of nurses was higher at a younger age, with lower clinical experience, and lower length of stay (odds ratio [OR], 1.56; 95% confidence interval [CI], 1.51-1.63; OR, 2.11; 95% CI, 2.02-2.21; OR, 1.38; 95% CI, 1.33-1.44). Irregular work nurses had a very significant risk of turnover compared to regular work (OR, 3.15; 95% CI, 2.99-3.33). After stratification by age, irregular work nurses in the working environment and nurse rate grade of the hospital were the main factors affecting a turnover in all age groups. Conclusion: Nurse turnover was significantly differed according to the hospital characteristics and working environment. In the future, system design or health policy development to reduce the nurse turnover requires a customized design considering age, not introducing a comprehensive system for managing nurses.

High nurse turnover during nursing shortages can contribute to missed nursing care. This study investigated the prevalence of missed nursing care and how nurse turnover affects missed nursing care. A cross-sectional design was adopted to collect data from a convenience sample of nurses working in general hospitals in South Korea. Six-month turnover rates (0%, 1-14%, 15-22%, and 23-50%) and 24 missed nursing care activities were measured. A multivariate regression analysis was performed to examine the relationship between nurse turnover and missed nursing care, after controlling for nurse and work-related characteristics. The final sample was 264 nurses. The mean six-month turnover rate was 15.49%. Seven activities (turning patient every 2 h, attending interdisciplinary care conference, ambulation, patient bathing/skin care, emotional support, mouth care, full documentation) had a missed care prevalence of 30% or higher. Nurses in units with moderate turnover rates (15 and 22%) reported more missed nursing care than those in units with zero turnover. Nurse turnover increases missed nursing care, highlighting the adverse effects of nurse turnover on care processes. Consequently, hospitals and governments should implement policy changes and strategies to prevent nurse turnover.

Objective To understand the status of nurses work pressure and turnover intention in shareholding hospital, and to explore the relationship between them. Methods 153 nurses were investigated with Nursing Job Stress Scale and Turnover Intention Questionnaire. Results Nurses work pressure scored (102.07 ± 20.17). Workload and time allocation was the main job stressor among nurses; the nurses'turnover intention scored (14.73±3.54); the correlation coefficients between the job pressure and turnover intention was 0,374; the correlation coefficients between the pressure of nursing work- professional and turnover intention was 0.508; the correlation coefficients between the pressure of workload- time allocation and turnover intention was 0.348. Conclusions The job pressure of nurses was high in shareholding hospital. Nurses work pressure was positively correlated with turnover intention. Key words: Shareholding hospital; Nurses; Work pressure; Turnover intention

High turnover rates among nurses are a global concern. Previous studies show the negative impact on quality of care. The purpose of this study was to examine the relationship between nurse turnover and nurse's perceptions of patient outcomes. A cross-sectional study design was used. Nurses working in 35 general hospitals in South Korea were invited to participate in a survey assessing their perceptions of patient outcomes, including quality of care, patient safety, and adverse events. Nurse turnover was measured for the prior 6months. Data from 159 nurses were analyzed. There was a significant positive relationship between turnover rates and perceptions of poor quality of care, after controlling for demographic and work-related characteristics. Nurse turnover was not significantly associated with perceptions of patient safety or adverse events. The negative consequence of nurse turnover on patient outcomes is partially supported in this study.

To describe the characteristics of long-term care hospitals in 2010-2013 and to examine the longitudinal associations of nursing staff turnover with patient outcomes. The number of long-term care hospitals has exploded in Korea since the national long-term care insurance was launched in 2008. The care quality deviation across long-term care hospitals is large. This was a longitudinal secondary data analysis using the Health Insurance Review and Assessment Service's data. From 2010 to 2013, the nursing staff turnover rate decreased. The number of patients per registered nurse increased while that per total nursing staff and skill mix decreased. All adverse patient outcomes decreased. Higher nursing staff turnover and lower RN proportions were associated with adverse patient outcomes. Since the launch of the long-term care insurance, total nursing staffing, turnover rate and patient outcomes have improved, while the skill mix has decreased. Systematic efforts to decrease nursing staff turnover should be implemented for better long-term care patient outcomes. In addition to maintaining high levels of nurse staffing and skill mix, supportive work environments and competitive wages and benefits could reduce turnover, and ultimately adverse patient outcomes. Health care policy should separate nursing staffing levels for registered nurses and certified nursing assistants.

© 2021 British Association of Critical Care Nurses. This is the accepted manuscript version of an article which has been published in final form at https://doi.org/10.1111/nicc.12726

The authors conducted a meta-analysis of the relationship between turnover rates and organizational performance to (a) determine the magnitude of the relationship; (b) test organization-, context-, and methods-related moderators of the relationship; and (c) suggest future directions for the turnover literature on the basis of the findings. The results from 300 total correlations (N = 309,245) and 110 independent correlations (N = 120,066) show that the relationship between total turnover rates and organizational performance is significant and negative (ρ = -.15). In addition, the relationship is more negative for voluntary (ρ = -.15) and reduction-in-force turnover (ρ = -.17) than for involuntary turnover (ρ = -.01). Moreover, the meta-analytic correlation differs significantly across several organization- and context-related factors (e.g., types of employment system, dimensions of organizational performance, region, and entity size). Finally, in sample-level regressions, the strength of the turnover rates-organizational performance relationship significantly varies across different average levels of total and voluntary turnover rates, which suggests a potential curvilinear relationship. The authors outline the practical magnitude of the findings and discuss implications for future organizational-level turnover research.

This study explores the associations between pediatric adverse events (PAEs) and both hospital and patient characteristics within the inpatient hospital setting, specifically focusing on Neonatal Blood Stream Infection (NBSI) as defined by pediatric quality indicators (PDIs) from the Agency for Healthcare Research and Quality (AHRQ). This research aims to answer questions regarding the relationship between hospital characteristics and patient demographics with the occurrence of NBSI. This study utilized discharge data from the Healthcare Cost and Utilization Project (HCUP) Kids' Inpatient Databases (KID) for the year 2019. Bivariate and multivariate logistic regression models were employed to analyze patient-level encounters of NBSIs. The analysis examined various factors including hospital size, location, and teaching status, as well as patient-specific variables such as gender, age, race, service lines, payment sources, and major operating room procedures. The results indicate that Public and Private not-for-profit hospitals showed significantly lower odds of experiencing NBSIs when compared to Private investor-owned hospitals, as did smaller, rural, and nonteaching hospitals when compared to large hospitals. Additionally, individual factors such as gender, age, race, service lines, payment sources, and types of major operating room procedures were found to have varying levels of significance in relation to NBSI. This study provides important insights into PAEs within the inpatient hospital setting, particularly focusing on NBSIs within the PDI framework. The findings highlight critical areas for the development of evidence-based interventions and guidelines, which are essential for clinicians and policymakers. Ultimately, this study contributes to the understanding and improvement of pediatric patient safety by emphasizing the necessity for targeted strategies to mitigate the risk of NBSI.

Objective To analyze the relationship between the turnover rate of junior pediatric nurses and their psychological quality, and put forward the corresponding solutions. Method The turnover rate of pediatric nurses in 5 class Ⅲ grade Ⅰ hospitals of Guangzhou City in recent 6 years was analyzed. Results The turnover rate of junior pediatric nurses was high, there were 90 cases of turnover in nurses with the working age of 1-3 years, accounting for 83.33% of the total number of turnover; the main reasons included strong work intensity (90.74%), high work pressure (94.44%), poor working environment (83.33%), not ideal salary (88.88%). Conclusion We should improve the psychological quality of junior pediatric nurses, reduce the turnover rate, and promote the development of pediatric nursing career. Key words: Pediatrics; Junior nurses; Turnover; Psychological quality

Background: Nurses turnover is a current and international problem which is closely related to the organizational culture. Despite being widely discussed, the evidence available in the literature is dispersed and most studies only concern specific health contexts and sectors. The aim of this study is to identify scientific evidence on the factors of organizational culture associated with nurses turnover. Methods: A systematic literature review was carried out between January 2014 and December 2018. The methodological quality of the articles was assessed through the Joanna Briggs Institute and Registered Nurses Association of Ontario guidelines. Results: Nurses’ turnover in healthcare organizations is complex and multifactorial. The evidence shows individual and organizational factors that influence nurses’ turnover. Some retention strategies to reduce this phenomenon were also identified in literature. Conclusions: Nursing managers should seriously consider the problem of nurses’ turnover, as it affects the productivity and quality of care provided in health organizations. By working the factors associated with organizational culture, organizational climate and leadership, it will be possible to reduce nurses’ turnover rates in different healthcare contexts. In the development of public policies, decision-makers should take into account two fundamental aspects: the needs and expectations of the population; and the stability of professional groups. It is suggested to investigate this issue in Portugal.

AimsWe describe an innovative research protocol to: (a) examine patient‐level longitudinal associations between nurse staffing practices and the risk of adverse events in acute care hospitals and; (b) determine possible thresholds for safe nurse staffing.DesignA dynamic cohort of adult medical, surgical and intensive care unit patients admitted to 16 hospitals in Quebec (Canada) between January 2015–December 2019.MethodsPatients in the cohort will be followed from admission until 30‐day postdischarge to assess exposure to selected nurse staffing practices in relation to the subsequent occurrence of adverse events. Five staffing practices will be measured for each shift of an hospitalization episode, using electronic payroll data, with the following time‐varying indicators: (a) nursing worked hours per patient; (b) skill mix; (c) overtime use; (d) education mix and; and (e) experience. Four high‐impact adverse events, presumably associated with nurse staffing practices, will be measured from electronic health record data retrieved at the participating sites: (a) failure‐to‐rescue; (b) in‐hospital falls; (c) hospital‐acquired pneumonia and; and (d) venous thromboembolism. To examine the associations between the selected nurse staffing exposures and the risk of each adverse event, separate multivariable Cox proportional hazards frailty regression models will be fitted, while adjusting for patient, nursing unit and hospital characteristics, and for clustering. To assess for possible staffing thresholds, flexible non‐linear spline functions will be fitted. Funding for the study began in October 2019 and research ethics/institutional approval was granted in February 2020.DiscussionTo our knowledge, this study is the first multisite patient‐level longitudinal investigation of the associations between common nurse staffing practices and the risk of adverse events. It is hoped that our results will assist hospital managers in making the most effective use of the scarce nursing resources and in identifying staffing practices that minimize the occurrence of adverse events.