The Cost of Turnover in Home Healthcare: A Conceptual Model.

The purpose of the present study was to design a preceptorship programme and to evaluate its effects on turnover rate, turnover cost, quality of care and professional development. A high turnover rate of nurses is a common global problem. How to improve nurses' willingness to stay in their jobs and reduce the high turnover rate has become a focus. Well-designed preceptorship programmes could possibly decrease turnover rates and improve professional development. A quasi-experimental research design was used. First, a preceptorship programme was designed to establish the role and responsibilities of preceptors in instructing new nurses. Second, a quasi-experimental design was used to evaluate the preceptorship programme. Data on new nurses' turnover rate, turnover cost, quality of nursing care, satisfaction of preceptor's teaching and preceptor's perception were measured. After conducting the preceptorship programme, the turnover rate was 46.5% less than the previous year. The turnover cost was decreased by US$186,102. Additionally, medication error rates made by new nurses dropped from 50-0% and incident rates of adverse events and falls decreased. All new nurses were satisfied with preceptor guidance. The preceptorship programme effectively lowered the turnover rate of new nurses, reduced turnover costs and enhanced the quality of nursing care, especially by reducing medication error incidents. Positive feedback about the programme was received from new nurses. Study findings may offer healthcare administrators another option for retaining new nurses, controlling costs, improving quality and fostering professional development. In addition, incentives and effective support from the organisation must be considered when preceptors perform preceptorship responsibilities.

We estimate turnover costs in small retail sales teams using daily sales data and an advance notice requirement to address endogeneity concerns. In addition to short-staffing and onboarding costs, we identify two less familiar sources of turnover costs: incumbent workers’ recruitment activities and reductions in team morale after a departure is announced. Our estimates of total turnover costs are relatively modest, however: 10% higher turnover is about as costly as a 0.6% wage increase. We attribute these low costs to a set of complementary personnel policies that ensure that only 25% of departures result in a short-staffing spell.

Nurse is the largest number of four medical personnel, and the stability of the nurses is directly related to the quality of medical service, but countries around the world are faced with the high turnover rate of nurses [1]. At present, Chinese researches on the issue of nurses’ resignation mainly focus on the analysis of the variables and causes of nurses’ resignation, while there is few research related to the turnover costs of nurses which the managers focus most. All these problems lead to there is still no consensus and cognition on composition and measurement methods of turnover costs and the harm of the organizations. Based on the literature research, this paper summarizes the composition and measurement of the voluntary turnover cost of Chinese nurses, and draws the main constituent elements and feasible measurement methods of the nurses’ voluntary turnover cost. Furthermore, this paper takes a military hospital in Beijing as an example and shows the composition and measurement methods of turnover cost by the actual measurement of the nurses’ turnover costs in this hospital. Hope this paper can provide some reference for the future theoretical research and medical practice.

This research investigates the negative impacts of low employee morale on organizations, focusing on high turnover and vacant positions. It emphasizes the need for future research to compare morale-boosting efforts with the costs of turnover and vacancies. it identifying effective intervention strategies, measuring financial and non-financial effects, and analyzing external stakeholders' influence. Using a quantitative approach with a cross-sectional survey design, this study will collect data from 234 employees using survey instrument. Structural equation modeling (SEM), correlation, and regression analysis will be used to analyze the data. The expected outcomes of the study will provide insights into the relationships between various factors and employee morale. These findings will help organizational leaders understand and address the different factors influencing morale, ultimately fostering employee motivation and enhancing work environments. Future research should also explore global and culture-specific morale dynamics and incorporate new trends like remote employment.

BackgroundThe World Health Organization estimated a need for around 6 million nurses by 2030 to meet the healthcare demand. The International Council of Nurses reported that, the impact of COVID-19 pandemic, the aging nursing workforce, and the high turnover of nurses were some of the factors that contributed to the anticipated 13 million nursing deficit. Globally, there is a worry about the high turnover with no doubt. The cost of turnover and recruitment incurred by healthcare organizations are huge which requires developing measures and interventions to address the problem. Nurse Residency Programs is a promising educational intervention for improving nurses' retention rates and reducing the impact of the shortage. PICO questionWhat effect does successful completion of Nurse Residency Program have on new nurses’ retention rates compared with new nurses who missed the Nurse Residency Program? Inclusion criteriaThe review included articles; published in English, between 2016 and 2023 that addressed nurse retention rates, associated with Nurse Residency Program participation. MethodsThe systematic review followed the PRISMA protocol. An extensive search on the Cumulative Index of Nursing and Allied Health Literature (CINAHL), MEDLINE, Academic Search Complete, and PubMed for studies published between January 2016 and March 2023 in English language. The key words, ‘graduate nurses’, ‘new graduate nurses’, ‘residency’, ‘internships and residency’, ‘NRP’, ‘retention and retention rates’. Utilizing the JBI Sumari, two reviewers screened the citations, reviewed the eligibility criteria, conducted the critical appraisal, and assessed the risk of bias and extracted data from the included studies. Cochrane Risk of Bias in Non – randomized studies of intervention (ROBINS-I) tool was used to assess risk for bias. ResultsOut of 189 studies, 48 studies removed as duplicate, remaining with 141 article. After screening titles and abstracts, only 48 papers retrieved for full-text evaluation. Out of 48 research only 5 publications were included in the review. The researchers identified the methodological heterogeneity is a major factor to stop the metanalysis and keep the systematic review. ConclusionsNurse Residency Programs showed promise as an educational intervention to cultivate well-supported, competent, and confident new nurses. These programs have the potential to improve retention rates during the initial 12 months of employment. To gain a deeper understanding of retention beyond the first year, additional randomized control trials are essential. Furthermore, there is a need to integrate standardized Nurse Residency Programs into organizational policies and clinical practice settings in the UAE.

In the eighteenth-century British Empire and the antebellum South, slaves were concentrated in domestic service and rural enterprises like agriculture and ironworks. I argue that employers in these sectors chose to employ slaves rather than free labor because they faced especially high turnover costs—that is, costs of searching for a worker and going without labor when a free worker quit or was fired. In the absence of slavery, these sectors were marked by other institutions designed to deal with turnover costs: indentured servitude, employment agencies, and deferred compensation.

Under what conditions would a principal choose to buy a slave rather than to hire a free worker? First, slaves cannot leave at will, which reduces turnover costs; second, slaves can be subjected to physical punishments, which reduces enforcement costs. In complex tasks, relation-specific investments are responsible for high turnover costs, which makes principals prefer slaves over workers. At the other end of the spectrum, in simple tasks, the threat of physical punishment is a relatively cheap way to produce incentives as compared to rewards, because effort is easy to monitor, which again makes slaves the better alternative. The resulting equilibrium price in the market for slaves affects demand in the labor market and induces principals to hire workers for those intermediate tasks. A thorough analysis of the historical evidence confirms this pattern. The relative prevalence of slaves over workers further depends on the slave supply, the turnover costs and the cost of applying sticks. These comparative statics are used to shed light on cross-society differences in the use of slaves and on diachronic trends. Finally, the analysis sheds light on current policies to fight slavery and warns that some of them might have negative effects on the welfare of remaining slaves.

The delegation of tasks to a subordinate and his access to key firm resources allow an organization to make optimal use of his knowledge and ability, but at the same time, thanks to on‐the‐job learning and the possibility of expropriation of these resources, this might increase the agent’s outside options. We model these risks as an increase in the quit propensity of the agent which determines higher turnover costs for the firm. The choice of the degree of delegation a principal offers to her subordinate is analyzed taking into account its benefits and costs. We show that the level of delegation is influenced by the principal’s and the agent’s abilities, but it is lower the higher turnover costs are and the lower the degree of specificity of human capital is or the higher the degree of expropriability of resources is. Finally, bureaucratic rules establishing the documentation of the agent’s activity are seen as a device to reduce turnover costs and to allow more delegation.

Recent work on nursing home staffing and turnover has stressed the importance of ownership and resources. However, few studies have examined spending behaviors, which might also influence staffing levels and staff turnover rates. This study investigates whether spending behaviors measured by financial ratios are associated with staffing levels and staff turnover in nursing homes. We analyzed cross-sectional data from 1,014 Texas homes. Data were from the 2002 Texas Nursing Facility Medicaid Cost Report and the 2003 Area Resource File. First, we examined differences in financial ratios by ownership type. Next, the effect of 10 financial ratios on staffing levels and turnover rates for registered nurses, licensed vocational nurses, and certified nursing assistants was examined using robust regression models. Descriptive data indicated that expense ratios related to resident care activities and staff development were significantly higher among not-for-profit than for-profit homes. Higher profits were associated with lower staffing levels, but not higher turnover rates. Administrative expenses (a measure of management capacity) had a negative impact both on staffing levels and staff turnover for licensed vocational nurses and certified nursing assistants, but they did not affect registered nurse staffing. Employee benefit expenses exhibited a positive impact on registered nurse and licensed vocational nurse staffing levels. The addition of information on financial ratios to models predicting staffing indicators reduced the effect of ownership on these indicators. Solutions to the staffing and turnover problem should focus on more effective management practices. Certain levels of administrative and staff benefit expenses may be necessary to improve professional staff recruitment and reduce both staffing and turnover costs. Differences in these financial ratios may partially explain the role played by ownership in determining staffing levels and turnover.

The US seafood industry is dependent on foreign workers. It is estimated that majority of seafood workers are foreign born. Labor is a major input in the seafood processing industry. Shortage in seafood workers (labor, majority of which are nonimmigrant H-2B workers) can significantly affect seafood production, processing, and result in severe financial problems. However, the relative significance of labor attributes that are most important in hiring decisions, including immigration status, are not clear. Seafood processor preferences for hiring employees are explored in light of references, wages, and immigration status. Using survey data and conjoint analysis, this study determines the relative importance of labor attributes and identifies distinct clusters of processors in terms of processor preferences for hiring labor. The H-2B program reduces companies' training and turnover costs. Many survey respondents complained about high turnover among US workers. Results indicate that for seafood pro...

To conduct a systematic literature review and to examine the effectiveness and application of mentorship programmes for recently registered nurses. The implementation of mentorship programmes is an important strategy that health care institutions employ to retain nurses who have been recently registered. By better understanding the applications and effectiveness of mentorship programmes, the retention rate for these nurses can be enhanced. We collected existing literature to examine experimental and quasi-experimental studies that adopted mentorship programmes as an intervention. Five studies were included in the final analysis. The strength of the evidence provided through the selected studies was ranked at Level III based on the study design. Furthermore, these studies revealed that the implementation of mentorship programmes reduced turnover rates, employee turnover costs and medical negligence rates. Job satisfaction and professional identity were improved. The results of this systematic review suggest that mentorship programmes are a beneficial process for mentors and recently registered nurses. In addition, mentorship programmes involve multi-dimensional teaching strategies and training courses and require long-term development. The findings of this systematic review on the application and effectiveness of mentorship programmes for nurses who have recently registered can provide references for nursing managers who are selecting mentors and for the design of practical programmes.

High teacher turnover in large U.S. cities is a critical issue for schools and districts, and the students they serve; but surprisingly little work has been done to develop methodologies and standards that districts and schools can use to make reliable estimates of turnover costs. Even less is known about how to detect variations in turnover costs for teachers of different grades and disciplines. This study created a model and methodology to document turnover costs for the middle and high schools in the Boston Public Schools to test the degree to which it could detect differences in costs for teachers of science, and to explore the feasibility of its implementation by school personnel. We found that although the model and methods were sensitive enough to detect differences between schools and for science teachers, it could not be easily or fully applied at the district or school levels, where the component costs of turnover were scattered between department budgets, and where some costs were undocumented. At the same time, our data show that when teachers leave a school, whether it is due to a departure from the district or a reassignment to another school, there is an associated cost that has previously gone unmeasured. Therefore, understanding the full cost of teacher departures is essential when trying to estimate the true cost—and cost savings—of a layoff. Since professional development consistently represents the largest cost in the district studied, we suggest steps that can be taken to track these expenses more systematically at the school and district levels.

This study looks at the relationship between labor productivity and employee turnover. I show that the average firm suffers a productivity loss of about 10 percent from employee turnover. Since strategies for increasing employee retention may be economically infeasible, organizational characteristics that affect turnover costs are important. I argue that slack resources may absorb productivity losses. This only appears to be the case for firms experiencing high turnover rates.

This study examined turnover rates of teams implementing psychosocial evidence-based practices in public-sector mental health settings. It also explored the relationship between turnover and implementation outcomes in an effort to understand whether practitioner perspectives on turnover are related to implementation outcomes. Team turnover was measured for 42 implementing teams participating in a national demonstration project examining implementation of five evidence-based practices between 2002 and 2005. Regression techniques were used to analyze the effects of team turnover on penetration and fidelity. Qualitative data collected throughout the project were blended with the quantitative data to examine the significance of team turnover to those attempting to implement the practices. High team turnover was common (M+/-SD=81%+/-46%) and did not vary by practice. The 24-month turnover rate was inversely related to fidelity scores at 24 months (N=40, beta=-.005, p=.01). A negative trend was observed for penetration. Further analysis indicated that 71% of teams noted that turnover was a relevant factor in implementation. The behavioral health workforce remains in flux. High turnover most often had a negative impact on implementation, although some teams were able to use strategies to improve implementation through turnover. Implementation models must consider turbulent behavioral health workforce conditions.

High-quality early care and education is a known protective factor for infants and toddlers who experience early childhood poverty, especially for early communication outcomes. However, the quality of care is variable in the United States, and efforts to increase the quality of interactions is impeded by cost and high rates of turnover in the field. In this paper, we explore a low-cost, light touch social media intervention that uses the TikTok platform to increase infant–toddler teachers’ (ITTs) knowledge of early communication and social interactions while validating the important role that ITTs play in the lives of young children. We use a mixed method, pre-post design to explore the feasibility and acceptability of the BabyTok project from the vantage point of the ITT participants. Teachers offered positive feedback about the content, delivery of the intervention through TikTok and the impact on their feelings about their role in helping young children learn.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10643-022-01426-y.