COMMENTARY

Nurse Turnover: The Revolving Door in Nursing

Laura A. Stokowski, RN, MS

Disclosures

December 16, 2014

What Does Nurse Turnover Rate Mean and What Is the Rate?

Kovner CT, Brewer CS, Fatehi F, Jun J
Policy Polit Nurs Pract. 2014 Aug 25. [Epub ahead of print]

Turnover Among Registered Nurses

For the most part, "nurse turnover" is an undesirable trend for healthcare employers. It's expensive, it's disruptive, and it threatens the quality of care and patient safety. There are exceptions; for example, nurses who aren't performing well and leave of their own accord or are dismissed. It is still expensive to replace them, but the unit or department is better off in the long run.

People are often interested in knowing the turnover rate among those in the nursing profession as a barometer for job and career satisfaction and to aid in staffing and workforce projections. "Nurse turnover," however, has no universal definition, making it difficult to compare turnover rates in healthcare facilities or geographic regions.

Nurses leave their jobs for many reasons, both voluntary (desire for change or promotion, job dissatisfaction, geographical move, returning to school, leaving the nursing profession, etc.) and involuntary (facility closure, dismissal). Some reasons for nurse turnover can be considered either voluntary or involuntary, such as retirement or health issues, depending on whether the nurse chooses or is forced to leave. The bottom line is that it is extremely difficult to quantify and compare turnover rates among registered nurses (RNs).

Turnover rates are highest when jobs are plentiful and nurses who are unhappy with their positions have many other options. A poor economy could influence turnover if nurses are reluctant to leave their jobs without securing another one. Turnover also tends to be highest during the early years of a nurse's career. Surveys of newly licensed hospital-based nurses have shown that 43% leave their first jobs within 3 years of employment.[1]

In this study, Kovner and colleagues used data from the RN Work Project to calculate turnover rates among newly licensed RNs. The RN Work Project is a Robert Wood Johnson Foundation-funded 10-year panel study of new RNs and is the only longitudinal study of RNs in the United States. The investigators were able to follow the same nurses over time and gather data about their job and career decisions. These data are not tied to specific institutions, but reflect all RNs working in nursing jobs.

The 1-year turnover rate among all newly licensed RNs was 17.5%, and the 2-year turnover rate was 33.5%. By geographic area, the 1-year turnover was lowest in the middle Atlantic region (13.7%) and highest in the east south central region (25%). Newly licensed nurse turnover is lower in hospitals than in other healthcare settings, such as ambulatory or long-term care. This unsurprising statistic is explained by the fact that newly licensed nurses typically seek hospital jobs, so if their first employment setting is not a hospital, they are likely to transfer to the hospital as soon as they are able. Conversely, if they have obtained a hospital job for their first position, they are less likely to leave it.

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