Nurse turnover and its impact on patient care quality

Reducing Blood Culture Contamination Rates in the ED

Quality Improvement & Patient Safety Issue Project

Problem Statement & Literature Support

At Ford Hospital, the current staff turnover rate is 25% after one year on the unit. In settings where nurse turnover exceeds 12%, the following clinical, organizational, and financial challenges have been noted:

Lower patient care scores on national benchmark data

Lower utilization management rates than national benchmark data

Higher bed per day cost than national benchmark data

Quality patient care as evidenced by patient care quality measures surveys, are correlated to successful clinical outcomes and strong revenue growth from clinical operations (Kaldenberg, Gobeli, 1995). Additionally, quality patient care is further correlated to the employment of a professional and highly competent nursing staff and with a focus to evidenced-based care (Clarke, Savitz, Pingree, 2010)

The facilitator to the problem, according to Runy (2008), is nurses that are pulled from their bedside duties to attend to tasks that are outside of their scope of optimization. According to Runy, "To give nurses more time to spend at the bedside, hospitals need to develop supportive work environments that foster communication and teamwork and eliminate wasteful work. That will reduce staff turnover, increase patient satisfaction and improve clinical outcomes." (Runy, 2008)

Quality Improvement (QI) programs are adept at maximizing worker ability into high performance operational standards, which yield a higher profit per worker hour. According to Runy, "Nurses complained that they often spent up to an hour at the end of a shift updating the new shift on their patients' conditions. A standardized, online shift-to-shift report was developed, and the process now takes under 20 minutes. The reduction in time saves one unit nearly $80,000 per year in overtime." (Runy, 2008)

Plan Design

As indicated from the literature review, an effective approach to establishing a performance improvement process is to establish a 'Champion" to drive the process through the organization and to obtain ensure management is on track with the program and the efforts of the performance improvement staff

. The role of nurses in performance improvement programs is critical and integral to the overall effectiveness of the program. According to, "Nurses are critical to the delivery of high-quality, efficient care. Lessons from Magnet program hospitals and hospitals implementing front-line staff driven performance improvement programs such as Transforming Care at the Bedside illustrate how nurses and staff, supported by leadership, can be actively involved in improving both the quality and the efficiency of hospital care." (Needleman, Hassmiller, 2009)

The reference is to illustrate how critical nurses are to the overall effectiveness of a performance improvement program. The time frame for the program is 3 years with an annual review using a zero-based budgeting approach. The appropriate plan design to reduce turnover, improve patient quality, and improve the yield per bed is to integrate nurses into the bedside care with more vigor and to increase the use of nurses aides for the non-critical care activity. To commence the activity, data is collected using scorecards on the unit that records nurse input per shift regarding activities performed at the patient bedside that correlates directly to increasing patient satisfaction. Patient surveys are distributed monthly and response rates are monitored against revenue per bed. Nursing turnover rates are additionally tracked and morale surveys are distributed every three months to gauge current sentiment and for feedback on improvement.

The expected result of implementing the recommended performance improvement program is a reduction in turnover by 1/2 from current levels by the end of the third year of operations.