This paper examines the persistent problem of nursing shortage and high nurse turnover in the healthcare industry, drawing on research from multiple countries to identify its causes and consequences. It distinguishes between the roles of nurse managers and nurse leaders, highlighting how effective leadership can mitigate workforce instability. The paper outlines several strategies for reducing turnover—including wage increases, nurse unionization, fair wage-setting practices, appropriate staffing ratios, and ongoing research and education. It concludes with a professional philosophy favoring competitive pay and democratic leadership as the most effective approaches to retaining nursing staff and sustaining quality patient care.
Nursing shortage and high nurse turnover are very common issues faced in the healthcare industry. This instability of the workforce in many countries is raising questions about the performance of nurses and the quality of patient care.
Gray and Phillips (1996) pointed out that nursing turnover has a negative impact on an organization's ability to meet patients' needs and provide quality care. Tai et al. (1998) also identified nursing shortage and turnover as an important factor responsible for poor performance in healthcare centers. This is because high turnover affects the morale and productivity of the nurses who remain, as they must care for patients while the healthcare unit recruits new staff members (Sofer, 1995; Cavanagh and Coffin, 1992; Shields and Ward, 2001).
Aiken et al. (2001) pointed out that the common reasons behind nurse turnover in Canada, America, Germany, and Scotland included problems in work design and emotional exhaustion. Other contributing factors include the availability of alternative career options, low wages, departure from the profession altogether, and the increasing average age of the nursing workforce.
Nursing shortage and turnover affect not only performance but also the profitability of healthcare units. Patients prefer healthcare facilities with stable, well-trained, and active nursing staff who provide high-quality care. Constant nurse turnover distracts staff, forces them to take on extra work, causes frustration, and results in lower-quality patient care. Losing a single nurse carries a financial cost estimated at roughly double that nurse's annual salary. Beyond this direct cost, healthcare units experience a range of additional consequences: declining quality of care, a reduction in patient volume, increased absenteeism, a rise in workplace accidents, higher rates of medical staff turnover, and increased expenditure on temporary and contingent staff.
The terms nurse leader and nurse manager are often used interchangeably, but there is a significant difference between them. A nurse leader can be an effective manager, but not every nurse manager necessarily becomes a good nurse leader. The responsibility of a nurse manager is to fulfill assigned duties and oversee the nursing staff who report to them. A nurse leader, however, plays a very different role: they must inspire and motivate others to perform their duties within the broader organizational framework. Leadership qualities are often considered innate — effective leaders possess the ability to motivate, inspire, and drive other staff members toward the vision and mission of the healthcare unit.
A nurse leader should have effective communication and interpersonal skills. They should be a risk-taker with the ability to think beyond the immediate issue and go the extra mile to achieve desired results. They must remain committed to the core goal of providing high-quality patient care and should collaborate with management to design strategies that help the nursing staff achieve their objectives. Because a nurse leader serves as a role model for all staff members, they must be willing to shoulder considerable responsibility and set an example for colleagues and managers alike. Leadership in a healthcare unit can be both formal and informal, and an effective nurse leader must take responsibility for streamlining the workforce and allocating resources appropriately.
There are several methods that can help nurse managers and leaders reduce nursing turnover.
Raising compensation is the most direct way to retain current nursing staff and attract experienced nurses to hospital employment. Higher pay helps reduce nurse shortage and enables hospitals to provide improved patient care. A stronger pay scale also supports the expansion of nurse education by sustaining a consistent supply of nurses in both the present and the future. Nurse managers who observe staff resignations driven by salary concerns should raise the issue with senior management.
Allowing nurses to form a union and voice their concerns gives nurse managers and leaders insight into staff issues through a collective channel. Addressing these concerns collectively can lower nurse shortage and reduce high turnover. Leaders and managers should welcome input from nursing staff and work actively to resolve the issues raised.
Management must adopt fair wage-setting practices and avoid unlawful agreements. Antitrust laws should be enforced where applicable, and wage data collection should be made as transparent as possible to ensure equitable compensation across the organization.
Staffing ratio plays a critical role in providing quality patient care and controlling nurse shortage and turnover. When managers assign nursing staff responsibility for too many patients simultaneously, quality of care suffers and staff members become exhausted, increasing the likelihood of turnover.
Hospitals — and nurse leaders and managers in particular — should research and educate themselves about policies and strategies that address how pay scales and work pressure affect staff performance and contribute to high turnover. Staying informed enables proactive rather than reactive workforce management.
In my opinion, low pay is the primary driver of nurse shortage and high turnover. Students who might otherwise enter the nursing profession are deterred by low wages and demanding working conditions. Healthcare units experiencing nurse shortage and high turnover should therefore revise their pay scales. This change would not only retain current nursing staff but also attract more educated and experienced nurses seeking better employment conditions. However, healthcare units should not reduce the number of staff members simply to offset the cost of higher wages. Doing so would overburden existing nurses, lead to exhaustion, and prompt resignations despite the improved salary.
Nurse leaders should adopt a democratic style of leadership that encourages subordinates to participate actively in the decision-making of the healthcare unit. While the final decisions should rest with nurse managers and nurse leaders, all staff members should be given the freedom to contribute ideas, suggestions, and input. This inclusive approach helps staff members feel valued and recognized as important contributors to the healthcare unit's mission.
Aiken, L. H., Clarke, S. P., Sloane, D. M., Sochalski, J. A., Busse, R., Clarke, H., Giovannetti, P., Hunt, J., Rafferty, A. M., and Shamian, J. (2001). Nurses' reports on hospital care in five countries. Health Affairs, 20(3), 43–53.
Cavanagh, S. J., and Coffin, D. A. (1992). Staff turnover among hospital nurses. Journal of Advanced Nursing, 17(11), 1369–1376.
Gray, A. M., and Phillips, V. L. (1996). Labor turnover in the British National Health Service: A local labor market analysis. Health Policy, 36(3), 273–289.
"Advocating for fair pay and democratic leadership"
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