To Improve Healthcare Quality Outcomes, We Must Focus on Turnover

April 16, 2021
April 16, 2021

High turnover rates can have a significantly detrimental impact on hospitals, patients, and healthcare staff. As a result hospitals may experience increased contingent staff costs. Staff turnover in hospitals is estimated to cost at least two times the pay of a regular employed nurse. For the hospital, turnover costs also may be linked either to direct or indirect costs. Some of the direct costs include recruitment, orientation, training, and everything connected to the termination of workers. Indirect costs are created by a reduced work environment, diminished productivity, additional staff turnover, and reduced or lessened health outcomes. The cost of turnover is estimated by experts at 5% of the national annual operating budget (Hall, 2005). In this situation, healthcare organizations often are forced to depend on travel, agency, and contract nurses to fill positions left by nurses who quit.

Patient Satisfaction and Outcomes at Risk

Turnover regularly leads to a shortage of nursing staff that adversely affects patient satisfaction and outcomes. One study found that patients who were attended to by nurses who found their work meaningful experienced higher levels of satisfaction with the care they received than those who had nurses who expressed concern to quit their job. Hall (2005) also conducted research that found that higher rates of employee turnover were directly linked to higher patient mortality. Hospitals with sufficient staff record minimal adverse patient outcomes such as urinary tract infections, pneumonia, falls, post-operative complications, medication errors, and death. In fact, patient infections are argued to increase by roughly 30% with each loss of a nurse (Hall, 2005).

An Effect on Morale

High employee turnover results in low employee morale in hospitals. This stems from the fact that overworked staffs typically are given increased responsibilities and workloads following the loss of a key figure in a trained or active workforce (Clark, 2000). New staff members are not immune. They similarly suffer from reduced morale as they fight to learn new job procedures and duties. If such a work environment continues, it may lead to the hospital’s experiencing serious challenges in attracting and retaining high-quality talent. In turn, this negatively affects the hospital’s daily operations.

Reduced Productivity in Organizations That Have No Capacity for It

Reduced productivity arises from disrupted work environment following inexperienced or low number of employees without complete training (Clark, 2000). For instance, new nurses may not offer top-notch care because they are unfamiliar with the hospital’s policies. This may be manifested in scenarios as offering inappropriate medications to patients with chronic disease. Though from the face value it may look like a small issue, it might have a sizeable effect on patient outcomes.


Clark, T. N. (2000). The Relationship between Job Satisfaction and Turnover in Large Insurance Companies: A Survey Analysis. Minneapolis: Capella University.

Hall, L. M. G. (2005). Quality Work Environments For Nurse And Patient Safety. Sudbury, Mass.; Toronto: Jones And Bartlett Pub.