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How Nursing Turnover can be Reduced through Effective Leadership

by Daniyal


Healthcare is most prominent sector of the US economy and the nurses are the most important constituents of the healthcare sector for its efficient functioning. The American Association of Colleges of Nursing (AACN) is concerned about nursing shortage issues and is working toward identifying strategies and enacting legislation to address the nursing shortage. According to the Health Resources and Services Administration (HRSA), the nursing shortage would reach the mark of one million by the year 2020 (Nursing Shortage, 2012). Though several efforts have been initiated to address the nursing shortage issue at national, state and local levels yet the issue of nursing turn-over needs to be addressed at the organizational levels through managerial and leadership initiatives.  The paper explores how the nursing retention and turn-over issues can be tackled through an effective leadership and managerial approach in any healthcare organization.

Leaders and managers choose their leadership styles based on the situations; often, they are described as organizational structures, employee characteristics, nature of work, skills involved. From the managerial perspective, it will be most prudent to identify the situation that exists in the nursing profession in the US in the present times.

How Nursing Turnover can be Reduced through Effective Leadership

Reasons of High Turnover

CareerBuilder (2010) conducted one survey involving 12,147 registered nurses (RNs) to find their average stay in the healthcare organization. The results informed that the median stay of RNs was 1.4 years. The stay was lowest in the nursing care facilities at only 0.97 years and the longest was found to be 1.57 years at physicians’ clinics. On further investigations, the nurses gave several reasons for their short tenures in the job; prominents of them were high workloads, lack of advancement opportunities, lack of training, low salary, fewer staff, and poor organizational culture, poor fit with boss, and no access to technology.

Assessment of the Situation

Efficient managers assess the situation before resorting to any solution. Many of the issues that come out in the survey are interrelated such as fewer staff and high workload issue. Lower staff will obviously lead to the situation of high workload on nursing staff in any healthcare setting.  A experienced manager can see adequate staffing as the response to reducing the burden on nurses. Nurses usually leave due to excessive work pressures and that will be eased to a certain extent through this action.  On other issues raised by the nurses, the top management of the organization must formulate a strong retention policy and for that the company needs to pay nurses generously.

McConnell (2010) emphasizes on proper reward system to recognize the work of employees and that is where effective and appropriate leadership style is necessary. The issues that concern nurses and raised so far are mostly tangible and needs to be tackled by the top management of the organization where nothing much can be done at intermediate levels such as supervisors or managers because number of nurses in the healthcare unit and their salary structures are largely governed by the corporate recruitment and compensation policies (managerial decisions); however, even a well-formulated retention policy may fail if it is not supported by staff motivation and recognition efforts. It is precisely here that effective leadership is necessary at all levels.

Issues that Need an Effective Leadership Approach

In CareerBuilder (2010)’s survey on nurses, many issues raised by nursing staffs fall in the category of work culture, lack of training, and poor fit with boss. Yukl (2006) argues that effective leaders are usually transformational leaders. They do not hesitate to delegate authority to others, help create self-managed teams, eliminate unwanted controls; helps develop skills and self-confidence of staff so as to create self-managed teams and work toward staff empowerment. Through various research findings, it has been established that transformational leadership works best in inspiring and influencing front line staff such as nurses inculcating a sense of achievement. The approach helps enhance performance and productivity of the organization at all levels and yields much better results because motivated nurses become self-directed leaders themselves rather than just followers of some set process. Bass and Riggio (2006) emphasize several benefits of transformational leadership that include high level of worker satisfaction, improved levels of performance achieved through motivation and proper reward and reduced stress levels or burnout.

Several transformational leadership frameworks are in operation and one of them is engaging leadership model. Alimo-Metcalfe and Alban-Metcalfe (2008) describe about ‘engaging leadership’ model that has for major elements: engaging staff; engaging the team; core values and personal qualities. Engaging leadership aims at serving and enabling others to become proactive in their approach. This also speaks about transparency, openness and accessibility. Engaging leadership is found to be effective when it is embedded fully and becomes the culture of the organization. Evidence suggests that engaging leadership strengthens human capital in the organization and helps transform behavior and attitudes at all levels. 

Govier and Nash (2009) emphasize that transformational leadership works best in any healthcare delivery system enhancing the leadership roles of the nurses. As nurses adapt to the situations they also start recognizing value of the proactive approach in any healthcare setting. This kind of leadership approach will enhance team work among nursing staff and the sense of responsibility toward patients and organization.  Thus, the issues that cause high nurse turn-over, in spite of an effective retention policy in place, can be greatly improved by transformational leadership initiatives.  It is important that the supervisor or manager looks at the issues in its entirety so as to eliminate the root causes that are behind high turnover of the nurses.


The proper leadership approach is most critical and necessary in retaining the trained and efficient nurses.  Management needs to recognize the fact that recruiting a new and qualified nurse is more expensive than retaining existing ones. In the context of huge nursing shortage in the US, it becomes all the same more important for the management to have the most seasoned and professional approach to create the most pleasant working environment that will not only lessen work pressures on nurses but impart quality services to the patients.

  • Alimo-Metcalfe, B., Alban-Metcalfe, J. (2008). Engaging Leadership: Creating Organizations that Maximize the Potential of Their People. Retrieved December 9, 2012 from   http://www.cipd.co.uk/NR/rdonlyres/F72D3236-E832-4663-ABEC-BCC7890DC431/0/4585EngageleaderRIWEB.pdf
  • Bass, B.M., Riggio R.E. (2006). Transformational Leadership. New York: Routledge. Print CareerBuilder (2010). How to Cure the Retention Problems Ailing Your Health Care Organization. careerbuildercommunications.com. Retrieved December 9, 2012 from  http://www.careerbuildercommunications.com/pdf/turnoverrx-whitepaper.pdf
  • Govier, I., Nash, S. (2009). Examining transformational approaches to effective leadership in healthcare settings. nursing times.com. Retrieved December 9, 2012 from http://www.nursingtimes.net/nursing-practice/clinical-zones/prescribing/examining-transformational-approaches-to-effective-leadership-in-healthcare-settings/5001102.article
  • McConnell, C. (2010). Umiker’s management skills for the new health care supervisor, 5th ed. Jones and Bartlett Publishers. Sudbury.
  • Nursing Shortage (2012).  American Association of College of Nursing. aacn.nche.edu.
  • Retrieved December 9, 2012 from http://www.aacn.nche.edu/media-relations/fact- sheets/nursing-shortage Yukl, G. (2006). Leadership in organizations, 6th ed. Upper Saddle River, New Jersey: Prentice-Hall.

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