Monday, November 3, 2003

This presentation is part of : An International Examination of the Cost of Turnover and Its Impact on Patient Safety and Nurse Outcomes

A Critical Appraisal of the Literature on Nursing Turnover

Christine Duffield, RN, BScN, MHP, PhD, FACHSE, Centre for Health Services Management, University of Technology, Sydney, New South Wales, Australia, Pat Griffin, RN, PhD, Office of Nursing Policy, Health Policy and Communications Branch, Health Canada, Ottawa, ON, Canada, Patricia Hinton Walker, PhD, RN, FAAN, Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, MD, USA, Heather K. S. Laschinger, RN, PhD, School of Nursing, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada, Linda L. O'Brien-Pallas, RN, PhD, Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada, Judith Shamian, RN, PhD, Health Canada, Nursing Policy, Ottawa, ON, Canada, and Patricia W. Stone, PhD, MPH, RN, Columbia University, New York, NY, USA.

Objective: Nursing shortages are of critical concern to policy makers, managers, and registered nurses in hospitals in many countries worldwide. This paper will provide a description of the state of knowledge about nursing turnover. Specifically, we will describe: 1) the relationship between the costs of staffing practices and turnover; 2) the costs of staffing and turnover and the related impact on patient safety outcomes; and, 3) the costs of staffing and turnover and the related impact on health care worker outcomes.

Methods: Criteria proposed by Cooper (1982) for conducting integrated literature review were used to guide this activity. The process included: a) the development of an inventory of peer reviewed and non peer reviewed studies; b) an ongoing scan of relevant grey literature and the Internet; c) expert consultation to provide insight into current issues and the context of nursing turnover in hospitals; and, d) application of criteria for review.

Findings: At present over 2000 citations have been located and examined. Numerous research studies of varying quality have been completed on the factors which are hypothesized to influence turnover (e.g., nurse staffing, skill mix, management practices related to patient assignment, quality work environments, nursing sensitive outcomes such as nosocomial infections, skin breakdown, falls, and nurse outcomes such as injuries and health). However, only a handful of studies are reported which focus on nursing turnover explicitly.

Conclusion: Since limited work has been done, our paper will highlight key findings from studies to date and demonstrate how this work has helped us to specify the conceptual elements of our theoretical framework and the research questions we are exploring.

Implications: There is a significant shortage of methodologically sound studies which examine nursing turnover.

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