Nurse Turnover, Patient, Nurse, and System Outcomes

Tuesday, 23 July 2013: 11:05 AM

Michael A. Roche, RN, PhD, MHSc, BHSc, DipAppSc, CertMHN
Centre for Health Services Management, Faculty of Health, University of Technology, Sydney, Broadway, Australia
Christine Duffield, RN, PhD
Centre for Health Services Management, University of Technology, Sydney, Sydney, Australia

Learning Objective 1: Understand the factors that impact on nurse turnover

Learning Objective 2: Describe the relationship between nurse turnover, the practice environment, and nurse and patient outcomes


Workforce shortages and retention are critical issues facing healthcare organizations. Turnover rates in Australia have been estimated at between 12% and 38% and internationally from 14% to 39.2%. Both individual and organisational factors have been linked to turnover, but the impact of turnover on nurse and patient outcomes has been less frequently examined. This study describes the rate and costs of nurse turnover in Australia and the impact of turnover. It is part of an international project to examine the cost of nurse turnover and the impact of turnover on patient safety and nurse health and safety outcomes.


Data were collected on 62 nursing units in 11 public general acute hospitals in Australia, for two three-month periods each, between 2008 and 2010. Data included details of turnover, a unit profile, patient outcomes, the nurse practice environment, job satisfaction and other information. Turnover was defined as the voluntary transfer or resignation of nurses from their position. Ethics approval was granted. A total of 1673 Nurse Surveys were received (44% response) and over 5000 patient files were audited. In accordance with previous research that found significant differences between nursing units, data were described and correlational analyses undeertaken at that level.


Turnover rates showed substantial variation between units. The temporary replacement of staff vacancies represented the largest proportion of turnover costs. Patient falls, medication errors and other patient outcomes also varied per unit, and were associated with nurse experience and the practice environment. There was a relationship between nurse turnover, long work hours and the practice environment. 


Nurse turnover rates and costs are significant challenges to hospitals, but vary substantially between organisations. Improvements to the nursing practice environment, including access to continued education, career development opportunities and enhanced continuity of care, may influence turnover rates and patient outcomes.