New Nurse Turnover and Patient Safety: What’s the Problem?

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New Nurse Turnover and Patient Safety: What’s the Problem?

Ineffective staffing programs are often the invisible factors that cause the best intentioned patient safety programs to collapse. Positive patient care outcomes are dependent upon a “point of excellence” where the clinician and the patient interact synergistically every time. Variability between clinicians because of nurse turnover blocks the chances of achieving excellence—which is particularly harmful when it involves the new nurse.


As many as 57% of new nurses leave the field by their second year (Twibell, 2012), often due to inadequate orientation and scheduling concerns such as heavy workloads, excessive night and weekend work, and inability to work on the unit of their choice. Other retention factors include issues with management and lack of career progression (Beecroft et al., 2008). All of these causes of new nurse turnover have one thing in common: they jeopardize the safety of patients.


The Effect of New Nurse Turnover on Patient Safety


In a 2012 survey, only 10% of nurse executives believed that new graduate nurses were fully prepared to practice in a safe and effective way (Twibell, 2012). Nurse-sensitive patient outcomes, such as falls and pressure ulcers, are difficult to achieve with a workforce of continual new learners. It is also impossible to build the necessary teamwork, trust, and effective communication needed to achieve patient safety goals when new nurse graduates constantly turnover.


Patient confidence in healthcare organizations erodes when patients and families do not believe that they are being cared for by the very best—or by an excessive number of new nurses. That story is told by patients throughout the community, which damages organizational reputations. An excessive number of inexperienced nurses also creates higher workload demands and heightened stress for the experienced nurses, further contributing to patient dissatisfaction.


Preventing New Nurse Turnover


Many of the evidence-based principles proven to boost patient safety can be used to reduce staff turnover. Below are several best practices for reducing the unnecessary churn of new nurses in any healthcare organization.


  1. Integrate intelligent talent management technology. Utilizing integrated talent management systems (Oakes & Galagan, 2011) that include hiring processes that assess values and attitudes that will successfully fit with the organization have been shown to be very important. Post-hire, tracking the new nurse’s clinical performance and professional socialization while providing useful feedback is essential to building clinical competence and maintaining nurse engagement. When the information can be loaded into an electronic “Nurse Portfolio” document to manage and analyze the data, the nurse, preceptor, manager, and other necessary people can create data-driven plans that are built on evidence, enabling the organization to better develop competence among new nurses.
  2. Implement residency programs for new nurses. Residency programs for new grads have been proven to be highly effective in reducing turnover and increasing confidence and competency of new nurses. In a survey of several residency programs, turnover has been shown to be reduced by 12%. These programs have been found to obtain retention rates ranging from 88% to 96% for new graduate nurses (Twibell, 2012). The cost of new nurse residency programs is offset by the reduced turnover costs these programs deliver. At the core of this success are integrated talent management systems that provide the ability to track and analyze the new nurse’s competency, educational needs, and their progress in learning the professional role of the nurse.
  3. Put paper-based staffing systems where they belong, in the trash. Unfortunately, many healthcare organizations rely on paper-based staff management systems that cannot provide the analytics necessary to create data-driven staffing plans and evaluate their effectiveness. As a result, the perception of unfair schedules, excessive workloads, and inequitable assignments for new nurses become recurring issues. In comparison, digital staff management solutions provide easy retrospective analysis that can evaluate staffing effectiveness and match the right patient to the right nurse. Patient classification features in digital staffing systems also ensure optimal staffing assignments that take into account nurse skill levels and workload. This prevents new nurses from being paired with a patient who requires a higher level of care than the nurse is capable of based on her competencies and level of orientation.


Efforts to reduce turnover and improve patient safety must be closely aligned. The threatened or actual termination of a new nurse should be treated as a sentinel event because of the harm it causes to patients, the nurse, and the organization. To achieve better outcomes, healthcare organizations must examine the cause of nursing turnover and acknowledge its impact on patient safety.



Karlene Kerfoot has held a variety of positions in nursing and patient care administration, clinical practice, academic positions in nursing and MHA and MBA programs and healthcare consulting and is currently the vice president of nursing at API Healthcare. Kerfoot has been the corporate chief nursing and patient care officer at three of the largest healthcare systems in the country: Aurora Health Care System headquartered in Milwaukee, Wisconsin; Clarian Health Partners in Indianapolis, Indiana; and the Memorial Hermann Healthcare System in Houston, Texas. Kerfoot’s passion has been to improve the care of patients by improving the quality of work life for clinicians on the front line. She has therefore worked extensively in the area of retention, Magnet Recognition, patient safety, evidence-based staffing/scheduling, shared governance, and staff and leader development to create innovations that will enable caregivers at the front line to become the clinicians they always wanted to be. Kerfoot may be contacted


Beecroft, P. C., Dorey, F., & Wenten, M. (2008). Turnover intention in new graduate nurses: a multivariate analysis. Journal of Advanced Nursing, 62(1), 41-52