Stemming the tide of nursing turnover

By Robert Nieves*
Tuesday, 05 March, 2019

Stemming the tide of nursing turnover

Improved education, training and digital empowerment are key to keeping nurses on the job, critical at a time when demand for their services is on the rise.

A rising demand for health care in Australia, continual overtime to make up for manpower shortages and high patient acuity are causing massive burnout for new and experienced nurses. Some hospitals are experiencing as high as 30% turnover each year1 with nurses leaving their professions due to rising work demands and burnout. Furthermore, Australia’s Department of Health has forecasted a nursing shortfall of about 85,000 by 2025, growing to 123,000 nurses by 2030.2 If these predictions come true, hospitals will experience a major crisis in their ability to deliver high-quality and safe care.

Too often, policies that seek to address the nursing shortage issue focus primarily on recruiting new staff, overlooking retention of senior, experienced nurses. The former is much harder and more costly to achieve — an Australian study found that the average cost to provider was $49,225 per full-time position turned over3 — for several reasons. First off, employing new graduate nurses (NGNs) in Australia is expensive, and the onboarding of new nurses is a relatively long process.

Furthermore, there are unmatched expectations between NGNs and employers, where NGNs are not trained sufficiently to transition into the role, while employers expect much more — causing dissatisfaction on both ends. As a result of theory-to-practice gaps, NGNs often feel that they are lacking skills in key clinical areas and do not always feel ready to be wholly responsible for patient care in their first year of employment.

As we look at the various levels of nursing, one of the biggest causes of dissatisfaction for Enrolled Nurses (ENs) is the inability to practise to their full scope of their training and qualifications.4 Factors influencing this include organisational policy (including individual ward/unit policies), and the understandings and attitudes of Registered Nurses (RNs) and others in the healthcare team in their areas.4

While not much can change overnight with these circumstances, there are three ways to progressively stem the turnover tide:

1. Raising the quality of nursing education

It all begins with nursing education — knowledge can bridge theory-to-practice gaps and enhance nursing workforce performance. Nursing education should classify and frame nursing knowledge in ways that prepare graduates for complex nursing practice to safeguard the public.

A good example is Box Hill Institute, an Australian nursing faculty that adopted evidence-based training and references online solutions to transform and raise the quality of its nursing program. Leveraging these resources, Box Hill Institute standardised theory and skills across its three campuses and gave their nursing graduates more confidence in practising their skills. Faculty staff and students could also access learning materials from multiple devices.

Additionally, clinical placement experiences are crucial as they help to expose students to different health settings and facilitate both professional and personal growth. A study involving students from four Australian universities recommended that appropriate sequencing of clinical practice in relation to theory, consistency of venue and preparation for the health setting were important in providing quality clinical placements.5 The Australian Nursing and Midwifery Federation (ANMF) further supports these findings.

2. Providing training to onboard new nurses

In the same vein, healthcare organisations need to look into raising the quality of on-the-job training to equip new nurses with the necessary skills to be workforce-ready. However, nursing education should not stop with the onboarding process. To ensure a highly competent workforce, organisations must institute and invest in evidence-based competence programs to ensure that nurses are practising according to the latest evidence and organisational standards that will build up both individual competence and integrated competencies. Competence programs that include integrated competencies ensure that nurses fully understand how nursing practice works in collaboration with, and alongside, other interdisciplinary team members. Evidence clearly shows that when nurses are enabled and supported to do the job they were trained in, they are less likely to leave the profession.

3. Empowering the nursing community to use digital technology

Nursing students and nurses alike need to understand the benefits of digital health, and be confident and efficient in using technologies that continue to evolve. As EHRs are now a common addition in many healthcare settings, organisations must take advantage of the EHR technology to support nursing knowledge and decision-making at the point of care. Clinical nursing leadership must take ownership of the clinical workflows and processes that are implemented in the EHR, such as the care planning process. Increasing adoption of clinical decision support (CDS) tools that are evidence-based, such as the care planning process, are an effective mechanism to turn an everyday activity with little perceived value into a dynamic process that empowers the nurse with actionable knowledge.

Training on nursing informatics is therefore paramount to help current nurse leaders, staff nurses and nurses-in-training to be better equipped to manage the demands of the increasingly high-tech nursing environment.

Stemming the nursing turnover tide requires a systemic approach to addressing burnout among nursing professionals. Efforts must be made to elevate the level of nursing education to close knowledge gaps. Coupled with the adoption of digital tools to drive workflow efficiencies, providers can enable nurses to perform at their best, thereby directly impacting the quality and sustainability of the nation’s health care.

*Robert Nieves is Vice President of Health Informatics, Clinical Solutions for Elsevier, a global information analytics business which provides digital solutions and tools for the nursing and health industry.

  1. Parliament of Australia. Chapter 2 - Nurse shortages and the impact on health services. Retrieved from
  2. HealthWorkforce Australia. (2014). AUSTRALIA’S FUTURE HEALTH WORKFORCE – Nurses. Retrieved from$File/AFHW%20-%20Nurses%20detailed%20report.pdf
  3. Roche,M.A., Duffield,C.M., Homer,C., Buchan,J. and Dimitrelis,S. (2015). The rate and cost of nurse turnover in Australia. Collegian Journal, 22:353-358.
  4. McKenna,L., Wood,P., Williams,A., O’Connor,M., Moss,C., Griffiths,D., Della,P., Endacott,R. and Cross,W. (2018). Scope of practice and workforce issues confronting Australian Enrolled Nurses: A qualitative analysis. Collegian Journal.
  5. Birks,M., Bagley,T., Park,T., Burkot,C. and Mills,J. (2017). The impact of clinical placement model on learning in nursing: A descriptive exploratory study. Australian Journal of Advanced Nursing. Vol 34, Issue 3.

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