The Impact of Staff Turnover on Workplace Demands and Coworker Relationships

Abstract

Turnover among clinical staff can have detrimental effects on service provision and organizational efficiency. But how does it affect staff who remain employed at the agency? Researchers at the Institute of Behavioral Research at Texas Christian University sought to answer this question by examining the impact of staff turnover on perceptions of workplace demands and support among 353 clinical staff members from 63 outpatient substance abuse treatment programs. Study results documented that counselors in high-turnover programs reported higher demands (job stress, inadequate staffing) and lower support (communication, collaboration) within their organization, even after controlling for other factors such as decreasing budgets, increasing census, and individual measures of workload. Findings underscore the need to intentionally promote workplace communication and collaboration among staff following the departure of a coworker in order to reduce stress and minimize subsequent turnover among remaining clinical staff.

Introduction

Turnover among clinical staff has been cited as one of the most significant and challenging issues facing the substance abuse treatment field (McLellan, Carise, & Kleber, 2003). Rates are generally high, ranging from 18.5% (Knudsen, Johnson, & Roman, 2003) to 25% (Gallon, Gabriel, & Knudsen, 2003) among counselors and 24% (Knight, Broome, Edwards, & Flynn, 2011) to 54% (McLellan et al., 2003) among program directors. The problem appears to be pervasive, with instability sometimes spanning multiple years. While attrition in any organization is natural and sometimes healthy, workforce change can be particularly detrimental in social service organizations where personal growth and recovery is cultivated through relationships between clients and the individuals who deliver services – namely counselors, case managers, and social-workers. In order for clinical service agencies to provide consistent and quality services, there must be some degree of staffing stability.

While the impact of turnover on service delivery is obvious, loss of staff can also have more subtle effects on the organization. Studies of nursing and other social service industries suggest that turnover causes financial strain on organizations while they recruit and train new employees because it costs more to hire and train than it does to train existing staff (Shaw, Duffy, Johnson, & Lockhart, 2005). Turnover also disrupts organizational efficiency (Alexander, Bloom, & Nuchols, 1994) and can threaten the implementation and sustainability of new initiatives (Glisson et al., 2008). When staff members leave, aspects of organizational functioning that promote innovation and quality service provision (such as supportive co-worker relationships) become compromised, particularly when stress within the work environment is heightened (Flynn & Simpson, 2009). To further compound the problem, the likelihood of turnover among remaining staff increases when stress is high and co-worker support is low (Ben-Dror, 1994). Co-worker support, therefore, not only serves as a foundation for positive organizational functioning, but also as a protective factor against both emotional exhaustion and intention to quit (Ducharme, Knudsen, & Roman, 2008). Turnover may be especially detrimental when other organizational (increasing client census, decreasing budgets) and personal factors (length of employment), are also placing demands on remaining staff. For instance, budget cuts and downsizing can negatively impact perceptions of the work environment (Brown, Arnetz, & Petersson, 2003), creating additional demands on employees and further limiting opportunities for supportive interaction and collaboration among staff.

These previous studies raise important questions about how employee turnover impacts staff who remain employed at the agency. For instance, do counselors report higher demands and less supportive relationships with coworkers when their organization experiences high turnover? Furthermore, are perceptions merely due to budget and census changes or does loss of staff impact organizational health even when accounting for these factors?

To answer these questions, researchers at the Institute of Behavioral Research at Texas Christian University in Fort Worth, TX asked Program Directors and Clinical Staff working in 63 outpatient substance abuse treatment programs in 9 states to describe their workplace environment. Beginning in 2004, each program provided an annual “snapshot” of their organization. Program Directors completed an assessment that measured organizational structure and operations and clinical staff completed a survey of organizational functioning. The study sample consisted of 353 clinical staff with direct client contact (312 counselors and 41 clinical/program directors).

Programs were generally private-non-profit (73%) and affiliated with a parent organization (69%). Twenty-five percent described their services as regular outpatient (less than 6 hours of structured programming per week), 16% as intensive outpatient (minimum of 2 hours of structured programming on 3 days per week), and 59% as mixed (providing both regular and intensive tracks). On average, clients received 6.3 hours of counseling per week. Agencies employed an average of 5.4 counseling staff with caseloads averaging 26 clients (SD = 16). Clinical staff were predominantly female (60%), White (76%; 13% African-American, 11% Hispanic), and in their forties (M = 48, SD = 11). Twenty-five percent had been employed in their current job for less than 12 months and 28% for 6 or more years.

Measuring Staff Perceptions of Workplace Demands, Supportive Work Relationships, and Agency Turnover Rates

The questions used to measure workplace demands and support can be found in Table 1. Work-environment demands includes questions about job stress and inadequate staffing patterns. Supportive relationships includes questions about communication, cohesion and collaboration among coworkers. For each item, a rating scale was used ranging from “disagree strongly,” to “agree strongly.”

Table 1.

Measures of Work Environment Demands and Supportive Relationships

Stress

You are under too many pressures to do your job effectively. Staff members often show signs of stress and strain. The heavy workload here reduces program effectiveness. Staff frustration is common here.

Staffing

There are enough counselors here to meet current client needs. A larger support staff is needed to help meet program needs. ® Frequent staff turnover is a problem for this program. ® Counselors here are able to spend enough time with clients. Support staff here have the skills they need to do their jobs. Clinical staff here are well-trained.

Communication

Ideas and suggestions from staff get fair consideration by program management. The formal and informal communication channels here work very well. Program staff are always kept well informed. More open discussions about program issues are needed here. ® Staff members always feel free to ask questions and express concerns in this program.

Cohesion

Staff here all get along very well. There is too much friction among staff members. ® The staff here always work together as a team. Staff here are always quick to help one another when needed. Mutual trust and cooperation among staff in this program are strong. Everybody here does their fair share of work.

Collaboration

Counselors at this program make a conscious effort to coordinate with other service professionals. Most counselors at this program are cordial. Counselors here design therapeutic interventions together. The director, counselors, and staff collaborate to make this program run effectively.

Note: ® represent items with reverse scoring.

Assessment domains from the Survey of Organizational Functioning (SOF; Broome, Knight, Flynn, & Simpson, 2007).

For this particular study, measures of turnover, census, and budget reflected changes that occurred between Years 1 and 2. Staff surveys were collected during Year 2, which allowed researchers to examine how turnover, census, and budget changes affected perceptions of organizational functioning among staff who remained employed after some coworkers had left. At the start of the project, program directors were asked to indicate the number of staff members who had direct clinical contact with clients, including counselors, social workers, case managers, clinical supervisors, and therapists. At year 2, program informants were asked to indicate the number of clinical staff who left during the previous 12-month period. A ratio reflecting the number that left to the original number of counseling staff was calculated for each program. At Year 2, directors also reported whether their census and budget had decreased, remained stable, or increased over the previous 12-month period.

On average, programs lost 26% (SD = 27%) of counseling staff in the year prior to the survey. Census was generally stable (43%) or increasing (46%), and budgets were generally constant (63%; 19% decreasing, 19% increasing). The relationship between census and budget change was positive—programs reporting increased census also reported increased budgets. Higher turnover was associated with decreasing census, indicating that during the period of staff turnover, fewer clients were served. Whether turnover (in the form of layoffs) occurred because of reduced census or fewer clients were served due to staff shortages cannot be determined. Turnover was not related to budgetary changes, however, suggesting that economic factors did not contribute to staffing changes.

The Impact of Turnover on Workplace Demands and Supportive Work Relationships

Because the research questions involved both organizational and individual measures (e.g., tenure, caseload), a sophisticated analytical technique known as hierarchical linear modeling (HLM) was used to analyze the data (Raudenbush & Bryk, 2002). A detailed description of the methods, statistical analyses, and results were published in the Journal of Substance Abuse Treatment (Knight, Becan, & Flynn, 2012).

Staff members across programs reported moderate amounts of job stress, inadequate staffing, and communication. Cohesion and collaboration were slightly higher. The findings indicated that organizational change and program membership impact perceptions of workplace demands and relationships.

Individuals working in programs with high turnover reported higher stress and more inadequate staffing than individuals working in programs with lower turnover. Turnover also affects perceptions of supportive work relationships as evidenced by lower communication and lower peer collaboration. Furthermore, the impact of turnover remains significant, even after considering contextual and individual factors known to influence perceptions of organizational health.

For supportive work relationships, only turnover and budget change were significant predictors of communication and peer collaboration. Staff in low turnover programs reported better communication and peer collaboration than staff in high turnover programs. Communication and collaboration were also higher when budgets had increased. The fact that none of the individual-level measures that were included in the analyses predicted supportive work relationships suggests that organizational factors may play a larger role in shaping perceptions of supportive work relationships than individual factors.

Neither budget and census change, nor individual workload contributed to perceptions of inadequate staffing. This is somewhat surprising, given the general assumption that decreasing budgets translate to less than ideal staffing patterns. Yet the correlation between budget change and turnover for this sample was not significant. Relationships among actual and perceived budget and staffing issues appear to be complex and most likely involve additional aspects of organizational functioning beyond those measured in this study.

In contrast to inadequate staffing, the examination of perceived stress identified four other things to consider – in addition to turnover – that increased stress among clinical staff (increasing census, decreasing budget, longer tenure, and larger caseload). These findings are consistent with prior research documenting the link between budget strain and employee stress (Decker, Wheeler, Johnson, & Parsons, 2001) and illustrate that client census changes also affect stress, independent of budget changes. Furthermore, the longer a counselor had been in their position, the more stress they were likely to report, which could potentially reflect greater responsibilities (both clinical and/or managerial) among more senior staff members (Taylor, Audia, & Gupta, 1996). Consistent with previous studies, larger caseloads were also associated with greater perceived stress. Whereas perceptions of staffing patterns are influenced primarily by turnover, perceptions of stress appear to be shaped by a combination of organizational and individual factors.

Conclusions and Applications

Results demonstrate that turnover negatively affects workplace demands and coworker support, and operates independent of fluctuations in budget or census. Support is associated primarily with organizational factors, but stress is associated with both organizational and individual factors. The more complex model for stress may reflect that individuals respond differently to workplace demands, interpreting events through their own personal filters, expectations, and experience. For example, when stressors are perceived as a challenge, employees report greater job satisfaction; when stressors are perceived as a hindrance, the opposite is seen (Cavanaugh, Boswell, Roehling, & Boudreau, 2000). Staff turnover may be interpreted differently depending on one’s workload and regardless of concomitant changes in census or budget.

Because social resources within the workplace can serve as a buffer against potentially negative effects of high job demands on work/job outcomes (Bakker & Demerouti, 2007), it is important to find ways to facilitate the development of supportive networks within an organization. Supportive coworker relationships may diminish following staff turnover, and suggest that efforts to strengthen social resources may be important following the departure of an employee. Determining what aspects of the organization may be contributing to turnover and targeting ways of strengthening relationships to help staff cope with increasing workplace demands following coworker departure may help to reduce employee stress and prevent further loss of staff.

Research has documented effective strategies for retaining employees, even during tumultuous times (DeMarco, 2007). Intentional efforts to increase organizational identification and commitment have important implications for reducing employee intentions to quit (Knudsen et al., 2003). Individuals who are committed to an organization are more likely to remain employed there if they feel the organization is committed to personnel development (Kraimer, Seibert, Wayne, Liden, & Bravo, 2010) and is open to programmatic change (Knight, Landrum, Becan, & Flynn, 2012). Intentional efforts to improve employee perceptions of support through mentoring benefit both the organization and the individual by reducing turnover intentions and strengthening collaborative relationships (Dawley, Andrews, & Bucklew, 2010).

Several limitations should be noted. First, while it is likely that increased demands and decreased co-worker support may lead to poorer organizational outcomes (including increased risk of employee turnover), our study did not examine measures of organizational functioning over time. Second, the generalizability of these findings to behavioral health organizations in general may be limited because only outpatient substance abuse treatment organizations were included. Furthermore, data were drawn from only four geographic regions of the US, and due to sample attrition, only 64% of programs in the original sample provided data in the second year of the project.

Despite limitations, this study offers important insights into how clinical staff turnover within substance abuse treatment programs affects the workplace environment. Not only does turnover impact service provision (Glisson et al., 2008), it also affects organizational health, exacerbating stress and decreasing perceptions of supportive work relationships among staff who remain employed.