TABLE 1.
Characteristics of reviewed studies
| Authors (year), country | Study design | Sample | Quality score/quality | Measures/mean values of nurse turnover | Measures of outcomes (instruments) | Unit of analysis /data analysis | Main findings (p < 0.05) |
|---|---|---|---|---|---|---|---|
| Bae et al. (2010), USA | Longitudinal | 268 nursing units, 141 hospitals | 8/medium | RN unit turnover rates/4.29% (Jan–Feb), 4.58% (Mar–Apr) | Workgroup cohesion (Sauter et al., 1997), relational coordination (Gittell, 2002), workgroup learning (Rybowiak et al., 1999), Patient satisfaction (Bacon & Mark, 2009), length of day, patient falls, medication errors | Nursing unit/ordinary least squares, Poisson regression | Nursing units with turnover rates between 3.31% and 4.50% were likely to have lower levels of workgroup learning compared with nursing units with no turnover (β = −0.183, p < 0.01). Nursing units with turnover rates between 0% and 3.3% of turnover were likely to have lower levels of patient falls than nursing units with 0%. turnover (β = −0.297, p < 0.05). |
| Bae et al. (2014), USA | Cross‐sectional | 35 nursing unit, 3 hospitals, 511 unit‐month data points, 171 unit‐quarter data points | 6/medium | RN unit turnover rate/5.00% (quarterly turnover rate), 1.82% (monthly turnover rate) | Patient falls, falls with injury, pressure ulcer, unit‐acquired pressure ulcer | Unit‐month, unit‐quarter/negative binomial regression, logit regression | NS relationship with patient falls and pressure ulcers |
| Jones (2005), USA | Cross‐sectional | 3 service lines in 1 hospital | 4/low | RN turnover externally/19.4% (3 services lines, annual turnover) 18.5% (total annual turnover rate) | RN turnover cost, total turnover cost (NTCCM [Jones, 1990]) | RN, hospital/descriptive | RN turnover cost ranged from $62,100 to $67,100. Total nurse turnover cost for the 3 services lines raged from $5.9 million to $6.4 million. |
| Jones (2008), USA | Cross‐sectional | 3 service lines in 1 hospital | 4/low | RN turnover externally/19.4% (3 services lines, annual turnover) 18.5% (total annual turnover rate) | RN turnover cost, total turnover cost (NTCCM [Jones, 1990] adjusted by CPI) | RN, hospital/descriptive | RN turnover cost ranged from $82,000 to $88,000. Total nurse turnover cost for the 3 services lines raged from $7,875,000 to $8,449,000. |
| Kim (2016), South Korea | Cross‐sectional | 2 nurses in 1 hospital | 3/low | Not reported | RN turnover cost (NTCCM [Jones, 2004]) | RN/descriptive | Turnover costs were 8,111,163 in KRW consisting of 25.14% of nurses’ average annual income. The costs spent for the experienced nurse were 2.27 times less than the novice nurse. |
| Leitão et al. (2017), Brazil | Cross‐sectional | 3 ICU, 1 hospital | 6/medium | Monthly nurse turnover rate/0% (Feb), 1.72% (Mar), 2.53% (Apr) | Incidence of nonplanned extubation of endotracheal cannula, incidence of loss of nasogastric/enteral tube, incidence of skin injury, incidence of loss of central venous catheter | Nursing unit/Pearson correlation | NS relationship between nurse turnover and quality of patients’ care |
| North & Hughes (2006), New Zealand | Cross‐sectional | 2 units, 1 hospital | 5/medium | Annual nurse turnover rate/10.2% | Modified cost of turnover (Buchan & Seccombe, 1991) | Nursing unit/descriptive | The cost of RN turnover per nursing unit for the six‐month period was just under $5,7893 in NZ$. |
| North et al. (2013), New Zealand | Prospective | 19 units, 228 unit‐months | 7/medium | Annual RN turnover rate/44.3% ranged 13.7% to 90.9% | Modified cost of turnover (Buchan & Seccombe, 1991; O'Brien‐Pallas et al., 2006) | RN/descriptive, Spearman's rank order correlation | Per RN turnover cost was 23,800 in NZ$. The turnover rate is negatively correlated with the percentage deviation of actual FTE below budgeted FTE. |
| O'Brien‐Pallas et al. (2006), Australia, Canada, New Zealand, USA | Retrospective, cross‐sectional | 11 units | 7/medium | Annual RN turnover rate/9.49% (7.4% and 11.4% for medical and surgical units, respectively) | Turnover cost (Buchan & Seccombe, 1991) | RN/descriptive | Average cost of turnover per nurse was $21,514 ranged from $10,100 to $33,062. |
| O'Brien‐Pallas et al. (2010), Canada | Repeated cross‐sectional and longitudinal | 4,481 nurses, 182 units, 41 hospitals in wave 1, 3,844 nurses, 163 units, 39 hospitals in wave 2 | 12/high | Annual RN turnover rates/ 19.9% ranged from 13.7% (geriatrics units) to ICU (26.7%) | Nurse mental health (SF‐12 mental health status [McHorney et al., 1992]), job satisfaction (McCloskey/Mueller Satisfaction Scale [Mueller & McCloskey, 1990]), medical error | Multilevel (nurse, unit levels)/random intercept hierarchical linear model, hierarchical logistic regression | Higher turnover rates were associated with deteriorated mental health (β = −6.749, p < 0.05) and lower job satisfaction (β = −14.212, p < 0.05). Higher turnover rate was associated with an increased likelihood of medical error (OR = 1.38, p < 0.05). |
| Park et al. (2014), USA | Longitudinal | 10,935 unit‐quarter observations, 2,294 units, 465 hospitals | 8/medium | Quarterly RN turnover rate in unit/5.81% ranged from 5.41% (surgical units) to 6.14% (step‐down) | Unit‐acquired pressure ulcer, RN HPPD | Multilevel (unit, hospital levels)/multilevel logistic models | Higher rates of RN turnover in prior and current quarters were associated with lower levels of RN staffing in the current quarter (β = −0.004, p < 0.001; β = −0.002, p = 0.0071). The lagged effect of RN turnover on unit‐acquired pressure ulcers was significant (OR = 1.004, 95% CI = 1.000–1.008). NS association between concurrent RN turnover and unit‐acquired pressure ulcer. |
| Reilly et al. (2014), USA | Longitudinal | 12 units, 1 hospital, 838 unit‐month observations | 6/medium | Unit‐level monthly voluntary nurse turnover rates/ 0.61% ranged from 0% to 6.58% | Job demands (monthly adjusted patient days/number of nurses in unit), patient satisfaction (Hospital Consumer Assessment of Healthcare Providers and Systems, 6 items focusing on nursing services) | Nursing unit/fixed effects panel regression, panel vector autoregressive model | The effect of voluntary turnover rates on job demands (b = 13.30, SE = 3.23, p < 0.001) was positive and statistically significant. Voluntary turnover had effects on patient satisfaction through job demand, which were negative and significant. |
| Roche et al. (2015), Australia | Longitudinal | 1,673 nurse, 62 general units, 11 hospitals | 7/medium | Annual turnover rate/15.1% ranged from 12.6% to 16.7% | Turnover cost (NTCCM [Jones, 2008]) | Unit/descriptive | $49,225 per FTE in Australian dollars ranged from $17,728 to $104,255. |
| Ruiz et al. (2016), Brazil | Exploratory and descriptive | 12 inpatient units and 15 specialized units, 1 teaching hospital | 5/medium | External monthly turnover rate including nurse, technician, assistant/0.98 ranged from 0.84% to 1.06% | Turnover cost (NTCCM [Jones, 2004]) | Unit/descriptive | Turnover/employee cost was R$2,759.69 ranged from R$2,221.42 to R$3,073.23. |
| Waldman et al. (2004), USA | Cross‐sectional | 1 academic medical center | 6/medium | No reported | Turnover cost (CoRP [lesser effectiveness of new employees compared with experienced workers] and LCs [Waldman et al., 2003]) | Hospital/descriptive | Cost per nurse by phase of employment was $1,635 to hire and $15,825 to train. CoRPs for nurses were $6,027 (Pareto LC) and $14,026 (linear LC). |
| Winter et al. (2020), Germany | Cross‐sectional | 104 German hospitals | 7/medium |
Estimation of the average rate of fluctuation of nurse per year (annual turnover) in a hospital <5%: 33%, 6–10%: 48%, 11–15%: 15%, 16–20%: 4%, >20%: 0% |
Patient satisfaction (Schwappach et al.2011) | Hospital/least‐square regression | In the multivariate regression, fluctuation of nurse is significantly negatively related to patient satisfaction with nursing care (β = −1.13, p < 0.01). |
Note: β, coefficient estimates; CI, 95% confidence interval; CoRP, cost of reduced productivity; CPI, Consumer Price Indices; FTE, full‐time equivalent; ICU, intensive care unit; KRW, South Korean Won; LC, learning curves; SE, standard error; NS, nonsignificant; NTCCM, The Nursing Turnover Cost Calculation Methodology; NZ$, New Zealand dollars; OR, odds ratio; R$, Brazilian currency; RN, registered nurse; SF, short form; HPPD, hours per patient day; USA, United States of America.