Introduction
Healthcare is one of the industries that have experienced high levels of turnover coming second after the hospitality industry in the United States and the world over. As one of the sector that is described as customer-centered, the healthcare industry is highly affected by nursing staff turnover as it has a direct effect on the quality of care that patients receive in hospitals. Healthcare facilities must be a very concern of the effects that revolving door as it is always referred to have on the patient care and satisfaction. High nursing turnover in healthcare is no longer something that is taken lightly by organizations because of the impact it has on the quality of care and patient satisfaction (Edwards et al, 2018). However, despite the fact that it is a huge problem, most of the healthcare leaders see this as just a normal cost of doing business yet it does not only impact the care provided but also retard the reputation of the health facilities in general. The health leaders see this high turnover in the lens of monetary loss but they do not see it in relation to change in the quality of care provided and other implications that it has. Going by the effects of turnover that may be indirect or direct, it is required that healthcare leaders should take measures to address this issue that top issues that face the healthcare sector (Rondeau, 2015, April). This paper will discuss the types of healthcare staff turnover, the causes of the high turnover and its implications to the healthcare sector, the imperativeness of sufficient staffing in healthcare and the impact of turnover on the quality of care in United States, Brazil, and Saudi Arabia.
Types of Turnover in Healthcare :
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There are majorly four types of employee turnover that is witnessed in the healthcare sector. Employee turnover can be defined as the rate at which employee are leaving the organization and the rate at which organizations replace employees that have just left the company (Shuck et al, 2014). There are several reasons that cause employee turnover but this will be discussed further in the next section. The four main forms of employee turnover in the healthcare include the following.
Retirement is one of the types of employee turnover that exist in the
healthcare. This occurs when old and employees who have reached their retirement period finally go to retire. Similarly, this also occurs when an employee takes an early retirement because of their own reasons. Internal transfers in another form of employee turnover that is witnessed in the healthcare (Thanacoody et al, 2014). This happens when an employee working in a specific facility is transferred to another facility that belongs to the same company or organization or that are under one management and ownership. It also involves employees taking up a different position or role in the same organization.
The other type of turnover experienced in the healthcare is involuntary turnover. Involuntary turnover occurs when the organization asks employees to leave because of different reasons that include budget cuts, retrenchment, and underperformance or even because of the unethical issue around the dismissed employees (Rondeau, 2015, April). Last but not least is the voluntary turnover which occurs when employees in an organization decide to quit the company. This type of turnover is common among organizations that are not well administered or do not motivate its employees.
Causes of Staff Turnover and Its Effect in Healthcare Sector
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There are several causes of employee turnover in the healthcare sectors that range from legal, administrative and personal reasons. One of the leading causes of employee turnover in healthcare is overworking (Rondeau, 2015, April). Most of the nurses in the clinical setting are likely to quit their current job and join other organizations that understand the need for work-life balance. This cause contributes to almost 70% of organizational turnover. The other cause of employee turnover in the healthcare is the unequal treatment of the employees. Favoritism is one of the leading causes of employee turnover as those who feel discriminated against seeking to leave. This may involve making some employees to work few days as compared to others.
Thirdly, employees leave because of low compensation since most of the employees are motivated with high compensation. Healthcare is one of the most sensitive and complex working environment and a ten percent increase somewhere will make the employees quit their current job (Harmon et al, 2003). Company culture and organizational structure is also another reason why employees leave and contribute immensely to turnover. This is an administrative cause and it has been proven that organizational culture is correlated to the happiness of employees at any organization. Just like sports personalities, an employee like to work in places where they feel that their talent and career will be nurtured. In this regard, most of the employee leaves an organization that does not offer them an opportunity to develop their talents or careers. Employee turnover in the healthcare is an issue that needs to be addressed with the seriousness it deserves because of its impacts on health care delivery (Pawar & Chakravarthy, 2014). The consequences are far-reaching and include low productivity of employees, lack of personalized attention to the patients, understaffing which results in negligence among other issues.
Other consequences include lack of enough staff while the administration is filling the gaps in staffing that is left when the nurses leave the health facilities. The gaps that are created in the healthcare facilities create a shortage of the labor force which compromises the way nurses offer medical services to its patients and enhance the patient satisfaction (Pawar & Chakravarthy, 2014). Another impact of the high turnover in the healthcare is nurses burnout which results from the increased pressure that the remaining staff face after others leaving.
The significance of Adequate Staffing in Healthcare
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Adequate staffing is something that has been advocated for by most of the people who are a concern about the health of the people globally. In fact, the nursing ethics and code of conduct have realized the significance of having well-staffed health facilities as it contributed to the observation of the ethics and the code of conduct because of the required facilitation to work effectively (Pawar & Chakravarthy, 2014). It is because of these benefits of adequate healthcare staffing that most of the organizations have used all available means that include compensation, career development programs, staff satisfaction, flexing their time at work, awarding programs and retention bonuses that are meant to retain talents in their health organizations.
Adequate staffing has a number of benefits that include the following. The first benefit of the adequate nursing staff is that it contributes to the team cohesion (van de Klundert et al, 2018). Team cohesion is one of the most important elements of quality healthcare delivery in the sense that sabotage is eliminated. It is the views of most scholars that the higher the rate of employee turnover, the higher chances that employees will not be able to understand their teams, reduces teamwork, and group cohesion. Healthcare is very sensitive and any form of laxity among the teams of sabotage will definitely hurt the quality of care provided to the patients. Secondly, adequate staffing in healthcare does not only enhance the quality of service delivered but also ensure that patients are satisfied since they are given the attention that they deserve while in the hospitals (Waldman et al, 2004). Similarly, teamwork enhances employee productivity as cohesion experienced among the employees is one of the ways through which employees feel motivated and willing to work
Boredom is completely eliminated in health facilities where there is adequate staffing as nurses are able to have sufficient rest after their shift (Waldman et al, 2004). In a healthcare setting where there is inadequate staffing, the hospitals run the risks of not attending to its patients fully. This is eliminated when there is adequate staffing as the patients are given the full attention that patients deserve. Patient-centered attention given to the patients is important as it enhances the quality of care provided to the patient hence patient satisfaction (Pawar & Chakravarthy, 2014). One of the factors that have been documented to contribute to the high level of mortality in the healthcare is inadequate staffing in the healthcare. Having adequate health professionals in health centers is important as it allows nurses to adequately attend to emergencies and save a life in the process.
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Impacts of Turnover on Quality of Care in United States, Brazil, and Saudi Arabia
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Nursing care is significantly affected in the cases where there is a high level of turnover among the nursing staff. The impacts of the high turnover on the quality of care provided by the nurses can be divided into two categories that include the direct and the indirect impacts. However, the direct impacts are more financially oriented and impact the healthcare facilities more as compared to the nursing quality care (Collins et al, 2015). However, it is right to argue that though the direct cost affects administrations more than nurses; the impact has a tremendous impact on the quality of care provided by the nurses. The effects of high turnover in the healthcare systems in the United States, Brazil, and Saudi Arabia are almost similar. For instance, financial costs affect the quality of care in the sense that the administration will direct much of its resources to the administrative functions to fill the gaps that are created by the leaving nurses.
The effect of concentrating cash to the administrative functions in the healthcare due to turnover outcomes such as hiring, advertisement, and recruitment reduce the amount channeled to the quality of care provided by the nurses. This is an impact that is witnessed in Brazil, the United States and Saudi Arabia (Nei et al, 2015). High turnover in the healthcare reduces the amount of money allocated to the training and development of nurses in the healthcare as the nurses are not provided with the requisite training that is required to advance the qualification hence the quality of care the nurses provide to the patients. This is an impact that is witnessed in all the countries globally and the United States, Brazil, and Saudi Arabia in equal measure through the trend in high in Saudi Arabia (Collini et al, 2015). United States experience over 20% healthcare employees turnover, Brazil experience healthcare employees turnover of about 27% while Saudi Arabia has the lowest turnover at around 17%. The indirect costs of turnover in Brazil, United States, and Saudi Arabia is one of the most devastating issues that affect the quality of health care provided by nurses to satisfy the patients (Harris et al, 2018). One of the major problems is that indirect impacts are not easy to quantify though they reveal themselves in different ways.
The major impact of healthcare employees turnover in the above-mentioned countries is that high turnover results to retard productivity among the nurses (Harris et al, 2018). Loss of productivity is one of the impacts that result from high employee turnover in the healthcare. The productivity among the nurses comes as a result of the loss of the motivation and morale among the nurses. The lack of enough staff while the administration is filling the gaps in staffing that is left when the nurses leave the health facilities (Hogh et al, 2011). The gaps that are created in the healthcare facilities create a shortage of the labor force which compromises the way nurses offer medical services to its patients and enhance the patient satisfaction.
Another impact of the high turnover in the healthcare is nurses burnout which results from the increased pressure that the remaining staff face after others leaving. When two out of 6 nurses leave any hospital facilities, the remaining four will be expected to fill the gap in service left at the health facilities. This results in burnout which may compromise the service and quality of care provided by the nurses (Hogh et al, 2011). It is because of the burnout that most of the cases resulting from negligence have been reporting yet these cases may not be necessarily negligence but as a result of tiredness due to too much work. Similarly, high employee turnover in the healthcare results to less attention being directed to the patients because of the few employee or staff which reduce in any given facilities (Hogh et al, 2011). This results to the law attention n given to patients that require specialized care because of the responsibilities that a single nurse has to deal with. In this case, nurses are not able to concentrate on one patient and give them the attention that they deserve hence reducing the patient satisfaction because of its low quality of care provided.
Time to the time change of employees in a healthcare setting is in itself a very unethical issue since it deprives patients that chances to bond with the community and the patients (Mohr et al, 2012). Nursing is one of the professionals that is well served when the people involved are experienced in the type of health issues that relate to the area or region. In this essence, the healthcare sector is not well served when there is a regular change in the healthcare professionals in any given region. Similarly, it takes a very long time for the new nurses who are brought in to take the gaps that are left by outgoing nurses to adapt to the culture of the organization and fit in the facility. This delay in gelling with the other staff has a big effect on the quality of care the nurses provide to the patients (Collini et al, 2015). The other impact is the lack of knowledge of the practices that the health facility holds. This is a huge problem and vary based on religion, norms, patient knowledge, familiarity with other practices. Whereas the impacts that nurses face from a high turnover that compromise quality healthcare provision are similar across the global platform, the last issue that varies from one region to the other. The idea of culture affects every country differently. The issue of culture in Brazil and the United States may not be an issue that affects healthcare provision by the nurses (Carnahan et al, 2017). However, this is a big issue in Saudi Arabia as an employer in nursing care must have the knowledge and should be able to understand the Arab culture to be gelled into the system and provide quality care to the patients.
Conclusion
There can be no doubt that adequate staffing is what determines the type of healthcare services provided by the healthcare as it results in safe and quality services. As earlier noted, nurse turnover is one of the issues that affect the delivery of services to the patients. The phenomenon that is high in the healthcare sector has been documented as one of the factors that reduce quality care provision and reduce patient satisfaction in the healthcare setting. However, based on the analysis of the effects of the employee turnover in healthcare, it is very clear that the impacts experienced countries are similar say for those that are related to culture. It is therefore expected that healthcare leaders and administrators should change tacks on the way they deal with employees so as to retain the nurses in their health facilities since most of the causes of turnover are linked to the administration.
References
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