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Over 70% of Nurse Staff Turnover is Due to Bad Leadership

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Specializes in Gastrointestinal Nursing. Has 28 years experience.

What can we do about bad management?

We all have had bad managers and good managers, but there is a phenomena regarding the bad ones. How do they get into management? How are they able to keep their jobs? Is it because upper management is lazy and doesn’t want to bother with replacing them? Could it be that no one reports the bad managers and therefore upper management doesn’t know? Let’s discuss!

Over 70% of Nurse Staff Turnover is Due to Bad Leadership

In our country, and specifically in healthcare, we are leadership deprived. It is difficult to lure good leaders into management positions due to the increased stress that they will have to deal with. Adding to that, younger nurses don’t want it either. There are other fields of nursing that they can invest education and experience in that will yield them more money. Some nurse managers are promoted out of convenience or because they are great nurses. However, Good clinicians don’t always make effective managers because they may not have any leadership skills.

Over 70% of nurse staff turnover is because of bad managers (Roussal, 2016). When a nurse leaves a position, it can cost around $75,000 to replace that person (Roussal, 2016). This includes the recruitment of the new staff person, replacement, and possibly temporary staff until the position is filled. Included in that number is the overtime paid to the present staff and the orientation of the new person. When there is a high turnover, the core staff become burned out and unhappy leading to the potential of additional turnover.

Personally, I have had some fantastic nurse managers, and some not so fantastic. But my recent experience tops the not so fantastic scale by epic proportions. I kept waiting for the lies to catch up to this person, or the emotional bullying to escalate until someone finally reported the problem. For years, I had begged for help from the manager’s superior, but to no avail. Nothing happened. I felt trapped, frustrated, and angry. Was there no one who cared that the whole department was stressed and unhappy? A part of my frustration was that my co-workers would not stand up for themselves and report the manager. A culture of co-dependency and toxic circumstances had festered for so many years, that I guess they accepted it as status quo.

Recently, my manager did something that was so egregious that this person is now forced to step down from their position. What I have realized from this experience is that some of my co-workers who would not have reported this incident. The manager would have gotten by with it, and gone on to commit other intentional errors. Now that there is some exposure to the bad management, my co-workers are more willing to speak up. The people who were brave enough to speak up in the first place did so with much consideration and purpose. There are incidents that are reportable, that must be reported by those with knowledge of what happened. Of course, there are incidents that aren’t harmful but still need to be reported. This allows for a review of the system and root cause analysis that improves how we do things and prevent future incidents.

There are a few leadership qualities that lead to failure; lack of vision is one of them. Leaders must be able to articulate their vision so that the staff can relate and understand. This will help staff know that they are a vital part of fulfilling that vision. If a leader has no connection to the larger picture, the staff feel disconnected and unimportant. When a manager has no empathy, the staff don’t feel cared for. Part of having empathy is being able to listen and hear them when they have concerns. No motivation can kill a department’s ability to thrive. Having an environment that helps to create energy and purpose will allow the staff to enjoy their workplace. Also, when a leader has no eye on the future, the staff feel stifled and are unable to learn and grow.

Good leaders create trust between themselves and the staff. If the staff has trust, then they will feel comfortable bringing to you issues that they have. They will also know that the manager has their back in difficult situations. A nurturing environment will grow empowerment amongst the staff. A good leader accepts responsibility for things that are their responsibility. They don’t deflect blame onto the staff, or elsewhere but instead are mature enough to self evaluate and use situations to improve their leadership skills. Being an advocate and liaison between the staff and upper management, other departments, and ancillary is an important part of being a good manager. Being open and approachable will go a long way in human relationships. Having a good emotional IQ helps as well. Communication is extremely vital in maintaining any relationship, and especially important with management. Being able to effectively communicate and have crucial conversations will make all the difference in how staff respond to changes. Not every good leader can be excellent in all aspects, but they can continue to try and learn. As for those bad leaders. . . I have no idea!

Tell us about your good leader, or bad one. Give us the reasons they are either good or bad.

References

Roussal, L., Harris, J., Thomas, T. (2016). Management and Leadership for Nurse Administrators, 7th Edition. (Western Governors University). Retrieved from:

https://wgu.vitalsource..com/#/books/undefined/
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18 Comment(s)

Asystole RN, BSN, RN

Specializes in Vascular Access, Infusion Therapy.

There is a significant difference between upper (executive) leadership and middle or clinical management. Your article (at least your example) seems to focus on middle management. The goals and skills required to be a good "manager" are different from executive leadership. Not dissimilar to the non-commissioned v. commissioned officer roles in the military. If you are saying that 70% cite leadership in their exit interviews I can believe that but stating 70% of turnover is directly due to bad leadership is ridiculous and I would love to see the source research. It doesn't take into account personality conflicts, poor performance, natural healthy turnover, etc...unless every turnover is automatically put up to poor leadership?

What you haven't accounted for are healthy v. unhealthy turnover rates. Every industry has a turnover rate and there should never be a rate of 0, 0 is not healthy. There are retirements, promotions, etc. About 16% is the national average for hospitals, high for most professionals but low compared to other public facing industries like service or hospitality which can run well over 100%.

The 2018 National Health Care Retention & RN Staffing Report by Nursing Solutions cites turnover cost at about $49,500 with a high of $61,100, reflective of most estimates and even a bit higher than normal. $75,00 seems very high unless you are averaging in LIPs.

As a manager and even an executive leader your goal is never to obtain 0% turnover but to obtain a healthy and sustainable turnover rate. The question is where is that healthy rate and how best to achieve that? Quality leadership is a resource like anything else. You have a finite amount of resources, do you invest in recruiting and training quality leaders, increase FTEs, etc? Super complicated matrix where every action has a profound impact.

llg, PhD, RN

Specializes in Nursing Professional Development. Has 43 years experience.

I also think the statement that 70% of turnover is due to bad leadership is either wrong or misleading. I work with turnover data and with orientees and nursing students. I see a whole lot of people beginning a new job with no expectation of remaining in that job for more than a year or two. To them, it is just a temporary stepping stone to something else.

And let's not forget ... even the OP said that she has had good managers before ... but she still left those jobs.

kbrn2002, ADN, RN

Specializes in Geriatrics, Dialysis. Has 25 years experience.

I have survived lousy leaders before and probably will again. Right now we are pretty lucky in that the management team is pretty good. A great and responsive DON with unit managers that actually seem to value feedback from staff and act on it when appropriate.

Even with a relatively good management team the turnover has been high. Nurses leave to look for the mystical greener pastures, they leave for higher pay or what for them is a better shift/schedule. They leave because they were not in the least bit prepared for working in a SNF and discovered it's way harder than they thought it would be. Not a single one left because they were upset with management at any level so I have a real hard time believing that turnover can be 70% attributed to dissatisfaction with management.

I have found that management style or behavior can be drastically different from one individual to another. I have never left an employer due to bad management. My need for a paycheck is too great. However, when an employer has forgotten about me, I have made the conscious decision not to return the next time I am looking for work. I do not care to take the chance that I may be disappointed more than once by the same management actions even if it comes from a new individual.

traumaRUs, MSN, APRN, CNS

Specializes in Nephrology, Cardiology, ER, ICU. Has 27 years experience.

I have been in my current job for 12+ years. I am fortunate to have very stable leadership.

In my last RN job of 10 years, we had 6+ unit managers (mid-level managers). Most were "fairly good." I learned quickly to keep my head down, do my job and ignore the rest.

Like several of you have mentioned, we gotta eat!

Nurse Beth, MSN

Specializes in Med Surg, Tele, ICU, Ortho. Has 30 years experience.

I also am so fortunate to have a great manager, but I've had my share of poor managers and at least one that was toxic.

Typically there's not much training for new managers even though the skill sets needed are much different from the skill sets needed of clinical nurses.

My hat's off to managers who do a good job despite all the challenges.

Yes! There are managers that should not be managers! I was bullied by my manager who involved a Dr and other staff. It got so bad even with the involvement of my union, labor relations and HR, I had to retire for the sake of my health. A very horrible experience to go through and it has affected my health longterm. I have had to come to be at peace with this situation and move on with my life post nursing career. Prayers to any nurses who are being bullied in the work force, stay strong and continue to stand up for yourself !

This was the exact thing that happened prior to me quitting my job. I was the one who stood up and tried to make upper management aware and was ignored, after I quit one of my "friends"/co-worker told me that all of my co-workers knew I was going to "snap" but did nothing to support me. I was traumatized by the whole situation, and am not sure I will go back to nursing.

brandy1017, ASN, RN

Specializes in Critical Care.

Overall I've been fortunate to have supportive managers and one really great boss, best I ever had, who really pitched in and helped and had your back. However the problems I've dealt with ran the gamut from bullying, thankfully I outlasted the culprit who ended up demoted and left of her own accord to now the corporate destruction of healthcare. While I agree a bad boss can cause employee turnover, some of the main reasons for turnover are poor working conditions and high patient ratios that come down from corporate on high. I don't think bedside nursing will stop the bleeding of staff until they lower the patient ratios, provide adequate staff, and supplies and I don't see that happening unless more states or ideally the federal govt enacts a patient ratio law like California has, along with a no lift environment. There are just too many negatives to stay in bedside nursing the constant short staffing, foley free environment, constant neverending alarms, back-breaking work without lift equipment down to the scripting of nurses.

On 1/21/2019 at 10:41 AM, Asystole RN said:

There is a significant difference between upper (executive) leadership and middle or clinical management. Your article (at least your example) seems to focus on middle management. The goals and skills required to be a good "manager" are different from executive leadership. Not dissimilar to the non-commissioned v. commissioned officer roles in the military. If you are saying that 70% cite leadership in their exit interviews I can believe that but stating 70% of turnover is directly due to bad leadership is ridiculous and I would love to see the source research. It doesn't take into account personality conflicts, poor performance, natural healthy turnover, etc...unless every turnover is automatically put up to poor leadership?

What you haven't accounted for are healthy v. unhealthy turnover rates. Every industry has a turnover rate and there should never be a rate of 0, 0 is not healthy. There are retirements, promotions, etc. About 16% is the national average for hospitals, high for most professionals but low compared to other public facing industries like service or hospitality which can run well over 100%.

The 2018 National Health Care Retention & RN Staffing Report by Nursing Solutions cites turnover cost at about $49,500 with a high of $61,100, reflective of most estimates and even a bit higher than normal. $75,00 seems very high unless you are averaging in LIPs.

As a manager and even an executive leader your goal is never to obtain 0% turnover but to obtain a healthy and sustainable turnover rate. The question is where is that healthy rate and how best to achieve that? Quality leadership is a resource like anything else. You have a finite amount of resources, do you invest in recruiting and training quality leaders, increase FTEs, etc? Super complicated matrix where every action has a profound impact.

Great point, some turnover is expected. And yes, turnover is highly multifactorial, I am too interested on seeing where the authors of the textbook came up with that figure.

NursesTakeDC

Specializes in Safe Staffing Advocate/Group.

I would like to see actual researched data to confirm that claim. Not just a leadership class work book.

Tomascz, ASN, RN

Specializes in Wound care; CMSRN. Has 5 years experience.

Managers work to fulfill the needs of management. Management at the floor level has an impossible job trying to mollify JCAH, Medicare, Infection control, burned out nurses, etc etc etc. Beyond that they have to deal with trying to keep up with the impossible demands of administration to constantly do more with less.

We tell nurses who hate bedside to move up. Nurses who hate direct patient care don't make good nurse managers. Management is about dealing with people under stress effectively and humanely. Surprise.
Nobody wants to deal with suits who have no idea what your job really entails or what empathy looks like. There is no room for any level of arrogance anywhere in a healing facility. The list goes on...

The problem is the lack of direct feedback to upper management. No one says no to the CNO. They may say, "That will be difficult", but not "no that's dumb" because it is career suicide. It's like a group of people all standing around smelling their own farts and telling everyone they don't stink because they drive a prius. It all starts with ANM's. They want a non threatening never written up goodie two shoes that has been on the unit for years. Demonstrates great nursing, accepts all new policy changes with no flack, leadership skills were "learned" in corporate leadership inservices. They take those and cull the popular ones into NM's and it can become very cliquish to those outside and insulates them into the management world. If they do it right like keep a rotating musical chairs setup of directors so that every few years they maintain some fresh blood. Poof they will distill "proper leadership" that's accountable for numbers and not how they get them. This may not be a popular opinion but it's been what I've observed at multiple hospital systems in a non union setting. The new trend is to get rid of ANM's. Just have an experienced "charge" that takes 3-4 patients. Turf the ANM responsibilities to nurse managers and provide no direct path for advancement and hire compliant outside leadership from other hospitals.

OUxPhys, BSN, RN

Specializes in Cardiology. Has 4 years experience.

100%. There are too many people in charge who did not spend enough time at the bedside or forgot where they came from.