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

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! Nurses General Nursing Article Video

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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.

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.

Specializes in Wound care; CMSRN.

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.

Specializes in Cardiology.

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

Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.
On 12/4/2019 at 9:15 PM, NursesTakeDC said:

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

The figure, according to a Gallup poll, is actually more like 50%.

https://www.gallup.com/workplace/236570/employees-lot-managers.aspx

On 12/7/2019 at 8:44 AM, CaptKris said:

... 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.

? South Park fan, eh?

Specializes in Med surge.

I know this is old but I came upon this article and I agree with the writer.  Bully managers are the worst but I have not had a good manager so far.  When your manager is a bully there is no way but to leave.  When your preceptor is a bully when your clinical instructor on orientation is a bully it is just the worst.  Most nurses leave because of working conditions not because they don’t like their nursing responsibilities. So please don’t try to blame high turnover rate on nurses who can’t handle the stressful job, it’s not the exposure to patients that drives nurses to quit it is the environment that lacks support staff/lazy support staff, supply shortages, under staffed environment, overworked residents who don’t want to be bothered, favoritism by nurse managers, residents who have no respect for hospital policies that were created for patient safety and management who won’t defend nurses in their journey to adhere to hospital policies.  When you want to help your patients but you can’t because of all reasons I mentioned it hurts your soul.  

Specializes in Gastrointestinal Nursing.
On 6/26/2021 at 1:11 PM, Nurse2001 said:

I know this is old but I came upon this article and I agree with the writer.  Bully managers are the worst but I have not had a good manager so far.  When your manager is a bully there is no way but to leave.  When your preceptor is a bully when your clinical instructor on orientation is a bully it is just the worst.  Most nurses leave because of working conditions not because they don’t like their nursing responsibilities. So please don’t try to blame high turnover rate on nurses who can’t handle the stressful job, it’s not the exposure to patients that drives nurses to quit it is the environment that lacks support staff/lazy support staff, supply shortages, under staffed environment, overworked residents who don’t want to be bothered, favoritism by nurse managers, residents who have no respect for hospital policies that were created for patient safety and management who won’t defend nurses in their journey to adhere to hospital policies.  When you want to help your patients but you can’t because of all reasons I mentioned it hurts your soul.  

Thank you for your comments. I couldn't agree more