Nancy Short and DNP alumna Allison Ong recently published an article in Nursing Management. The article, "Ripple effect: Shared governance and nurse engagement" was featured as the cover article of the journal.
Staff turnover has far-reaching implications: Exiting RNs cause productivity losses and organizational inefficiencies due to instability within the nursing staff, leading to additional costs.1 Productivity diminishes when more experienced RNs precept new hires and take time to thoroughly orient them to the required competency level.2 Other costly ramifications include overtime, temporary agency costs, and recruitment expenses.1
Even more alarming, care quality decreases with inadequate RN staffing and high turnover.3 Increased medication errors, patient falls, and other adverse events are linked to RN turnover.4,5 And, as turnover increases, the percentage of patients satisfied with their care decreases.6 With value-based purchasing, the decrease in these quality metrics consequently results in a reduction of reimbursement and the ability of a health system to sustain services for many patient populations.7
In this article, we discuss an evidence-based quality improvement project to evaluate the outcome of a newly implemented shared governance environment on RN engagement and turnover. Our setting is the medical intensive care unit (MICU) at an academic health center in southern California. As a frame of reference, RN turnover here in 2016 was approximately 17%, and the turnover rate on the MICU in 2013 was 21%. (The national average for clinical nurse turnover is 17%.8) When you consider the national average replacement cost of $64,000 per RN, our facility's RN turnover translated to a $17.7 million expense.9