Study of leadership issues and behavior related to nurse turnover, and the consequences on company finance


Study of leadership issues and behavior related to nurse turnover,and the consequences on company finance

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One of the main trends in the nurse job market is registered nurseturnover. According to healthcare business analysts, nurse turnoveris slowly becoming a critical issue, which is affecting almost everyprofessional healthcare organization across the word. Hayes et al.(2006) say that turnover rates are the highest when there are manyjob openings in the nurse job market. This assertion seems toindicate that one of the influencing factors in nurse turnover ratesis economic conditions. Regardless, while the organizations thatattract nurses are gaining, the organizations that are losing thecritical manpower are at the danger of running out of business.

Nurse turnover has previously been attributed to some elements, mostsignificantly, job satisfaction. Other related factors includegeographical movement, career progress, voluntary and involuntarylayoffs. Despite the fact that there are myriad other reasons thatinfluence the phenomenon, the results are almost similar. However, tocontrol the negative influence on the turnover on healthcareorganization business, there is need to study some of thecontrollable facts that influence the same. This paper identifiesleadership and organizational behavior as some of the controllablefacts that are responsible for nurse turnover.

The problem of nurse turnover becomes magnified during times whenhealth organizations face nurse shortage. The concerns may originatefrom the economic perspective of healthcare business, as well asnon-economic perspective. The economic perspective includes factorssuch as the pay that the industry can manage to give the nurses,promotions, growth of the industry and other stakeholderinvestment-related factors. On the other hand, the non-economicfactors include the organizational structure, organizationalbehavior, nursing leadership and others. This paper proposes aresearch to investigate the leadership issues and organizationalbehavior factors that related to nurse turnover, and the impact ofthe outcomes on company finances.


In the healthcare industry, nurse turnover has been described as anundesirable trend (Murrells, Robinson &amp Griffiths, 2008). One ofthe reasons that it is undesirable is that it turns out to be costlyand inconveniencing. When nurses leave a certain facility foranother, the former has to look for new replacements. The replacemententails looking for new entrants and training them. This activity mayprove to be too costly for the health facilities, especially whenconsidering the technical nature of the nursing profession. Secondly,nurse turnover is disruptive. It is disruptive in the sense that itaffects the way that healthcare is offered to patients who wereformerly accustomed to the nurses who left. This way, they are mostlikely to quit using the facility’s services, and move on toothers’. Losing customers is a business opportunity cost that mustbe avoided at all costs. In the long run, all health facilitiesattempt to reduce or do away with nurse turnover, which means thatthey have to do investigative studies to ascertain the cause of theproblem.

All hospital managements automatically make decisions to avert thenegative effects of nurse turnover. However, according to Jones &ampGates (2007), the decisions that are made by most of the healthorganizations that are affected by this problem are made without thesupport of full knowledge of the associated factors. These includethe costs and benefits of the same decision. The main reason for lackof this knowledge is privation of the understanding of organizationaland behavioral factors that lead to the problem. Based on thisobservation, researchers have noted that there is need to discuss theconstruction of the problem and evaluate the outcomes in the run upto making the decisions. However, as of the moment, there is lack ofadequate research that addresses the matter from both a nursing andbusiness perspective.


Healthcare professionals are interested in establishing the cause ofnurse turnover. Besides controlling the negative impacts that areassociated with it, establishing this is a barometer for determiningjob satisfaction in the profession. Additionally, the healthcareprofessionals are interested in knowing the factors that influencethe low job satisfaction rates in health facilities, which Murrellset al. (2008) identify as one of the reasons for high turnover rates.In acknowledgment of the influence of leadership in the nursingprofession, this research paper will provide knowledge regarding theleadership issues that are most aligned to nurse turnover.Additionally, the research will give openings to studying in detailthe organizational behavior as a form of institutional culture, whichalso has a bearing on nurse turnover. The findings from the studywill fill the gap in knowledge in some of the key issues in nurseleadership and organizational behavior, as factors that have asignificant influence on the human resource. Additionally, thefindings will establish an association between the turnover rates andfinancial performance of healthcare organizations, as a businessperspective of the study. While the core objective of healthcareorganizations is to provide quality health care to the clients, thebusiness performance, as a shareholder interest, are important aswell.


Elanain (2014) conducted a research to evaluate the impact ofleader-member exchange, as an independent factor, on staff turnoverintention and role conflict. The other dependent factors in thisstudy were job satisfaction and organizational commitment. Accordingto the findings of the study, the management has the obligation ofimproving job satisfaction at their organizations, so as to motivatethe employees (Elanain, 2014). Additionally, this is most likely tohelp the organizations to improve the influence of leader-memberexchange on turnover intention. To investigate the intention behindthe decision by nurses to leave their respective organizations,Tummmers, Growneveld &amp Lankhaar (2013) conducted a large-scaleanalysis in long-term care. Alongside identifying negative evaluationof development as the main reason, Tummers et al. (2013) noted thatthe turnover had a negative influence on the performance of theorganizations, as they had to spend on recruiting new employees.Their research concluded with recommendations that the management andhuman resource should improve the workplace environment to avoid suchoccurrences (Tummers et al., 2013).

Alhamwan&amp Mat (2015) conducted a research that sought to establish theassociation between different organizational factors on employeeturnover. The organizational factors included pay level, leadershipand advancement opportunities. Their study established that turnoverintention is one of the main areas of concern for human resourcemanagers, which in turn has direct and indirect costs that arecritical to organizational performance (Alhamwan &amp Mat, 2015).Moreover, the study further established that there is little that hasbeen done in establishing the effect of leadership, pay level andadvancement opportunities in turnover intention. In an earlierresearch conducted by Alhamwan, Mat &amp Muala (2015), it was alsoestablished that one of the major challenges that healthcareorganizations face are costs that are associated with high turnoverrates. Similarly, the costs are attributed to employee recruitmentand replacement.

Research objectives

The main objective of this research is to investigate the issues inleadership and organizational behavior that have the biggestinfluence on nurse turnover. Having established this, the researchwill seek to evaluate the impact that nurse turnover has on thefinancial performance of the affected organizations. The researchwill look to investigate the impact that leadership styles andorganizational culture have on their employees. These have beenidentified in business studies as influential factors in determiningthe structure and functioning of the human resource in any particularorganization.

Theresearch questions that the research will seek to address are: –

  1. What are the main leadership issues that influence nurse turnover?

  2. What organizational behaviors are associated with nurse turnover?

  3. What is the impact of nurse turnover on organizational financial performance?


The independent variables are leadership issue and organizationalbehavior. These two are unique to every organization and are thedeterminants of the outcome of the research problem. The dependentvariables are nurse turnover and financial performance. Unlike theindependent variables, these two are influenced by factors before theoutcome.

Thediagram below is a representation of the research variables and theirassociation.


Qualitative research methodology will be applied. This is because theresearcher will be looking to create an understanding from data, asthe research analysis process continues. Additionally, based on thefact that the researcher will be limited in scope by the researchquestions. At the same time, given the nature of the topic, thisresearch design is best applicable, as it is not preemptive.


The researcher will adhere to the healthcare research code of conductas outlined by the American Nurses Association and the Ethics inBusiness Research.


Abu Elanain, H.M. (2014). Leader-member exchange and intent toturnover: Testing a mediated-effect model in high turnover workenvironment. Management Research Review. 37 (2),110-129.doi:

Alhamwan, M., &amp Mat, N. (2015). Antecedents of turnover intentionbehavior among nurses: A theoretical review. Journal of Managementand Sustainability. 5 (1), 84-89.

Alhamwan, M., Bt Mat, N., &amp Al Muala, I. (2015). The impact oforganizational factors on nurse turnover intention behavior at publichospitals in jordan: How does leadership, career advancement andpay-level influence the turnover intention behavior among nurses.Journal of Management and Sustainability. 5 (2),154-161.doi:

Hayes, L. J., O’Brien-Pallas, L.,Duffield, C., Shamian, J., Buchan, J., Hughes, F., &amp Stone, P. W.(2006). Nurse turnover: a literature review.&nbspInternationaljournal of nursing studies,&nbsp43(2),237-263.

Jones, C, B. &amp Gates, M.(2007). The costs and benefits of nurse turnover: A business case fornurse retention. AmericanNurses Association, 12 (3).

Murrells, T., Robinson, S., &ampGriffiths, P. (2008). Job satisfaction trends during nurses` earlycareer.&nbspBMCnursing,&nbsp7(1),7.

Tummers, L.G., Groeneveld, S.M., &amp Lankhaar, M. (2013). Why donurses intend to leave their organization? A large-scale analysis inlong-term care. Journal of Advanced Nursing. 69 (12),2826-2838 13p. doi:10.1111/jan.12249.