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The Causes and Impacts of Nurse Turnover: A Comprehensive Analysis
Staff turnover is a topic of considerable interest to researchers due to its significant impact on business operations and overall organizational performance. Nurse turnover is a major concern for several critical reasons, particularly in healthcare systems where quality of care and patient outcomes significantly depend on staffing stability.
This paper analyzes various aspects of nurse turnover using information from reliable journal articles. The areas explored include the different types of turnover, the factors contributing to staff turnover in Saudi Arabia, the impact of adequate staffing on service delivery, and the negative effects of turnover in nursing practice. The paper concludes with a summary of the findings and key insights drawn from the analysis. Given the direct link between nurse staffing and health outcomes, minimizing turnover is not only a financial and administrative priority but also a vital component of ensuring high-quality, safe, and compassionate care.
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Definition of Terms
Turnover: As defined by Zhang (2016), employee turnover refers to the process by which individuals leave an organization, whether through resignation, termination, or other circumstances.
Quality care: In the nursing field, quality care is defined by key attributes such as respect, compassion, empathy, responsibility, advocacy, and intentionality (Burhans & Alligood, 2010).
Types of Turnover
Voluntary Turnover
Voluntary turnover occurs when an employee chooses to leave an organization. This form of turnover is positively associated with the availability of alternative employment opportunities (Parker & Gerbasi, 2016). It may also result from low job satisfaction in the current workplace. While voluntary turnover can be detrimental to an organization, it may be seen as beneficial when it involves the departure of underperforming employees. Healthcare providers aim to reduce voluntary staff turnover by offering competitive remuneration, flexible work schedules, and other supportive benefits.
Involuntary Turnover
As the term suggests, involuntary turnover occurs when the employer terminates employees’ contracts. This can result from a variety of factors. For instance, a healthcare provider may cease operations, necessitating employee termination; it may outsource services, leading to downsizing; or it may dismiss underperforming employees (Parker & Gerbasi, 2016). The process by which employers terminate staff depends on the terms of the employment contract, internal organizational policies, and the legal regulations governing the industry or country.
Internal Turnover/ External Turnover
Turnover is considered internal when employees leave their current positions to take on new roles within the same organization. This phenomenon has both positive and negative implications. On the positive side, such moves may reflect increased employee morale and engagement. On the negative side, internal turnover can lead to project disruptions and the breakdown of established workplace relationships. It is important to note that, according to the Peter Principle, strong performance in one role does not necessarily guarantee similar success in another (Pluchino et al., 2010). A high-performing employee may struggle in a different position within the same organization. In contrast, external turnover occurs when employees leave to take positions in other organizations. The Peter Principle is also relevant in this context, as individuals may not replicate their previous performance in a new organizational environment. Ultimately, both forms of turnover require careful management to minimize disruption and ensure that employees are well-matched to their roles.
Reasons for Nursing Turnover in Saudi Arabia
The healthcare system in Saudi Arabia experiences employee turnover due to several factors, including:
Demographics
Demographic factors play a significant role in influencing job satisfaction and employee retention in Saudi Arabia’s healthcare sector. Parveen (2015) conducted a study to examine the impact of various demographic factors—including gender, nationality, cultural barriers, age, and marital status—on job satisfaction and employee retention. The research found that some of these factors significantly affect both job satisfaction and retention rates, thereby influencing employee turnover. For example, gender differences revealed that women are less likely to retain their positions compared to men, often due to challenges in balancing professional and personal responsibilities. In terms of nationality, Saudi employees reported greater satisfaction with personal growth opportunities, professional support, and remuneration, making them more likely to remain in their jobs than their non-Saudi counterparts. With respect to age, older nurses retained their positions longer than younger nurses, who generally exhibited lower levels of job satisfaction and commitment.
These findings are supported by Alonazi and Omar (2013), who also explored factors affecting nurse retention and reported similar patterns. Parveen (2015) concluded that turnover is often driven by demographic factors—such as age, gender, and nationality—that employees have limited control. Therefore, understanding the impact of demographic variables is crucial for developing effective strategies to enhance employee retention in the Saudi healthcare system.
Workload
Many professionals in the healthcare sector face heavy workloads and long working hours, which can have significant effects on their well-being and increase their intention to leave. For instance, excessive workloads make it difficult for employees to maintain a healthy work-life balance. This imbalance often leads to further complications, as healthcare providers may struggle to perform effectively if they are unsettled in their personal lives. As a result, low productivity, reduced commitment, and a higher likelihood of resignation can follow.
Heavy workloads are also strongly associated with employee burnout. This is supported by a study conducted by Elbarazi et al. (2017), which found that healthcare professionals in Saudi Arabia and other Arab countries exhibited high levels of emotional exhaustion and depersonalization. In addition to workload, the researchers identified other contributing factors to burnout, including length of service, gender, and nationality. When healthcare workers are unable to find effective solutions to manage excessive workloads, turnover becomes increasingly likely. Therefore, addressing workload-related stress is essential for improving retention and maintaining a healthy, productive workforce in the healthcare sector.
Educational Level
Educational qualifications and professional training play a vital role in ensuring the effectiveness and stability of the healthcare workforce. Skills and expertise acquired through education are essential across all healthcare professions, including physicians, nurses, and clinical officers. In Saudi Arabia, the evolution of nursing education reflects longstanding disparities. Initially, female nurses underwent only a one-year training program until a Bachelor’s degree program was introduced in 1976 (AlYami & Watson, 2014). A similar program for men was not established until 2004, highlighting a historical lag in educational access for male nurses. This delay has likely contributed to a persistent skills gap within the healthcare sector.
Moreover, the number of individuals enrolling in nursing programs remains insufficient to meet the growing demand for healthcare services. As a result, the limited pool of qualified professionals is burdened with high workloads, leading to exhaustion, low job satisfaction, and ultimately, increased nurse turnover rates. The issue is further exacerbated by low remuneration and limited opportunities for career advancement—particularly for male nurses, who currently lack access to Master’s-level programs available only to female students (AlYami & Watson, 2014). This gender-based inequality in professional development opportunities intensifies male nurses’ intentions to leave the profession. To address high nurse turnover rates, it is essential to expand educational access, improve career development pathways, and ensure equitable opportunities for all healthcare professionals.
Positive Impact of Adequate Staffing
The previous section covered the key factors influencing nursing turnover. This section explores the benefits of adequate staffing in the delivery of healthcare services. Below are some of the positive outcomes associated with sufficient staffing levels in healthcare institutions.
Improved performance
Adequate nurse staffing benefits not only patients but also nurses and the healthcare facilities they serve. Past studies reveal a positive correlation between sufficient staffing levels and improved nurse performance, enhanced patient care, increased patient safety, and better overall organizational outcomes. According to Alghamdi (2016), more than 80% of medical errors in modern healthcare settings are attributed to nurse overload. When nurses are overburdened, the likelihood of medical errors increases significantly due to fatigue. In fact, adding just one nurse for every 10 patients in the United States could lead to a 30% reduction in monthly fatalities and a 12% annual decline (Alghamdi, 2016). This translates to a substantial number of lives saved. Therefore, adequate staffing not only improves the performance of nurses but also enhances patient outcomes and the overall efficiency of healthcare systems.
Reduced costs of seeking and delivering healthcare
In addition to benefiting nurses, adequate staffing positively impacts patients and healthcare organizations alike. Patients are more likely to access affordable, high-quality care, while healthcare facilities can deliver services more efficiently and at lower costs. According to Nantsupawat et al. (2013), approximately 10% of patients globally receive substandard medical attention during their initial visits due to nurse understaffing. This often results in prolonged hospital stays or premature discharges, leading to readmissions with more severe conditions than before.
The situation would be significantly improved with a lower nurse-to-patient ratio. For instance, a 1:1 ratio has been associated with shorter hospital stays and no readmissions (Nantsupawat et al., 2013). When patients recover quickly and are not readmitted for issues related to poor initial care, the overall cost of healthcare is reduced substantially for both individuals and health systems.
From an organizational perspective, high patient volumes due to extended stays or avoidable readmissions place a financial burden on healthcare facilities. These costs could be significantly reduced through the employment of an adequate, well-trained nursing workforce. Thus, investing in sufficient nurse staffing is not only a clinical necessity but also a cost-effective strategy for improving healthcare outcomes and system sustainability.
Adequate staffing lower nurse’s turnover
Understaffing in the nursing profession leads to serious consequences for both healthcare workers and the broader healthcare system. When nurses are understaffed, they are overworked and forced to attend to many patients simultaneously. This significantly increases the likelihood of medical errors—both minor and major—for which they may face litigation. Additionally, seeing a high number of patient deaths due to inadequate care can be deeply demoralizing (Saqer & AbuAlRub, 2018). To avoid legal consequences and protect their careers, many nurses choose to voluntarily leave the profession. Others lose interest entirely, perceiving their role as ineffective or lacking impact.
The issue of high nurse turnover rate is compounded by alarmingly low nurse-to-patient ratios. According to the World Health Organization (WHO), there are only three nurses for every 1,000 patients globally, contributing to a shortage of approximately one million nurses worldwide. This widespread understaffing is a core driver of the growing rate of voluntary nurse turnover.
In developed countries, average nursing turnover rates are approaching 16%, with even higher rates expected in developing nations. This trend results in a significant loss of expertise, placing patients at greater risk. Healthcare facilities also suffer financially, as they lose experienced staff and patient trust, and must bear recruitment and training costs. To reduce nursing turnover and its associated risks and cost of nurse turnover, healthcare systems worldwide must prioritize maintaining adequate and sustainable nurse staffing levels.
The Negative Impact and Cost of Nurse Turnover on the Quality of Nursing Care
High nurse turnover significantly undermines the quality of patient care, creating challenges for healthcare systems, professionals, and governments. According to Zhang (2016), the nurse turnover rate refers to the rate at which nurses leave their positions due to termination, resignation, or other reasons that prevent them from fulfilling their duties. Whether turnover is voluntary or involuntary, it negatively impacts patients, healthcare facilities, and the government responsible for ensuring public health. When experienced professionals leave the field, the quality of nursing care suffers.
Increased cost of medical care Paid by Patients
The world is currently facing a severe nursing shortage, with an annual deficit of one million nurses, creating a growing healthcare crisis. According to Alghamdi (2016), the current nurse turnover rate of 16% suggests that this shortage will escalate dramatically if left unaddressed in the coming years. The situation has already reached critical levels, and continued attrition will only worsen existing problems. In some regions, nurse turnover leads to temporary staffing shortages until replacements are found, or permanent gaps remain if positions remain vacant.
A lack of sufficient nursing staff forces patients to endure prolonged hospital stays or receive substandard care. Poor attention from overworked nurses increases fatality rates due to medical errors or preventable complications, often leading to patient readmissions. Consequently, healthcare costs rise significantly—both for individual patients and the broader economy—as hospitals struggle to compensate for staffing shortages. Without urgent intervention, this escalating nursing shortage will continue to degrade healthcare quality, increase mortality rates, and place unsustainable financial burdens on global health systems.
Nurse Turnover causes the government to incur costs
The government bears the responsibility of designing and implementing a functional healthcare system. Such a system cannot operate effectively without adequate staffing. As Coleman (2018) noted, nurse turnover creates staffing shortages that may be either temporary or permanent in nature.
First, nursing turnover results in a loss of expertise when experienced nurses leave the profession, whether voluntarily or involuntarily. When local expertise is lacking, governments may need to recruit nurses from other regions or countries, often at higher wages than those paid to their predecessors due to urgent staffing needs.
Even when qualified local candidates are available, turnover generates significant replacement costs, including expenses for advertising vacancies, conducting interviews, vetting candidates, and training new hires. While healthcare facilities initially absorb these costs, the financial burden ultimately falls on governments or private healthcare providers. This expenditure represents a substantial drain on resources that could otherwise be allocated to improving patient care and healthcare infrastructure.
Nurse turnover limits learning and demotivates personnel
Experienced nurses play a crucial role in mentoring new staff members, helping them develop into skilled professionals. Under veteran guidance, novice nurses can work more efficiently while minimizing medical errors. However, when new nurses enter a profession lacking proper mentorship or facing severe staffing shortages, they often become demotivated. This frequently leads to early career departure before reaching retirement age (Subramony et al., 2018). Moreover, such environments significantly increase the likelihood of medical errors. Nurse turnover consequently deprives the next generation of professionals from receiving proper training and career development opportunities, ultimately weakening the entire nursing workforce.
Nurse turnover causes the organization to incur costs
Healthcare organizations experiencing high nurse turnover face significant reputational and financial risks. Such institutions often develop negative perceptions that deter patients from seeking their services, making it difficult to distribute fixed administrative costs across an adequate patient base. Like government healthcare regulators, these organizations directly incur nurse replacement costs. Regardless of their current staffing levels, facilities risk losing repeat patients due to substandard care quality—whether from their own understaffed teams or other affected facilities (Wang & Yuan, 2018). Ultimately, high turnover creates a vicious cycle of declining reputation, reduced patient volume, and compromised care quality that threatens organizational sustainability.
Conclusion
Nurse turnover rates are a result of staffing quality and workplace conditions. Three critical factors require attention when addressing nurse turnover rates: manageable workloads, continuous professional education, and demographic alignment within the profession. Healthcare systems must maintain reasonable nurse-to-patient ratios, provide regular training opportunities, and adapt staffing structures to match both workforce and patient demographics.
When staffing requirements are neglected, facilities experience increased voluntary and involuntary turnover – leading to substantial financial burdens for healthcare providers and governments through elevated care delivery costs. By implementing strategic staffing improvements, healthcare organizations can significantly reduce turnover rates, enhance care quality, and create more sustainable nursing work environments.
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