Nursing Shortage and Nurse Turnover


Nursing shortage and nursing turnover present a significant problemin the American health sector. The trend of nursing shortage has beenrising over time, especially with the flourishing baby boomerpopulation. According to the American Bureau of Labor and Statistics,the demand for qualified nurses will increase by will be 26% between2010 and 2020 (Bureau of Labor Statistics, 2012). The expected demandwill increase from 2,737,400 registered nurses in 2010 to 3,449,300by 2020 (Bureau of Labor Statistics, 2012).

The statistics on turnover rates are also alarming. The estimatedavoidable turnover rate stands at 64% as compared to the unavoidableturnover rate of 26% (Rosseter, 2009). Unavoidable turnover is due tosuch life events as marriage, death and pregnancy while avoidableturnover is because of the inability of hospitals. The inability ofretention is as a result of poor working environment, poorremunerations and educational prospects among other reasons(Rosseter, 2009).

Nursing shortage and turnover affect both the operations andprofitability of health care settings because of the costs involvedafter losing a single nurse. The cost per nurse lost is estimated tobe between $30,000 and $60,000 (Cox, Willis &amp Coustasse, 2014).The main reasons why nurses may choose to exit from their jobsinclude lack of career development opportunities low payment andother benefits inadequate staff low turnover from nursing schoolsoverworking long travel distance to facilities unfair and demandingjob schedules poor relationships with the management ineffectiverole clarity and poor working environments (Cox, Willis &ampCoustasse, 2014). Nursing shortage is attributed to decreasedenrollment of new nurses in nursing schools increasing agingpopulation of nurses who retire leaving unfilled gap increasingpopulation especially of baby boomers and increasing turnover ofnurses to other jobs or due to various reasons listed above(Rosseter, 2009.

This current trend requires a sustainable solution through goodleadership. Much of these problems are attributed to death of goodand able nursing leaders in the hospitals (Cox, Willis &ampCoustasse, 2014). Nursing fraternity require a new breed of leadersto manage the looming crisis. Every level of nurse trainingencompasses a government-endorsed curriculum which ultimatelyproduces qualified nurses (Valentine, 2002). It is a high time thatwe train more nurses to become leaders and cease to leave theleadership to high level administrators and managers. Nursesthemselves can forge their own destiny through promotion of goodleadership skills and enrollment of new members into leadershippositions especially the newly registered nursing officers(Valentine, 2002).

In healthcare, managers differ from leaders in their administrationstyles. Although both leaders and managers share common objectives ofgetting things done and promoting the hospital or organizationprosperity, they also differ in their management styles (Zaleznik,2004). The best way to solve the shortage and turnover crisis wouldbe to employ good leadership policies that are sustainable and longlasting rather than short-term remedies employed by managers.Managers usually administer, control and maintain the status quoinstead of looking for new and innovative ways to solve problems(Zaleznik, 2004). Managers on their part are the source of theproblems of nursing shortage and turnover. Their control is based oncost economy rather than personal development and empowerment. Manynurses are coerced to remain in their demanding and hostile workingenvironments with threats of being fired if they did otherwise.Managers only want the work done and to get short term solutions tothe problems at hand.

Leaders on the other hand strive to achieve long term solutions toany problem (Zaleznik, 2004). They innovate new ways such asincreasing the number of nursing schools by lobbying the governmentinstitutions for necessary financial and technical assistanceprovide good working environments and forming collective bargainingagreements with their employees to quell standoffs of wage and salarydissatisfactions . They also promote development of new leadersinstead of maintaining the traditional status quo of leadership whereonly old people occupy leadership positions (Zaleznik, 2004). Leaderscreate links with their employees and empower them through involvingthem in decision-making whereby they can provide input on criticalmanagement decisions. Leaders promote personal development of theiremployees through continuous trainings and educational empowerments(Zaleznik, 2004). Employees are allowed to further their educationalprospects and engage in continuous educational conferences andresearch. Managers see this as lost income and time and fail to grantthe necessary resources for personal development of their employees.

There are theories of leadership that have been put forward toexplain nursing leadership that rationalize managers and leadersstyles of management. The notable theories are the transformational,quantum and dynamic leader-follower theories (Valentine, 2002).Transformative leadership tries to connect the leaders and followersideals and focuses on unity of both employees and managers (Sullivan&amp Decker, 2001). Transformative leadership encourages new peopleto exercise the leadership roles (Sullivan &amp Decker, 2001). Thisstyle of leadership also encourages change in the system and is thebest choice for the ever-dynamic healthcare setting. The style wouldbe ideal in solving the nursing shortage and nursing turnover sincemost of the reasons for exit or shortage can be addressed.

Due to the changing healthcare system, leadership should not be basedon the traditional up-the-ranks form of promotion to leadership butrequires new breed of leaders to take over. Technological advancementhas promoted this quantum theory where horizontal leadership issupported rather than the traditional vertical leadership where aperson became a leader after climbing the ladder of experience andknowledge (Porter-O’Grady, 1999). Technology has promoted vastacquisition of necessary knowledge for newly registered nurses. Dueto their daily routine with patients at bedside, nurses both new andold, yield a lot of influence and power to make an impact in thefield of nursing and management.

The dynamic leader-follower style of leadership proposed by Laurent(2000) is heavily borrowed from the Ida Orlando’s model of nursingwhere distress in patients and immediate needs are followed byimmediate remedy. The theory promotes a dynamic relationship betweenthe leader and follower where both work together to ensure thesuccess of the nursing unit (Laurent, 2000). The leader’s role isto give directions to followers who subsequently participate in theprocess to achieve the set objectives. The leaders do not control butrather offer guidance and this promotes motivation and commitment intheir work.

In conclusion, Transformative leadership style fits my professionalobjectives because this style creates an environment where any personcan become a leader. The style focusses on the unity of both theleader and follower meaning that no party is sidelined indecision-making (Sullivan &amp Decker, 2001). Avoidable nursingturnover and nursing shortage can be eliminated through suchleadership because most of the nurses’ needs can be catered for.Better working environment, better benefits, good interpersonalrelationship, effective communication are reasons for turnover andcan be catered for in this symbiotic relationship. Change inmanagement and operations are also possible because sharing of ideasis encouraged.


Bureau of Labor Statistics. (2012). Table 6, The 30 occupationswith the largest projected employment growth, 2010-2020. Washington,D.C.: BLS. Retrieved from,&lt July 22, 2016

Cox, P., Willis, W. K., &amp Coustasse, A. (2014). The AmericanEpidemic: The US Nursing Shortage and Turnover Problem

Porter-O’Grady, T. (1997). Quantum Mechanics and the Future ofHealthcare Leadership. Journal of Nursing Administration,27(1), 15-20.

Laurent, C.L. (2000). A nursing theory for nursing leadership.Journal of Nursing Management, 8, 83-87

Rosseter, R. (2009). Nursing shortage fact sheet. AmericanAssociation of Colleges of Nursing (202), 463-6930

Sullivan, E.J. &amp Decker, P.J. (2001). Effective Leadership andManagement in Nursing (5th Ed.). Upper Saddle River, NJ: PrenticeHall. And Bartlett Publishers.

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