An estimated 17.5% of newly licensed registered nurses (RNs) leave their first nursing job within the first year and 1 in 3 (33.5%) leave within 2 years, according to newly published research. Hospitals have lower turnover for this group than other health care settings.

Turnover is an important and widely used measure in analyzing the health care workforce. It is used to project the job market and availability of jobs for nurses and it can also be considered an indicator of whether a health care organization has a good working environment.

The study, published in Policy, Politics & Nursing Practice (2014; doi:10.1177/1527154414547953), synthesized existing turnover data and reported turnover data from a nationally representative sample of RNs. It was conducted by the RN Work Project, directed by Christine T. Kovner, PhD, RN, FAAN, professor at the College of Nursing, New York University (NYU); and Carol Brewer, PhD, RN, FAAN, professor at the School of Nursing, University at Buffalo [New York]. The project is funded by the Robert Wood Johnson Foundation. It is the only longitudinal study of registered nurses in the United States. The data comes from surveys of three cohorts of newly licensed RNs conducted since 2006.

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RN turnover, defined as registered nurses leaving their jobs, is costly for hospitals and affects quality of care. Organizational costs associated with nurse turnover can be as much as $6.4 million for a large acute care hospital, and studies have associated turnover among health providers with an increase in the use of physical restraints, pressure ulcers, and patient falls.

The authors pointed out many problems with existing turnover numbers in the literature. “One of the biggest problems we face in trying to assess the impact of nurse turnover on our health care system as a whole is that there’s not a single, agreed-upon definition of turnover,” said Kovner. “In order to make comparisons across organizations and geographical areas, researchers, policy makers, and others need valid and reliable data based on consistent definitions of turnover. It makes sense to look at RNs across multiple organizations, as we did, rather than in a single organization or type of organization to get an accurate picture of RN turnover.”

The research team noted that there are different kinds of turnover, and that nurse turnover can actually be helpful in some cases. Functional turnover is when a poorly functioning employee leaves, whereas dysfunctional turnover is when well-performing employees leave. Authors recommend that organizations pay attention to the kind of turnover occurring, and point out that their data indicate that when most RNs leave their jobs, they go to another health care job.

“Developing a standard definition of turnover would go a long way in helping identify the reasons for RN turnover and whether managers should be concerned about their institutions’ turnover rates,” said Brewer. “A high rate of turnover at a hospital, if it’s voluntary, could be problematic, but if it’s involuntary or if nurses are moving within the hospital to another unit or position, that tells a very different story.”