2003 Open Grants Competition Project Summaries
Linda O'Brien-Pallas / Gail Tomblin Murphy / Judith Shamian
Understanding the Costs and Outcomes of Nurses' Turnover in Canadian Hospitals
Objective:
The purpose of this study is to determine how the rate and intensity of nursing turnover (lost human capital as experienced nurses leave and lost productivity as new hires are trained) affect patient satisfaction and safety; nurse satisfaction, health, and safety; and system outcomes (turnover costs). This project will provide a tool that will describe the costs of nursing turnover that will be useful for other disciplines and will contribute to the health human resources modelling activities at the Nursing Effectiveness, Utilization and Outcomes Research Unit, University of Toronto and partner universities.
Importance for Decision Makers:
The study will allow decision makers to better understand costs associated with turnover, how staffing decisions influence turnover, potential changes in the workplace which may lead to a reduction in turnover and improve nurses' health and satisfaction, and how these factors influence the quality of care nurses deliver.
Nurse turnover is of considerable interest to a wide audience of health-system managers and policy makers and will continue to be relevant for the next five years. Governments and managers face significant challenges in ensuring that sufficient nursing services are provided to meet the needs of the population and the goals of the health system. The need to closely monitor the work environment as well as the supply of nurses participating in the workforce has been reinforced in numerous provincial/territorial and federal reports. Many team members have stated that an understanding of the factors related to turnover and the effect of turnover will help them design mechanisms and policies to effectively recruit and retain nurses.
Through its decision-making partners, the project has strong links with healthcare organizations and provincial and federal levels of governments. These links will facilitate expedient incorporations of findings into policy at all levels. The team is made up of deputy health ministers and principal nursing officers at the provincial and federal levels, chief executive officers and vice-presidents of nursing in healthcare organizations, as well as established researchers representing a variety of disciplines (such as nursing, health economy, demography, sociology, and psychology).
Description:
The research questions underpinning this study are:
- What is the nature of the relationship between system inputs (patient, nurse, hospital, and unit characteristics) and system outputs (nurses' health, safety, and job satisfaction, and nurse turnover rates; patient satisfaction and safety outcomes; and the costs of turnover)?
- How do system inputs (patient, nurse, hospital, and unit characteristics and behaviors) influence system throughput (staff deployment and utilization and environmental complexity)?
- How does system throughput mediate both inputs (patient, nurse, hospital, and unit characteristics) and outputs (nurse, patient, and system)?
- How do system outputs feed back into the system and what are the implications for nurses, patients, and the system?
- How might modifications of throughputs alter system outcomes?
This project will form the Canadian arm of an international project on nurse turnover with the following six countries: Australia, Canada, New Zealand, Scotland, the United Kingdom, and the United States. This Canadian study has committed support from the following 10 jurisdictions: British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, Quebec, Nova Scotia, New Brunswick, Prince Edward Island, and Newfoundland & Labrador.
Approach:
Data will be collected in two waves on patients, nurses, units, and hospitals. Each wave will consist of a three-month data collection period. The two waves will be a year apart; this one-year interval will control for seasonal effects (for example, influxes of new nurses after spring graduations). In addition, data collection times will be staggered over a two-year period to help control for historical confounders (such as funding changes or restructuring).
The design incorporates two components. First, a multi-level, longitudinal study design will be used to study the effects of turnover and other inputs/throughputs on nurse and patient outcomes (research questions 1-4). Nurse and patient outcomes will be studied in separate analyses. The longitudinal design will enable us to establish the temporal ordering of independent and dependent variables so that input variables that are affected by feedback processes (such as unit turnover rates, which are influenced by nurse outcomes) can be treated as exogenous in the analyses.
The second component of the design will employ system dynamics (simulation) modeling to investigate outcomes on units and systems (for example, unit turnover rates, turnover costs) and explore potential interventions (research questions 4-5). Using the results from the multi-level longitudinal analysis and data on turnover-related costs, simulation models will be developed to estimate the effect of various policy and management interventions on unit and system outcomes.
Project Identifier:
RC1-0951-06
Funding Provided by:
- Canadian Health Services Research Foundation
- Health Canada
- Newfoundland & Labrador Centre for Applied Health Research
- Nova Scotia Health Research Foundation
- Quebec Ministere de la Sante et des Services Sociaux
- Ontario Ministry of Health and Long-Term Care
- Saskatchewan Science and Innovation Fund
- British Columbia Provincial Health Services Authority
- Calgary Health Region
- Capital District Health Authority
- Centre hospitalier de l'Universite de Montreal
- Health Care Corporation of St John's
- IWK Grace Health Centre for Women, Children and Families
- McGill University Health Centre
- Prince Edward Island Department of Health and Social Services
- Regina Qu'Appelle Health Region
- Regional Health Authority to Atlantic Health Services Corporation
- Saskatoon Health Region
- St. Michael's Hospital
- The Ottawa Hospital (Civic Campus)
- University Health Network
- Vancouver Coastal Health Authority
- Vancouver Island Health Authority
- Winnipeg Regional Health Authority
Principal Investigators:
Linda O'Brien-Pallas, RN, PhD
Nursing Effectiveness, Utilization and Outcomes Research Unit (NRU)
Faculty of Nursing, University of Toronto
50 St George Street, Toronto, Ontario, M5S 3H4
Telephone: (416) 978-1966; Fax: (416) 978-8222
Email: nru.info@utoronto.ca
Gail Tomblin Murphy, RN, PhD(c)
School of Nursing, Dalhousie University
Halifax, Nova Scotia B3H 3J5
Telephone: (902) 494-2228; Fax: (902) 494-3482
Email: Gail.Tomblin.Murphy@dal.ca
Judith Shamian, RN, PhD
President and Chief Nursing Officer, VON Canada
110 Argyle Avenue, Ottawa, Ontario K2P 1B4
Telephone: (613) 952-7892; Fax: (613) 230-4376
Email: shaminaj@von.ca
