The effects of high nurses’ turnover on patient care: Perspectives of unit managers in critical care units

Context: Hospitals are faced with a major challenge of high nurses’ turnover and staff shortages, and critical care units (CCUs) are no exception. Aim: The purpose of this study was to examine how the high nurse turnover affects the provision of quality care in CCUs from the perspectives of unit managers. Setting and design: The qualitative, exploratory and descriptive study was conducted at an academic hospital. Materials and methods: Individual face-to-face interviews were conducted with unit managers. Participants were purposively selected from CCUs of an academic hospital in South Africa. Tech's method of data analysis was used to identify themes and sub-themes. Results: The sample consisted of nine unit managers highly experienced in critical care and had managed these units for over eight years. Two main themes emerged, the reasons for high nurses’ turnover and the effects of high nurse turnover on patient care. High nurses’ turnover in CCUs was influenced by inadequate staffing ratios, absenteeism and increased workloads. The high nurse turnover contributes to non-compliance with the standard norms of nurse-patient ratios. The study revealed that optimal nurse staffing is essential to delivering high quality, cost-effective care with better patient outcomes. Conclusion: The nurses in CCUs possess specialized skills. However, insufficient number of critical trained nurses; and the assigning of unskilled nurses to provide care in CCUs led to compromised quality patient care. High nurse turnover also affected the ability of unit managers to plan, direct, organise, and control.