High turnover rates in nursing remain one of the most critical determinants of a healthcare organization. The rate and frequency that nurses or hospital workers join and leave affect the provision of healthcare directly or indirectly. The nursing profession is unique and demands practical as well as strategic leadership and management skills and approaches that will ensure new hires and experienced nurses are retained in a healthcare facility or organization (Wood, 2017). Imperatively, to tackle this issue, nursing leaders and managers need to interrogate the causes of high turnover and contributing situations. The high turnover rate of nurses emanates from a host of factors that require leaders in the profession as well as institutional managers to seek effective methods to minimize their occurrences. These include career advancement, retirement, increased workload, lack of life and work balance, rescheduling, and low nurse staffing ratios, among other issues (Hughe, 2017). Imperatively, this paper focuses on how leaders can deal with the issue of turnover and address it through an appropriate leadership style.

Nurse Turnover

An increasing recognition exists that the attainment of a health system’s objectives, including sustenance of efficient delivery of quality patient outcomes, requires an adequate and effective nurse workforce (Carlson, 2018). As such, organizations should have effective retention of their nursing staff and ensure that they possess the right skills within the sustainable workforce. Different studies and reports demonstrate the extent and the effects of a high nurse turnover that affects almost the entire global healthcare industry and nursing sector (Hughe, 2017). Nurse attrition results in different and high costs to healthcare organizations.

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In their article, Ellrich and Nelson (2020) observe that the industry registered the highest levels of nurse turnover in 2019, and the most affected nurses are mainly those with less than two-year period in an organization. The authors note that the industry registered about 17% in turnover rates and costing every hospital about $4.4 million each year. The authors are pessimistic that with the current problem of COVID-19 pandemic, hospitals will continue to register increased workforce instability than ever before. According to Wood (2017), high turnover rates are costly to the healthcare system and harm the quality outcomes for patient care. Carlson (2018) asserts that nurse attrition has enormous impacts on both organizations and employees, especially nurses in units like emergency departments and rooms. The adverse effects include reducing overall morale, chaos in the scheduling process, loss of resources, and a stretched human resource capacity as well as overwhelming the human resource teams and their ability to have effective recruitment. Carlson notes that the staffing process is the worst hit by attrition, and it becomes harder for nurses to perform their duties usefully due to increased burden and long shifts.

As such, overworking the nursing staff that is retained may be the prudent move in the short term for nurse managers. However, it increases the nurse-patient ratios, which can lead to burnout, possible medication errors, and even more turnover. The replacement of a nurse costs a health institution between $22,000 and $65,000. Further, reports show that a hospital can lose close to $8 million each year indirect costs related to nursing turnover (Wood, 2017; Ellrich & Nelson, 2020). The implication is that high nurse turnover can result in a loss of essential memories by affected nurses about an institution. Imperatively, leaders and nurse managers need to get strategic solutions through better leadership approaches and management interventions to address this critical problem.

Roles of Leaders and Managers Based on different Approaches to the Issue

Nurse turnover is a critical issue that has attracted the attention of all stakeholders in the healthcare industry and even policymakers within the government. Turnover is an important determinant of organizational output, especially in the healthcare sector that is transforming and also dealing with unique situations like pandemics and infectious diseases (Heidari, Seifi & Gharebagh 2017). While different initiatives, programs, and strategies have been proposed by different players, right from nursing and other medical professionals, as well as scholars and policymakers in government, nurse leaders and managers, remain critical at having these solutions work.

 Leaders and managers must establish retention initiatives as practical approaches to dealing with the problem. Having retention strategies means that the leaders and managers should apply critical leadership as well as management skills, competencies, and abilities to ensure that the issues raised by nurses or leading to attrition are addressed collaboratively. According to Heidari et al. (2017), nurse leaders and managers need to understand the reasons for nurses leaving their employment and mitigate the factors that lead to the intentions of these professionals leaving the workplace. For instance, studies demonstrate that most nurses leave because of job dissatisfaction, especially when a nurse requires career progression and empowerment. The implication is that leaders should advocate for nurses to get better training and career progression opportunities in the organization. Nurse leaders need to ensure that bedside nurses have a manageable workload and get chances to increase their competence and skills for better service delivery.

Additional Aspects by Leaders and Managers to enhance Professionalism

According to Wood (2017), nurse leaders and managers should develop effective approaches in their efforts to address the problem by getting an excellent fit to mitigate the turnover, right from the hiring process. Leaders should engage the nurses to avoid burnout. At the same time, the management should institute an effective hiring process which allows an organization to attain the best fit based on an individual’s attitude and ability to stay. Managers can establish retention policies when hiring nurses. For instance, a strategy that requires a nurse to spend at least a certain amount of time at the organization can mitigate turnover (Ellrich & Nelson, 2020). Managers should develop retention strategies like the creation of growth opportunities for nursing staff, recognizing nurses for meaningful performance and achievement, and improving the work environment. 

Effective Leadership Style and Advocacy

On their part, nurse leaders should develop and nurture the collaborative working relationships with the nurses and ensure that the professional code of conduct and ethical principles guide how they deal with bedside RNs in their units. According to Hughes (2017), specific leadership strategies can promote the retention of nurses. These include trust, loyalty, having integrity through the use of both aesthetic and authentic leadership models. As nurse advocates, nurse leaders should ensure that their staff work in a secure and safe environment for effective service delivery to patients. The leaders should also support the nurses and use team-building strategies to attain a coherent and high performing team.

The implication is that nurse leaders should use a transformational leadership approach to inspire their nurses, encourage them to attain career goals, and ensure that they deliver the best quality outcomes to retain them (Maxwell, 2017). Studies show that a positive relationship exists between transformational leaders and nurse performance and retention in healthcare organizations. From a Christian and biblical perspective, leaders and managers have to protect their employees and ensure that they are treated well to offer better services to patients (Maxwell, 2017). Transformational leadership ensures that nurses develop professionally, and organizations use effective strategies to solve problems facing them.


Nurse leaders, as well as managers, need to develop responsive and practical models to deal with the issue of nurse turnover to ensure that they mitigate costs and adverse effects associated with the problem. The use of a transformational leadership approach and application of ethical as well as professional code of conduct principles should the starting points. 


Carlson, K. (2018). Avoiding the organizational pain of high nurse turnover. Retrieved from

Ellrich, M. & Nelson, B. (2020 March 23). Nurse Turnover, Part 1: How to Retain Your Best.

Retrieved from

Heidari M, Seifi B, Gharebagh Z. A (2017). Nursing staff retention: Effective factors. Annals of

 Tropical Medicine and Public Health, Vol. 10, No.6, pp.1467-73.

Hughe, V. (2017).  Review Article: Leadership Strategies to Promote Nurse Retention. Scientific

 Journal of Nursing & Practice.

Maxwell, E. (2017). Good leadership in nursing: what is the most effective approach? Nursing

            Times [online]; Vol.113, No. 8, pp.18-21.

Wood, D. A. (2017). Employers need to address nursing turnover. Retrieved from

Assessment Description

In this assignment, you will be writing a 1,000-1,250 word paper describing the differing approaches of nursing leaders and managers to issues in practice. To complete this assignment, do the following:

  1. Select an issue from the following list: bullying, unit closers and restructuring, floating, nurse turnover, nurse staffing ratios, use of contract employees (i.e., registry and travel nurses), or magnet designation.
  2. Describe the selected issue. Discuss how it impacts quality of care and patient safety in the setting in which it occurs.
  3. Discuss how professional standards of practice should be demonstrated in this situation to help rectify the issue or maintain professional conduct.
  4. Explain the differing roles of nursing leaders and nursing managers in this instance and discuss the different approaches they take to address the selected issue and promote patient safety and quality care. Support your rationale by using the theories, principles, skills, and roles of the leader versus manager described in your readings.
  5. Discuss what additional aspects managers and leaders would need to initiate in order to ensure professionalism throughout diverse health care settings while addressing the selected issue.
  6. Describe a leadership style that would best address the chosen issue. Explain why this style could be successful in this setting.

Use at least three peer-reviewed journal articles other than those presented in your text or provided in the course.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. 

You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance. 


Benchmark – Effective Approaches in Leadership and Management

The nursing practice, its managers and leaders encounter diverse issues that impact their ability and competence to deliver quality and patient-centered care. These issues range from lateral violence to nurse turnover rates and even nurse staffing ratios that leaders and managers must address to ensure effective and quality care delivery. High rates of nurse turnover emanate from different factors like the nurse staffing ratios (Bryant et al., 2019). Recent legislations like in California focus on mandating healthcare organizations to ascertain that they have sufficient nurse staffing ratios to deliver quality patient care. The purpose of this paper is to discuss different approaches that nurse leaders and managers can employ in addressing nurse staffing ratio in healthcare settings.

Nurse Staffing Ratios and Impacts on Quality of Care and Patient Safety

Nurse staffing ratio denote the ratio of nurses on a certain unit, floor or ward to the number of patients in such settings. For instance, units with increased acuity care like the intensive care unit (ICU) have lower ratio of nurses to patients meaning that nurses serve few patients as compared to those with lower acuity which experience fewer nurses to more patients (Antwi & Bowblis, 2018). The usual ratio for a medical-surgical unit would be one nurse to six patients while in higher acuity care areas like the ICU, the ratio is one nurse to two patients. However, the reality is that many units across the healthcare system are understaffed and experience high turnover rates making nurses to work based on unsafe ratios.

The huge cuts in hospital and healthcare budgets as well as a shortage of qualified nurses have pushed many facilities and nurse practitioners to work with these unsafe ratios. High nurse staffing ratios presents significant challenges that impact patient safety and quality of care provided by the practitioners. Studies have consistently demonstrated that nurses caring for many patients beyond the recommended levels risk being stressed and experiencing burnout that impacts their ability to offer quality care (Vuong, 2020). These nurses may be prone to medication errors and mistakes because of the hectic schedules and having several patients to monitor and care for during their shifts (Bridges et al., 2019). For instance, nurses in such units may not have sufficient time to offer patient-centered care through provision of emotional support and comfort. Further, they cannot offer patient education and other primary care interventions to improve quality of care because of the large numbers that they must handle. According to the American Nurses Association (ANA, 2022), appropriate nurse staffing levels lead to improved patient outcomes and also better satisfaction for both providers and patients. Staffing impacts the ability of nurses to deliver safe and quality care in all setting. Imperatively, safe nurse staffing is important for both the profession and the overall health care system as it implies quality care and patient safety as well as improved outcomes.

Professional Standards of Practice to Address the Issue and Maintain Professional Conduct

Advanced practice registered nurses (APRNs) must adhere to the expected professional standards of practice as developed by their professional organizations like the American Nurses Association and regulatory entities like the National Council for State Boards of Nursing (NCSBN) and their respective state boards of nursing (BON) (Haegdorens et al., 2019). These professional standards are an integral part of how they handle diverse patients and situations like the nurse staffing ratios with the aim of maintaining their professional conduct. These standards reflect a desirable and attainable level of performance for each nurse to evaluate and compare theirs and ascertain if they meet the regulatory mandates (ANA, 2022). The primary purpose of professional standards of practice is to offer guidelines and directions as well as maintain a safe and clinically competent nursing workforce and practices. These standards address the right nurse to patient ratios to inform safe care delivery and ensure that nurses take responsibility for their actions on each patients.

Having a balanced or a requisite nurse-to-patient ratio can entail several professional standards and implore nurses to maintain such standards to deliver safe and quality care. Nurses, patients and the healthcare systems experience safer and quality outcomes when the staffing ratios are safe and within the best practices and professional standards (Haegdorens et al., 2019). Having safe staffing levels demonstrates the professional standards required and that should be maintained by nurse leaders and managers in different practice settings. Through these standard ratios, nurses will offer better and safe patient-centered care and develop best practices for long-term staff and patient satisfaction.

Roles and Approaches of Nurse Leaders and Managers

Nurse managers and nurse leaders may take diverse approaches and play different roles in addressing nurse staffing ratios in their facilities. Transformational nurse leaders are at the forefront of healthcare delivery systems and set practice standards aimed at delivering safe, quality and efficient patient care. They also bring their teams together and make sure that they attain unit goals and objects. They also delegate and acquire input from subordinates on the best way to handle the issue. A core aspect of these roles and approaches is innovation (Whitney, 2018). As innovative leaders, they creatively allow their teams to develop new ideas and ways of attaining requisite nurse-to-patient ratios in different units, from the ICU to medical-surgical wards based on the acuity levels (Rafferty, 2020). Nurse leaders can also take patient assignments despite their positions and responsibilities. Nurse leaders should always inspire their staff to voice their concerns and ideas on the issue at hand as such approaches institute and nurture trust and respect between the leader and the nursing staff.

Nurse managers have different approaches based on the responsibilities and positions that they hold. Nurse managers may be keen on maintaining the status quo and ensuring that they follow the management’s position on the issue (Reinhardt et al., 2020). For instance, nurse managers can make necessary changes like hiring appropriate number of nurses to attain adequate levels required. They also have a duty to develop schedules and planning in advance on issues that arise in the care setting. Nurse managers also mandate subordinates to report issues and concerns based on changes in their units for better staffing measures (Schwenker, 2022). Managers may be more transactional because they follow their functions like planning, hiring and directing. However, their approaches may be devoid of the best ways to handle the nurse-to-patient ratios.

Differing Roles of Nursing Leaders and Managers

Nursing leaders and managers are vital in addressing nurse staffing ratio issues. Nurse leaders tend to concentrate on strategic planning, vision development, creating an enabling environment, advocating for organizational changes, and engaging in policy creation as they guide staff nurses. Conversely, nursing managers typically play more of an operational role: monitoring daily operations while assuring adequate staff levels are met and responding quickly when staffing issues arise (Blok et al., 2021). Nursing leaders indirectly approach staffing issues by shaping policy changes, lobbying for adequate resources, and creating a safety culture in their organization. They use their expertise to engage stakeholders, collaborate with other departments, and champion evidence-based staffing guidelines. On the other hand, nursing managers focus on immediate staffing challenges by coordinating schedules, redistributing workload, and encouraging communication between staff members.

Additional Considerations to Achieve Professionalism

Nursing leaders and managers must implement several vital aspects to maintain professionalism in various healthcare settings while meeting staffing ratio requirements. One key area includes ongoing education and training, where leaders provide continuous learning opportunities that improve nurses’ knowledge about staffing ratios, patient safety measures, and quality care delivery. Transparency is also essential in setting open and honest lines of communication, enabling nurses to express any staffing ratio-related grievances without fear of retaliation from management. Team meetings and feedback sessions facilitate this dialogue and allow nurses to voice their opinions freely while sharing experiences.

Collaborative decision-making can also play a crucial role in addressing staffing ratio challenges. Inclusive processes that involve both leaders and staff nurses in developing effective strategies. Nurses can take ownership of proposed solutions by working together, creating commitment and shared responsibility toward solving their issues. Securing sufficient resources is just as essential, with leaders and managers needing to ensure enough staffing levels, equipment, and technology to support safe staffing ratios. They should advocate for budget allocations that prioritize patient safety and quality care while emphasizing the necessity of adequate resources to achieve optimal results.

Acknowledging and rewarding nurses who exhibit outstanding professionalism when meeting staffing ratio challenges is another effective way of upholding professionalism within an organization. Recognizing and appreciating their efforts helps foster an atmosphere of professionalism across the board. At the same time, performance evaluations provide crucial feedback that identifies areas for improvement and potential growth, thus furthering professionalism and improving care quality.

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