Nurse turnover rate post

pandemic & the effect on

patient care
 Clinical problem: The effect on patient care in regards
to the turnover rate of nurses during the pandemic

Due to the widespread pandemic, many of nurses have

become debilitated to eject their duties -- particularly in
inadequate patient care and medical errors, the end result is
that many opt to quit the profession thus increasing the
turnover rate of nurses. The poor self-care of nurses has
increased their turnover rate during pandemics (Senek et al.,
2020). This creates a shortage of nurses in the country.
Research Process
● The researching process consisted of a widened approach of search strategies that incorporated
approaches including online platforms, identifying key search related cues or words, credible
databases and search engines, and identifying sources surrounding PICOT related questions.
● Minor barriers encountered throughout the research process were typically surrounding time
management and the ability to compile all thoughts and input into one concise proposition.
● Aspects that went well were emphasized through moments where our research and different
perspectives gave us the opportunity to grasp a deeper understanding of why nursing research
and evidence based data is so valuable in a field where information and practice is continuously
evolving.
● As we underwent the pursuit of a deeper understanding of what our clinical problem would
entail, we were able to transcend our knowledge through our research to collect all necessary
data and unfold a higher level of comprehension of what nurse turnover rates post-pandemic
meant on patient care.
 Research Findings
By July, 2020, researchers have found that more than 40 percent of nurses and other health care professionals were at risk
of burnout, according to the American Journal (AJN, 2020) published in lippincott portfolio.

● The researchers also conducted an online survey of nurses and other non-physician health care workers (HCWs),
2,459 participant responded to the survey. It focused on risk factors that minimized nurse’s wellness: a vital
benefactor to the epidemic of burnout among health care professionals.
● The survey also focused on aspects of resilience, which is defined as the ability to cope with and adapt positively to
adversity, resilience contributed tremendously to well-being of every individual. Data were collected in June and
July 2020, providing a snapshot of well-being and resilience among HCWs a few months into the pandemic .
Research findings (continued)
The survey revealed that 44 percent of HCWs were "at risk" well-being (AJN,2020) which is linked to increased risk of exhaustion, burn out,
and patient care errors. Several factors contributed with increased odds of poor well-being, including:

● Having low scores on a measure of resilience

● Worryness about insufficient (PPE)
● Feeling that the organization did not understand health care workers' emotional support needs during the pandemic
● Thinking that workload had increased due to workplace being short of staff
● Believing that staffing was inadequate to safely care for patients
● Having a lower degree of psychological safety

In contrast, opposite levels of some of the same factors were associated with higher scores for resilience:
● Feeling that the organization did understand emotional support needs
● Having a higher degree of psychological safety
Research findings (continued)

● Less than one-fourth of health care workers reported using the resources available to aid them through their well-
being and resilience (such as meditation apps, employee assistance programs, and counseling). Perhaps reflecting
high levels of stress early in the COVID-19 pandemic, those who used such resources were more likely to have "at
risk" well-being (AJN, 2020).
Summary of the validity of qualitative evidence

● A survey found that the rate of burnout among health care workers related to
COVID-19 is at 61% using the Maslach Burnout Inventory (Restauri & Sheridan,
2020).
● Another study was conducted in April 2020. The findings showed the prevalence of
mental health issues such as anxiety which has a rate of 23.2%, depression rate of
22.8%, and insomnia estimated at 38.9% among health care workers and nurses
during the COVID-19 outbreak (Sampaio et al., 2020).
● Through a systematic review with a meta-analysis that was conducted, it is found that
a probability of 66.4% shows that there is a connection between health professionals
burnout and patients safety (Lima Garcia et al., 2019).
Summary of the validity of quantitative evidence

* A table provided in a study showed the consequences of workplace stress related to the COVID-19 pandemic (Restauri &
Sheridan, 2020).

● Lack of job control results to emotional exhaustion -> decreased productivity

● Excessive workload leads to decrease quality of patient’s care
● Prolonged work stress -> decrease sense of accomplishment that will turn to decrease patient satisfaction
● Imbalance between demands and skill set -> increased turnover and increased medical errors

* A study conducted by Hofmeyer et al. (2020) discussed how self-awareness and self care including emotion regulation and
compassion during the COVID-19 pandemic among nurses play a major role in patient satisfaction in the health care settings.

* A 2020 study found that creating a safe and trustful work environment and implementing good communication strategies among
nurses will improve delivery of safe and high quality care for patients (Rangachari & Woods, 2020).
RECOMMENDED PRACTICE CHANGES
The research is indicative of a dire need for self-care implementation to mitigate current nurse turnover rates (as we are still amidst
the pandemic), thereby improving patient care.

● Self-care encompasses a vast array of elements, such as mental, physical, emotional, and professional, to name a few
(Registered Nursing, 2021).
● Factors to reduce turnover include level of education and professional experience in areas such as end-of-life care,
infectious diseases, risk prevention, and critical care prioritization (Chen, et al., 2021). These factors can be categorized into
the aforementioned self-care categories.
● It should be recommended that practice changes should be made to incorporate the above-mentioned factors into the
workplace to empower the nurses, and place them in a position to feel more prepared, considered, valued and
acknowledged, and stress the importance of off duty self-care as well.
● Surveys should be conducted pre-, intra- and post implementation to ensure measurability so that changes can be made
accordingly.
● This endeavor has to be made feasible, in an effort to reduce turnover rates and improve patient care. Failure to do so will
have detrimental effects for all involved.
Suggestions for implementations
● Psychological support for nurses through communication and counseling.
● Providing tips and essential resources for nurses to practice self care during the
COVID-19 pandemic (Atkins et al., 2018).
● Availability of Personal Protective Equipment supplies
Conclusion
Given the circumstances surrounding the ongoing pandemic and the current climate in healthcare, nurses have
become the forefront of this battle. With extensive hours, uneven nurse-to-patient ratios, and constant exposure to a
deadly virus -- our healthcare heroes are finding themselves burnt out and opting to leave for the sake of their own
(mental and physical) selves. With climbing numbers surrounding turnover rates, patient care becomes jeopardized
as the workload doubles for those who remain at the bedside.

An online survey in July 2020 asked 2,459 healthcare workers and illustrated that more than 40% of nurses and
related personnel all show signs of burnout fatigue, opting they flee the bedside for their own health as they
determined it was “at risk” (Murphy, 2021).
Conclusion (continued)
Qualitative evidence demonstrated through the Maslach Burnout Inventory that over 61% of
healthcare workers were experiencing burnout since the onset of COVID-19’s widespread
hospitalizations last year (Restauri & Sheridan, 2020).

In turn, recommendations to avoid further decline in patient care and inverse growth in turnover rates,
it is recommended that self-care being introduced and encouraged in the healthcare population. By
doing so, nurses are able to practice mindfulness and emphasis on their mental, physical, spiritual and
holistic needs to further provide care to these critical patients (Chen et al, 2021).

Psychological support and proper equipment such as PPE and training will not only stabilizes
turnover rates, but strengthen bedside care, prevent medical errors related to exhaustion, and increase
prognosis on COVID-19 patients (Atkins et al, 2018)..
References
Atkins, H. E., Campoli, M., Havens, T. R., Abraham, S. P., & Gillum, D. (2018). Self-care Habits of Nurses and the Perception of Their Body Image. The health care manager, 37(3), 211–

219. https://doi.org/10.1097/HCM.0000000000000218

Chen, H. M., Liu, C. C., Yang, S. Y., Wang, Y. R., & Hsieh, P. L. (2021). Factors Related to Care Competence, Workplace Stress, and Intention to Stay among Novice Nurses during the

Coronavirus Disease (COVID-19) Pandemic. International Journal of Environmental Research and Public Health, 18(4), 2122–. https://doi.org/10.3390/ijerph18042122

Hofmeyer, A., Taylor, R., & Kennedy, K. (2020). Knowledge for nurses to better care for themselves so they can better care for others during the Covid-19 pandemic and beyond. Nurse

Education Today (94). Retrieved from https://doi.org/10.1016/j.nedt.2020.104503

Lima Garcia, C., Abreu, L. C., & Bezerra, I. M. (2019). Influence of Burnout on Patient Safety: Systematic Review and Meta-Analysis. Medicina 55, 553. doi:10.3390/medicina55090553

Jill Murphy, A. E. (2021, July 28). Survey shows nurses face significant burnout risks in covid-19 pandemic. contemporaryclinic. https://www.contemporaryclinic.com/view/survey-shows-nurses-face-

significant-burnout-risks-in-covid-19-pandemic.
References (Continued)
Rangachari, P. & Woods, J. L. (2020). Preserving organizational resilience, patient safety, and staff retention during COVID-19 requires a holistic consideration of the psychological safety of

healthcare workers.

International journal of environmental research and public health 17 (12), 4267. doi:10.3390/ijerph17124267

Registered Nursing (n.d.) 2021. The Ultimate Guide to Self-Care for Nurses, Registered Nursing. https://www.registerednursing.org/articles/ultimate-guide-self-care-nurses/

Restauri, N., & Sheridan, A. D. (2020). Burnout and Posttraumatic Stress Disorder in the Coronavirus Disease 2019 (COVID-19) Pandemic: Intersection, Impact, and Interventions. Journal of the

American College of Radiology : JACR, 17(7), 921–926. https://doi.org/10.1016/j.jacr.2020.05.021

Sampaioa, F., Sequeirab, C., & Teixeirad, L. (2020). Impact of COVID-19 outbreak on nurses’ mental health: A prospective cohort study. Environmental Research 194.

https://doi.org/10.1016/j.envres.2020.110620

Senek, M., Robertson, S., Ryan, T., King, R., Wood, E., Taylor, B., & Tod, A. (2020). Determinants of nurse job dissatisfaction-findings from a cross-sectional survey analysis in the UK.

BMC nursing, 19(1), 1-10.