Nursing Turnover in a Large Health System

Nursing turnover is a leading source of inefficiency in health care systems and accounts for a quarter of all turnover costs. Nurses in inpatient settings are at a higher risk of leaving their jobs, which may compromise patient care and workplace morale. In this study, we examine inpatient nursing turnover in the Sanford Health System, which is a large provider spanning the Dakotas and neighboring states. Using detailed human resources data, time stamp data, and patient encounter data that are rarely available to researchers, we aim to identify the determinants of nursing turnover, including workload (e.g., patient-to-nurse ratio, share of newly admitted patients) and scheduling (e.g., night and weekend shifts). We address the endogeneity of workload and scheduling using instrumental variables, including weather patterns and whether a nurse’s colleague took a pre-planned vacation. Important confounders include tenure, which has a non-linear relationship with turnover, and whether nurses worked in critical access hospitals.