The Role of Leadership and Organizational Climate in Turnover during Statewide Behavioral Health Reform












Literature Review

Lisa Oll-Adikankwu

Southern New Hampshire University: NUR 300

March 25, 2019

Literature Review

There’s an ongoing instability in the nursing workforce of nurse retention that is a problem experienced worldwide. Left unresolved could have a serious impact on the foundation of quality health care. The purpose of this paper is to explore the reasons for low nurse retention, to acknowledge its effects on patient care quality, and to present strategies to combat this professional issue. A systematic and comprehensive literature review of data was undertaken retrieving articles from the Shapiro Library using several electronic databases including CINAHL, Ovid, PubMed, Google and Google Scholar. The key words used for the terms searched were “nurse retention,” “turnover,” “nurse mentors,” and “communication.” The limiting factors were that the work was peer reviewed and the search resulted in articles published from 2011 to 2017.

Article One

The article, “Analyzing U.S. nurse turnover: Are nurses leaving their jobs or the profession itself?” was published by Mazurenko, Gupte and Shan (2015). Their objective was to assess and compare amongst registered nurses (RN), factors associated with making the decision to vacate a job (organizational turnover) versus leaving the profession (professional turnover). This article suggests that a number of individual, organizational and environmental factors were associated with an RN’s decision to leave an organization and the profession. RN’s who left an organization or profession,

“Were dissatisfied with their jobs due to factors such as (burnout, stress, physical demands, disability, illness, lack of good leadership, lack of collaboration, scheduling issues, inadequate staffing, lack of advancement opportunities, better pay benefits, age, marital status, level of education, race/ethnicity, geographical location, and previous place of work). Job satisfaction can be defined as the extent to which an employee likes his or her job and has been consistently associated with the intent to leave and actual organizational turnover (Mazurenko, Gupte and Shan, 2015).

Job dissatisfaction is essentially very important as it results in a decrease of nurse retention. The authors collected a data analysis survey on RN’s who either left the organization to work in a different health care setting or left the profession in total. Their findings revealed a total 62.4 percent of nurses who left the organization and the profession altogether. According to (Mazurenko, Gupte and Shan, 2015), “Approximately 14 percent (4,682) of RNs left the profession and 14 percent left their organization (4,114) from a total sample size of 36,646” related to the factors mentioned above. This article is important because it gives understanding as to why RNs are leaving health care organizations or the profession altogether.


Article Two

Lin (2013) published a review of literature in the article, “The impact of nurse staffing on quality of patient care in acute care settings: An integrative review paper.” The objective of this study was to examine the relationship between nurse staffing and quality of care in acute care settings. Twelve measurable studies were included in this review focusing on acute care in the adult setting. Although two studies found no significant association between nurse staffing and quality of patient care, the remaining ten studies proposed that higher staffing level and higher level of RN skill is associated with improved patient outcomes. According to Lin, (2013), the studies, “concluded that hospitals with lower levels of nursing staff encountered a 7% increase in 30-day mortality and a 7% increase in failure-to-rescue.” This finding was supported by another study performed by Zhu et al. in 2012, which established that when nurse-to-patient ratio decreased, patient outcomes were significantly deteriorated. Turnover within hospitals can compromise organizational functioning, continuity of care, and provision of evidence-based treatment (Lin, 2013), thus leading to poor quality of service and client outcomes. The significance of this article is that it supports the issue of low nurse retention affecting patient quality of care.

Article Three

published a review of literature in their article, “The Importance of Communication for Clinical Leaders in Mental Health Nursing: The Perspective of Nurses Working in Mental Health.” Their objective of the study explored the attributes and characteristics required for effective clinical leadership in mental health nursing, specifically the views of nurses working in mental health and the importance of effective communication in day to day clinical leadership.

“Leaders should have the insight and knowledge to identify aspects in the workforce that threaten the overall function and strength of the organization. Values that strengthen cohesion in a work force include effective communication, teamwork and collaboration. Communication in nursing is essential but for nursing leadership in mental health settings it is pivotal for working relationships, retention of staff, improved patient outcomes, and the development of our profession (Ennis, Happell, Broadbent and Reid-Searl, 2013).

Effective teamwork and collaboration is essential in a healthcare setting, especially in stressful settings, such as the ER, Psych unit or ICU. Nurses and other healthcare providers rely on each other within the team to provide care and in pursuit of optimal patient outcome. According to Ennis, Happell, Broadbent and Reid-Searl, “teamwork can be fostered in an environment that acknowledges the values, talents, and work ethics of each generational cohort. However, when team members do not respect and value one another’s generational differences, conflict, distress, and incivility are unavoidable.” (2013). The significance of this article is to demonstrate that effective communication, an attribute of effective clinical leadership is considered important and essential for successful working relationships, improved learning experiences and overall helped combat the issue of nurse retention and motivate employees to stay with an organization or within the nursing profession, especially in the mental health setting.

Article Four

Schroyer, Zeller and Abraham (2016) produced an important review titled, “Increasing Registered Nurse Retention Using Mentors in Critical Care Services.” The objective of their study focused on retention rates after the implementation of a mentorship program for RNs entering a specialty unit within critical care service. Their study covered five years and eighteen hospitals, targeting nurses who were new graduates, re-entry nurses, and nurses new to the critical care specialty. According to Schroyer, Zeller and Abraham (2016), “The retention rate of nurses with a mentor was 91%, a significant increase from 66% for the not-mentored group” hence proving that nurses are retained when a mentor program is used. This study indicated an increase in retention when a mentor was used with a new graduate or a nurse new to the critical care service specialty. Increasing RN retention creates an environment of stability, fosters teamwork, builds confidence, and increases patient satisfaction (Schroyer, Zeller and Abraham 2016). This article is important because it supports the fact that introducing mentorship programs within the nursing field decreases nurses’ intent to leave their workplace and the subsequent organizational turnover.



Aarons, G. A., Sommerfeld, D. H., & Willging, C. E. (2011). The Soft Underbelly of System

Change: The Role of Leadership and Organizational Climate in Turnover during

Statewide Behavioral Health Reform. Psychological Services8(4), 269-281.

Mazurenko, O., Gupte, G., & Shan, G. (2015). Analyzing US nurse turnover: Are nurses leaving

their jobs or the profession itself. Journal of Hospital Administration4(4), 48-56.

Schroyer, C. C., Zellers, R., & Abraham, S. (2016). Increasing registered nurse retention using

mentors in critical care services. The health care manager35(3), 251-265

Yoder-Wise, P. S. (2015). Leading and managing in nursing (6th ed.). St. Louis, MO: Mosby,

Inc., an affiliate of Elsevier Inc.

Ennis, G., Happell, B., Broadbent, M., & Reid-Searl, K. (2013). The importance of

communication for clinical leaders in mental health nursing: the perspective of nurses working in mental health. Issues in mental health nursing34(11),

Chin How Lin. (2013). The impact of nurse staffing on quality of patient care in acute care

settings: An integrative review paper. Singapore Nursing Journal, 40(4), 10–23.

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