NURS 491 Week 2 Discussion Board Forum 2 Example

Discussion Board Forum 2: Turnover, Retention and the Nurse Manager

NURS 491 Nursing Management, Discussion Board Forum 2

Thread by [Student Name]

The unit, its turnover figures and the classmates are composites; the textbook, Scripture and journal articles cited are real.

Part 1: Why Our Nurses Left

Last year our 32-bed medical-surgical unit lost 11 of its 42 registered nurses, a turnover rate of about 26%. Five of the eleven had been nurses for less than two years. I am not the manager, but I sit on the unit's retention committee, and we read every exit interview. The reasons repeated: too many patients on nights, not enough help from experienced nurses during the first year, mandatory overtime and a feeling that no one in leadership noticed how hard the work had become. Two nurses left for travel contracts that paid more, but even they mentioned staffing first. When we sorted the departures by shift, eight of the eleven had worked mostly nights, and six had been pulled to float elsewhere two or more times monthly before they resigned. Those patterns did not appear in any single exit interview; they appeared only when we put the interviews and the schedules side by side.

Our experience fits the research closely. De Vries et al. (2024) combined 33 studies and put the share of hospital nurses who planned to leave their current job during the pandemic at 38%, with 28% planning to leave nursing altogether. Their review grouped the determinants into personal characteristics, job demands, employment conditions, working conditions, work relationships and organizational culture, and identified age, experience, burnout and support as major individual factors. Our younger nurses, who were also the least experienced, were the ones most likely to go, and the support they described lacking is one of the factors the authors highlight.

Finkelman (2016) frames staffing and retention as management responsibilities that affect both quality and cost, because each departure brings recruitment and orientation costs and leaves the remaining staff with heavier loads. That second effect is what worries me most. When five experienced nurses left, the newer nurses lost their mentors, and turnover began to feed itself. Our orientation hours also rose by more than a third in a year, and the remaining senior nurses precepted almost continuously, which several told us was wearing them down as well. A unit can reach a point where the cost of turnover is paid mostly by the people who stayed.

Part 2: What a Nurse Manager Can Do

A manager cannot set pay scales or open new positions alone, but several things are within reach. The first is how new nurses are brought in. Mohamed and Al-Hmaimat (2024) reviewed studies of nurse residency programs and concluded that they help new graduates become supported, competent and confident and may improve retention in the first 12 months of employment, although the evidence beyond the first year is thin. De Vries et al. (2023) reviewed 55 studies of retention strategies for nurses and physicians and recommended onboarding programs and mentoring above all, while noting that managers should match any intervention to the specific reasons their own staff give for wanting to leave. For our unit, exit interviews point clearly to support in the first year. Finkelman (2016) adds that a manager's influence over the work environment, through scheduling fairness, recognition and visible presence, shapes whether staff feel valued, and those are levers that do not require a new budget line.

The second factor is one I had never considered: the manager's own workload. Warshawsky et al. (2026) surveyed 255 nurse managers, who together ran 296 units across 47 hospitals, and showed that units lost more nurses when each manager was responsible for more full-time staff and more beds; falls, too, were more frequent where census was high and a manager covered many beds. Our manager oversees our unit and the step-down unit next door, about 90 staff in all. It is difficult for any leader to notice how hard the work has become when she has that many people to know.

Based on this evidence, our committee will recommend three actions: a structured first-year program pairing every new graduate with a trained preceptor and a mentor, quarterly stay interviews in which the manager or assistant manager asks nurses what would keep them, and a request to administration to fund an assistant manager for nights, supported by our exit interview themes and the span of control evidence. Retention is decided in the first year and on the night shift, which is where a manager is least likely to be watching.

Reply to Courtney

Courtney, you argued that the simplest answer to turnover is higher pay and that hospitals lose nurses to travel agencies because they will not compete on wages. Pay matters, and I would not dismiss it, but the research suggests it is rarely the whole story. In the meta-analysis by De Vries et al. (2024), the main determinants of intention to leave were burnout, support, experience and working conditions, and pay was one employment factor among many rather than the leading one. De Vries et al. (2023) also found that the retention strategies with the most support were onboarding and mentoring, along with interventions on work relationships and job demands. A raise that leaves a nurse with seven patients and no help on nights may delay a resignation, but it probably will not prevent it. Nurses who leave for travel contracts often return to permanent jobs later, and they tend to choose the units where the work felt manageable. Two of our travel departures told us they would have stayed for better staffing at the same pay. Pay also has a ceiling for a manager: she can advocate for market adjustments, but she cannot set the wage scale, while she can influence assignments, scheduling and support every day. Focusing only on pay can leave the factors within her reach unaddressed.

Scripture gives managers a picture of attentive care for the people they oversee. Proverbs tells the herdsman to know well the condition of his flocks and give attention to his herds (English Standard Version Bible, 2001/2016, Proverbs 27:23). A manager who knows her staff well enough to hear that the problem is support, not only salary, is following that counsel. Peter also urged the elders to shepherd God's flock willingly, not under compulsion and not domineering over those in their charge, but being examples (English Standard Version Bible, 2001/2016, 1 Peter 5:2-3). For a nurse manager, being an example might mean working a night shift beside the staff to see what they face.

I think the strongest approach combines fair pay with the support and staffing that nurses keep asking for. Has your hospital tried stay interviews or a residency program alongside its wage changes? I would be interested to know whether retention improved more after one than the other, because that comparison would help our committee decide where to put limited money first. Your unit's experience could be a useful natural experiment for the rest of us.

Reply to Marcus

Marcus, thank you for being honest about how stretched you feel since being asked to manage both the orthopedic unit and the surgical unit. Your sense that you no longer know your staff is supported by research. Warshawsky et al. (2026) found that nurse turnover rose as the number of staff and beds per manager increased, and that hospitals differed widely in how many people each manager oversaw and how much backing managers received. They concluded that smaller units with smaller teams have an advantage in building a stable workforce and in patient outcomes. In other words, what you are experiencing is not a personal failure but a structural one, and it has measurable consequences. Finkelman (2016) describes the nurse manager as responsible for staffing, quality, budget and staff development at once, which is a demanding role even for a single unit. Doubling the number of units doubles the meetings, evaluations and schedules while the hours in the day stay the same.

Scripture has a striking example of this problem. Moses once sat from morning to evening hearing every case Israel brought him, until Jethro warned that the load was too heavy for one man and would exhaust both Moses and the people, and urged him to choose trustworthy men to lead groups of thousands, hundreds, fifties and tens (English Standard Version Bible, 2001/2016, Exodus 18:17-22). Moses listened and shared the load. Paul also tells believers to bear one another's burdens (English Standard Version Bible, 2001/2016, Galatians 6:2), which applies to a leadership team as much as to a congregation. Asking for help is not weakness; in Jethro's advice, it was wisdom. Moses did not stop leading when he shared the load; he kept the hardest cases and gave the rest to people he trusted, which is very close to what a manager with strong charge nurses can do.

You might bring the span of control evidence to your director as a case for assistant managers or charge nurse development on each unit, framed around turnover and falls rather than your own workload. Could your two units each have a stronger charge nurse role so that some daily decisions do not have to wait for you? That kind of structure might give you time to know your staff again, which may be the most effective retention strategy of all. Even an hour a week walking each unit on nights could tell your staff that their manager sees them, and that is often what nurses say they miss most.

References

De Vries, N., Lavreysen, O., Boone, A., Bouman, J., Szemik, S., Baranski, K., Godderis, L., & De Winter, P. (2023). Retaining healthcare workers: A systematic review of strategies for sustaining power in the workplace. Healthcare, 11(13), 1887. https://doi.org/10.3390/healthcare11131887

De Vries, N., Maniscalco, L., Matranga, D., Bouman, J., & De Winter, J. P. (2024). Determinants of intention to leave among nurses and physicians in a hospital setting during the COVID-19 pandemic: A systematic review and meta-analysis. PLOS ONE, 19(3), e0300377. https://doi.org/10.1371/journal.pone.0300377

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

Finkelman, A. (2016). Leadership and management for nurses: Core competencies for quality care (3rd ed.). Pearson.

Mohamed, Z., & Al-Hmaimat, N. (2024). The effectiveness of nurse residency programs on new graduate nurses' retention: Systematic review. Heliyon, 10(5), e26272. https://doi.org/10.1016/j.heliyon.2024.e26272

Warshawsky, N. E., Pascale, A., & Duemig, M. J. (2026). Impact of nurse manager span-of-control on turnover and patient safety in acute care. Journal of Nursing Administration, 56(4), 186-190. https://doi.org/10.1097/NNA.0000000000001709