Nursing Turnover and Hospital Efficiency: An Organization-Level Analysis

Authors

  • JEFFREY A. ALEXANDER PH.D.,

  • JOAN R. BLOOM PH.D.,

  • BEVERLY A. NUCHOLS M.S., M.P.H.


  • The authors' affiliations are, respectively, School of Public Health, University of Michigan; School of Public Health, University of California, Berkeley. We gratefully acknowledge the fiscal support of the Institute for Industrial Relations, University of California, Berkeley and the American Hospital Association for providing the data. We thank Te Wei Hu for his advice on econometric techniques, James Robinson for his insights on hospital competition, Joan Chamberlain for her technical assistance, and two anonymous reviewers for their critical insights.

Abstract

This study tests the competing arguments that organization-level turnover is positively associated with organizational inefficiency or, alternatively, positively related to organizational inefficiency only in those organizations experiencing very high or very low turnover. Findings from multivariate analyses support the former argument: in a national sample of 333 hospitals, turnover among registered nurses was found to be associated in a positive linear fashion with both nonpersonnel operating and personnel costs per adjusted inpatient day.

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