We examined the concurrent and lagged effects of registered nurse () turnover on unit‐acquired pressure ulcer rates and whether staffing mediated the effects.
Quarterly unit‐level data were obtained from the National Database of Nursing Quality Indicators for 2008 to 2010. A total of 10,935 unit‐quarter observations (2,294 units, 465 hospitals) were analyzed.
This longitudinal study used multilevel regressions and tested time‐lagged effects of study variables on outcomes.
The lagged effect of turnover on unit‐acquired pressure ulcers was significant, while there was no concurrent effect. For every 10 percentage‐point increase in turnover in a quarter, the odds of a patient having a pressure ulcer increased by 4 percent in the next quarter. Higher turnover in a quarter was associated with lower staffing in the current and subsequent quarters. Higher staffing was associated with lower pressure ulcer rates, but it did not mediate the relationship between turnover and pressure ulcers.
We suggest that turnover is an important factor that affects pressure ulcer rates and staffing needed for high‐quality patient care. Given the high turnover rates, hospital and nursing administrators should prepare for its negative effect on patient outcomes.