The effect of nurse manager turnover on patient fall and pressure ulcer rates

Nora Warshawsky, Mary Kay Rayens, Karen Stefaniak, Rana Rahman

Research output: Contribution to journalArticlepeer-review

33 Scopus citations


Aims: The purpose of this study was to explore the effects of nurse manager turnover on the occurrence of adverse events. Background: Nurse managers create professional nurse practice environments to support the provision of quality patient outcomes. Inconsistent findings were reported in the literature testing the relationship between nurse managers and patient outcomes. All prior studies assumed stable nursing management. Methods: A longitudinal quasi-experimental study of 23 nursing units in two hospitals was used to determine whether unit characteristics, including nurse manager turnover, have an effect on patient falls or pressure ulcers. Statistical analyses included repeated measures and hierarchical modelling. Results: Patients in medical/surgical units experienced more falls than in intensive care units (F1,11 = 15.9, P = 0.002). Patients in units with a nurse manager turnover [odds ratio: 3.16; 95% confidence interval: 1.49-6.70] and intensive care units (odds ratio: 2.70; 95% confidence interval: 1.33-5.49) were more likely to develop pressure ulcers. Conclusions: Nurse manager turnover and intensive care unit status were associated with more pressure ulcers. Medical/surgical unit status was associated with more falls. The study was limited by a small sample size. Implications for nurse managers: Nurse manager turnover may negatively impact patient outcomes. Stable nursing management, strategic interim management and long-term succession planning may reduce adverse patient events.

Original languageEnglish
Pages (from-to)725-732
Number of pages8
JournalJournal of Nursing Management
Issue number5
StatePublished - Jul 2013


  • Nurse manager
  • Patient falls
  • Pressure ulcers
  • Retention
  • Turnover

ASJC Scopus subject areas

  • Leadership and Management


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