title: The effect of nurse manager turnover on patient fall and pressure ulcer rates.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  Nurse manager turnover may negatively impact patient outcomes. Stable nursing management, strategic interim management and long-term succession planning may reduce adverse patient events.
authors.affiliation: College of Nursing, University of Kentucky, Lexington, KY 40503-0232, USA. nwa229@uky.edu
authors.forename: Nora
authors.initials: N
authors.lastname: Warshawsky
authors.forename: Mary Kay
authors.initials: MK
authors.lastname: Rayens
authors.forename: Karen
authors.initials: K
authors.lastname: Stefaniak
authors.forename: Rana
authors.initials: R
authors.lastname: Rahman
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D015400:Clinical Nursing Research; D064648:Critical Care Nursing / Q000458:organization & administration; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units; D007857:Leadership; D008137:Longitudinal Studies; D009718:Nurse Administrators / Q000458:organization & administration*; D015401:Nursing Administration Research; D009741:Nursing Staff, Hospital / Q000458:organization & administration* / Q000706:statistics & numerical data; D010563:Personnel Turnover / Q000706:statistics & numerical data*; D003668:Pressure Ulcer / Q000453:epidemiology*
keywords: nurse manager; patient falls; pressure ulcers; retention; turnover