High nurse and doctor turnover rates linked to increased patient deaths in NHS hospitals

More than 4,000 people could be dying per year because of high turnover rates of nurses and doctors in NHS hospitals, according to new research from the University of Surrey.

The research has shown a clear association between high turnover rates of nurses and doctors in NHS hospitals and a troubling rise in patient mortality rates.

The study, published in The BMJ, analysed nearly a decade of data from 148 NHS acute hospitals in England using anonymised patient and worker records. The researchers found that a one standard deviation increase in nurse turnover is associated with 35 additional deaths per 100,000 hospital admissions within 30 days. For senior doctors, a similar increase in the turnover rates correlates with an additional 14 deaths per 100,000 admissions. With an average of 8.2 million hospital admissions occurring annually, the turnover rates of hospital nurses and senior doctors could translate to nearly 335 additional deaths each month across the NHS.

Dr Giuseppe Moscelli, Associate Professor in Economics and lead researcher of the study at the University of Surrey, said:

“Our findings underscore the vital role that stable staffing plays in ensuring patient safety. High turnover rates are not simply an administrative issue; they have real, life-or-death implications for patients. It’s time for healthcare leaders to focus on retention strategies that prioritise workforce stability.”

The research uses extensive datasets, which include over 236,000 nurses and 41,800 senior doctors, as well as 8.1 million patient records.

The findings suggest that as turnover rates increase, the quality of care diminishes, leading to higher mortality risks for patients, particularly those admitted for emergency care. One area of high concern is high nursing turnover, which seems to have a detrimental impact on surgical and general medicine wards. Notably, high turnover rates among senior doctors are linked to increased mortality in patients suffering from infectious diseases and mental health disorders.

The research suggests that addressing the root causes of turnover—such as job satisfaction, working conditions, and staff engagement—is essential for improving patient outcomes. In another recently published and related work, Dr Moscelli and colleagues find that the retention of NHS hospital nurses is strongly associated with their engagement at work, whereas the retention of NHS hospital doctors is crucially associated with the retention of hospital nurses.

Dr Moscelli continued:

“With the mounting pressure on NHS resources, it is essential that we invest in our healthcare workforce. Retaining skilled healthcare professionals is not just a cost-saving measure; it is crucial for safeguarding patient lives.”

The full paper in The BMJ, on the association between NHS clinical staff turnover and patient mortality risk, is available to view and download.

The full Economica paper, on the determinants of NHS nurse and senior doctor retention, is available to view and download.