Turnover: Identifying Causes and Solutions

Obtaining a work-life balance is a common, but often elusive, objective for many people in the workforce. Achieving this goal is especially difficult for veterinary nurses/technicians due to the demands of this career. Intensified work hours, fatigue, and exhaustion are commonplace and were magnified by the pandemic. As a result, there are higher than average turnover rates among veterinary nurses.¹ The high degree of turnover has led to a known shortage of educated and licensed veterinary nurses/technicians to fill positions.² Underscoring this shortage, the national averages of turnover in the veterinary industry exceed those in other healthcare industries.³

The role of the veterinary nurse demands high reliability, emotional labor, and agility between technical and soft skills. Moreover, this increase in emotional and physical demands on the veterinary nurse leads to an increase in work stress and preventable but profound health risks that are caused by a lack of qualified individuals in the industry.⁴ Without the veterinary nurse, unsafe patient and client practices will result. This article will explore various factors that lead to turnover in the profession and propose a range of solutions that could help reduce the rate of turnover and promote a healthier work environment for veterinary nurses/technicians.

Factors that Lead to Turnover

The factors that contribute to turnover in the veterinary nursing community can be associated with emotional fatigue,⁵ work stress,⁶ and conservation of resources (COR).⁷ Within these factors, the COR model is fundamental in understanding the process of burnout.⁷ The COR model embodies the relationship between emotional exhaustion, motivation, and job performance in the process of turnover. This model also offers 3 ways an employee could respond to stress: (1) loss of resources, (2) threat to current resources, and (3) inadequate return on investments made to maximize resources.⁷ The core of the COR model is the suggestion that a burned-out employee will carefully choose the manner in which they use their remaining resources. As an example, an employee can preserve resources by distancing themselves from emotionally exhausting situations or exerting less energy at work.

To understand and determine the scope of turnover among the veterinary nursing community, the authors conducted research by distributing an online survey to 77 veterinary nurses and their supervisors. Each participant completed a 10-minute self-completion questionnaire of 24 questions. These questions qualified emotional fatigue, turnover intentions, and questions about managerial leadership. The results demonstrated that 30% to 50% of the individuals surveyed intend to leave their job. This percentage is 2 times higher than that seen in other industries. In addition, 69% of respondents reported that they are currently experiencing signs of emotional fatigue, and 42% plan on leaving their job within 1 year.

The preservation and retention of the veterinary nurse are critical to the veterinary industry; without the technical and soft skills of the veterinary nurse, the industry will suffer countless deleterious effects. These effects will negatively influence client care and, most importantly, patient care.

Solutions to Reduce Turnover

Identifying and Increasing Resources

A primary solution to reducing turnover is the availability of tangible resources for the veterinary team. These tangible resources are items, such as functioning equipment and supplies, that allow a veterinary nurse to do their job in the fullest capacity. The inability to access these supplies, or the need to rely on substandard or broken equipment, will impact productivity and the ability of a person to perform at their highest caliber. Other side effects of broken or lacking resources are poor work attitudes and diminishing job satisfaction. Ultimately, leadership within veterinary hospitals is responsible for finding solutions to providing tangible resources.

Leadership’s role in improving tangible resources includes recognizing that repair or replacement costs are an investment that preserves equipment and the team. In comparison, intangible resources are feelings, objects, conditions, and anything that people value and enables them to meet their goals.⁷ For example, an intangible resource is the feeling of accomplishment when a difficult anesthetic case goes home, or the positive feedback received from a doctor or client. A significant intangible resource is the feeling of support and encouragement from leadership. The turnover process begins when veterinary team members are no longer capable of accessing, receiving, or benefiting from their tangible and intangible resources. The value of these resources varies, and they are connected to personal experiences and situations. This variability in definition and importance allows leadership teams to appreciate the scope and dimension of burnout. For example, time with family could be a valuable resource to one person, while positive feedback or a new piece of equipment is more valued by someone else. Research has shown that when individuals lose resources at work, they will also experience strain in the form of burnout or depression.⁷ Leadership teams have the ability to intervene and interrupt the process of burnout, which can prevent turnover. Veterinary leaders can achieve this by understanding the role of resources and how this affects their teams.

Motivating Team Members

An additional solution relating to resources is the role of motivation. The presence of motivation can preserve a veterinary nurse and enable them to preserve their resources. Motivation is critical in the preservation of our veterinary teams because it represents an investment of resources. Evidence and data support multiple methods to promote and spark motivation in the burned-out employee. These methods include increasing equity among team members, rewarding attainability, increasing value of rewards, and appropriately designing job responsibilities. Adjusting workflows and infrastructure to accommodate these resources has been proven to retain team members and ignite the motivation a person needs to achieve individual and professional success. In addition, preserving tangible and intangible resources has life-changing benefits that generate a team of accomplished individuals who have the capacity to interrupt and reverse burnout. Motivation achieves this through goal setting. Research consistently shows that goal satisfaction improves an individual’s wellbeing.⁸

Transformational Leadership and Fostering Mutual Trust

Another solution to reducing turnover is the fostering of trust. Research has demonstrated that a lack of trust and a poor mutual relationship between a team member and their leader is a primary cause of turnover.⁹ Changing leadership styles has the potential to preserve the veterinary team and opens the possibility of creating the motivation and inspiration a hospital needs to retain individuals. The steps to changed leadership involve achieving trust with the team. This can be accomplished in 3 steps: (1) an increase in group cohesion, (2) organizational commitment, and (3) applauding a team’s goals and endeavors.⁹ Practicing these steps demonstrates the principles of transformational leadership, which aims to inspire change with a focus on employee development. This form of leadership encompasses behaviors that inspire, engage, and intellectually stimulate followers.¹⁰ Within transformational leadership, 4 dimensions capture the capacities in which a leader can connect with their team: (1) charisma, (2) intellectual stimulation, (3) inspirational motivation, and (4) individual consideration.¹¹ A primary reason to consider this leadership style is its advantages in preventing turnover. Current research supports transformational leaders having the ability to discourage their team members in their decision to quit.⁹ The daily actions of a transformational leader go beyond basic and transactional relationships to motivate others to achieve more that they thought was possible.¹¹ The positive change that is seen with this form of leadership is a passionate and cohesive team that operates with mutual trust and respect.

Improving Utilization of Team Members

On a larger scale, a strategy to reduce turnover intention is improving staff utilization. One recommendation is increasing the demand on others.¹² Through even work distribution, unbalanced workloads can be alleviated. Further benefits of this suggestion are the opportunity for additional teamwork due to shared responsibilities. To accompany staff utilization, a second organizational recommendation to reduce turnover is the use of a cognitive emotion regulation questionnaire (CERQ) and a depression, anxiety, and stress scale (DASS). The CERQ is a 36-item measure that quantifies 9 cognitive emotion strategies.¹³ The questionnaire addresses strategies such as self-blame, blaming others, putting things in perspective, and acceptance. Because dysfunctional coping strategies are significantly associated with emotional exhaustion, addressing these repetitive thoughts can interrupt the turnover cascade.¹³ Accompanying the CERQ, the DASS allows the veterinary nurse to measure these negative emotional states. The DASS is a 42-item self-administered questionnaire focusing on DASS-depression reports of low mood, motivation, and self-esteem; DASS-anxiety on physiological arousal, perceived panic, and fear; and DASS-stress on tension and irritability.¹⁴ The findings of these interventions identified the capacities that emotional fatigue can influence turnover.¹³ The authors recommend a combination of these action items. It is documented that combining recommendations that have a person-centered and an organization-centered approach creates a synergistic effect.¹³

Servant Leadership

Because of the emotional and mental demands associated with this profession, combined with the service-oriented climate, a servant leader can play a significant role in retaining staff.¹⁵ Servant leadership is defined as an approach in which service takes precedent over leadership.¹⁶ Leaders who adopt this method prioritize the advancement of the people around them and aim to promote the needs and wellbeing of others, in part by sharing power rather than accumulating it.¹⁶ This manifests through the development of relationships between leaders and their coworkers and the empowerment of followers.¹⁵ Contemporary research has discussed the positive impact of servant leadership and how it is associated with a decrease in turnover and increase in employee engagement through the creation of a service climate.^15,17,18 An additional benefit of servant leadership is its ability to reduce emotional fatigue, a major cause of turnover, in followers.¹⁹ Additional focus on leadership training and examination of the leadership approach in veterinary clinics could help shift the mindset of managers in the workplace and promote a healthier dynamic between coworkers and lower rates of turnover.

Conclusion

It is critical for leaders in the veterinary profession and in individual clinics to recognize the scope and importance of reversing emotional fatigue, burnout, and turnover among veterinary nurses. This trend has widespread consequences for not only the health of our community but also our patients. While the proposed steps in this article do not create a definitive solution to this issue, they are all a piece of the puzzle that can lead to an improvement for this profession.