Advances in Nursing Science Vol. 40, No. 3, pp. 300–312 Copyright c  2017 Wolters Kluwer Health, Inc. All rights reserved. Patient Turnover A Concept Analysis Christopher A. VanFosson, MSN/MHA, RN; Linda H. Yoder, PhD, MBA, RN, AOCN, FAAN; Terry L. Jones, PhD, RN Patient turnover influences the quality and safety of patient care. However, variations in the conceptual underpinnings of patient turnover limit the understanding of the phenomenon. A concept analysis was completed to clarify the role of patient turnover in relation to outcomes in the acute care hospital setting. The defining attributes, antecedents, consequences, and empirical referents of patient turnover were proposed. Nursing leaders should account for patient turnover in workload and staffing calculations. Further research is needed to clarify the influence of patient turnover on the quality and safety of nursing care using a unified understanding of the phenomenon. Key words: churn, concept analysis, missed care, nurse burnout, nursing quality, nursing workload, patient turnover, time scarcity, turbulence, unfinished nursing care A PPLICATION of the nursing process is the mechanism through which nurses influence patient outcomes. The quality and safety of patient care may be adversely af- fected when elements within the work en- vironment impede effective and timely appli- cation of the nursing process by direct care nurses. 1 Patient turnover is one factor within the acute care work environment that poten- tially disrupts workflows associated with the nursing process. The term “patient turnover” refers to the relocation of patients to or from a nursing unit or hospital. Patient turnover may occur at various times on any nursing Author Affiliation: The University of Texas at Austin School of Nursing. The authors declare no conflicts of interest and received no funding for the manuscript. The first author (C.A.V.) attends the University of Texas at Austin on a profes- sional scholarship from the United States Army. The views expressed in this article are those of the au- thors and do not reflect the official policy or position of the US government or the Department of Defense. Correspondence: Christopher A. VanFosson, MSN/ MHA, RN, The University of Texas at Austin School of Nursing, 1710 Red River St, Austin, TX 78701 (cvanfosson@utexas.edu). DOI: 10.1097/ANS.0000000000000171 shift. 2 Therefore, every nurse in the acute care setting experiences patient turnover and the associated effects on the care they pro- vide. As such, understanding patient turnover is important to understanding how the nurs- ing care environment influences patient care. High patient turnover rates have been associated with an increased occurrence of adverse events. Specifically, adverse events linked to patient turnover include mortality, 3 nosocomial infections, 4 and med- ication errors. 5 In addition, high patient turnover is linked to increased rates of read- mission to intensive care units 6 and readmis- sions to the hospital. 7 High rates of patient turnover also are linked to nurse perceptions of increased uncertainty in the work environ- ment and decreased nurse tolerance of ambi- guity, which, in turn, significantly affects job performance. 8 Garrett and McDaniel 9 found that nurse perceptions of greater patient turnover were positively associated with the Emotional Exhaustion and Depersonalization subscales (β = .26-.36; P < .01) and inversely associated with the Personal Accomplishment subscale (β =-.23; P = .04) of the Maslach Burnout Inventory, indicating that nurse per- ceptions of high patient turnover significantly predicted greater nurse burnout. In addition, Copyright © 2017 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited. 300