The role of leadership in overcoming staff turnover in critical care

In this issue of Critical Care, Laporta and coworkers [1] review a multidisciplinary working group's analysis of a case study on the causes of and solutions for staff turnover in an intensive care unit (ICU) setting. This issue is of profound significance to health care leaders in Western countries because the workforce is shrinking as a result of impending Baby Boomer retirements and, as the population ages, the demand for intensive care services will grow considerably [2,3]. These demographic factors are further compounded by the fact that the complexity of care provided in the ICU demands professionals who are highly trained and skilled. In this environment, turnover can be costly to the organization because of the significant expenses associated with recruiting and training workers [4].There are many well documented reasons for staff turnover in the intensive care setting that are highlighted by Laporta and coworkers [1] as core reasons. These core reasons include job dissatisfaction due to inflexible scheduling practises, insufficient opportunity for professional development, as well as a lack of collaborative decision making around clinical and practice issues. The authors discuss that data on ICU turnover comes from nursing literature and that this research may be applicable to other health care professionals. However, it is important not to assume that reasons for turnover are the same among different groups of health care providers and that staff turnover is something to be avoided at all costs. For example, Misra-Hebert and coworkers [5] state that one contributor to physician turnover is conflict between the physician's and organization's philosophy and goals. Physician turnover in this case may be beneficial both to the physician and organization if the two parties cannot reconcile their differences and the conflict impacts on the ability of both parties to move forward.There are other important reasons for turnover that should be considered by ICU leade