Potadromous fishes are vulnerable to involuntary entrainment through hydropower turbines. However, turbines can also provide a downstream passage route for potadromous fish. Here, we review evidence for turbine entrainment and passage in potadromous fish, and evaluate the effects of these processes on upstream and downstream populations. We develop conceptual frameworks and metrics to quantify vulnerability to turbine entrainment removals, and to quantify the efficiency of turbines as a downstream passage route. We highlight factors that influence these processes and provide case‐studies demonstrating their applicability. We found that juvenile potadromous fish are being entrained through turbines at rates high enough to impact upstream populations. Given that juvenile passage survival is often high, we argue that turbines provide an important downstream passage route for potadromous fish. We show that entrainment vulnerability is likely a function of interactions between in‐reservoir fish behaviour, habitat configuration and operations and thus not well captured by passage mortality estimates. Similarly, we show that while passage mortality can limit downstream passage efficiency, passage success is also dependent on reservoir and forebay navigation, along with survival and fitness in the downstream river. We advocate for a shift in focus away from estimates of passage mortality and injury, which have previously accounted for the majority of turbine passage research. Instead, we recommend an approach that focusses on quantification of the factors that influence downstream passage efficiency and entrainment vulnerability. Moreover, we highlight the need to better understand the broader scale impacts of these events on upstream and downstream populations.