Understanding & Addressing Nurse Turnover
Nurse turnover is at an all-time high, and trending upward. If you are a healthcare leader, it’s likely you are acutely aware of the pressure this trend places on already thinning hospital margins and its impact on patient care. Reducing the $5.2 - $9.0 million on average that the typical hospital loses to nurse turnover each year1 may feel daunting—but it is doable. Strong first steps toward mitigating nurse turnover’s impact on your organization's culture, patient care quality, and finances include understanding what drives the cost of nurse turnover and addressing the factors contributing to its rapid rise. In this post, we outline what drives growing nursing turnover rates, the impact and costs associated, and what healthcare leaders can do to turn the tide.
Causes of Nurse Turnover
At the average hospital, 25.9%2 of nurses turnover each year, a percentage that consistently grew over the past five years. Between 2019 and 2022, the average hospital turned over 100.5%3 of its workforce. Why? Nurses are leaving healthcare organizations more often than ever to retire, change professions, or work for a different organization. These numbers vary by region, specialty, and hospital size and type—but one factor is consistent—nurse turnover rates are trending upward. Circumventing these driving forces will require fresh solutions and a comprehensive re-think of the way healthcare organizations staff and support nurses.
There are several primary causes of nurse turnover, and many of them were catalyzed by the impact of COVID-19. However, the pandemic only highlighted pre-existing issues. Nurses have long felt underappreciated, burdened by short staffing, and mentally and physically strained. A 2020 study found that hospital nurses were working in understaffed conditions that posed a threat to public safety in the weeks prior to COVID-194. Unfortunately, understaffed conditions have only continued to rise. More recently, the American Nurses Foundation’s Year-Two COVID-19 impact survey found that 71% of nurses reported feeling stressed within the past 14 days, while only 9% reported feeling empowered. In that same survey, 51% of nurses reported wanting to leave their position because work negatively affects their health/well-being.
- Inflexible Schedules
12-hour shifts are standard in nursing, but nurses increasingly seek scheduling flexibility. During the pandemic, nurses saw hospital leaders flex staffing norms and watched other professions enjoy the elasticity of the gig-economy. As a result, they seek similar opportunities within their nursing career. This desire permeates the healthcare job market: 71% of clinicians want more flexible work options, and 50% report that they are less committed to the profession than before the pandemic. Inflexible schedules lead to career dissatisfaction and add pressure to personal lives. 73% of clinicians say they miss important events because they cannot get time off, and 59% said the way holidays and paid time off is scheduled impacts their job satisfaction. One result of scheduling rigidity is nurses leaving their long-term positions in favor of more flexible (and often much more lucrative) travel nursing jobs.
- Retiring Nurses
Large numbers of aging baby boomers are leaving the nursing profession through retirement, and COVID-19 accelerated that trend. A 2015 study predicted that over one million nurses will retire5 from the workforce by 2030, contributing to a projected global shortfall of 13 million nurses6. After that study, the stress of the pandemic hit and inspired many aging nurses to retire early. This expedited exodus produced a ripple effect on nursing. Today, hospitals have a higher population of newly minted nurses on staff (the hiring pool has—on average—less than 2 years of nursing experience7). Younger nurses are not immune to the stresses of the profession. The National Council of State Boards of Nursing recently found nurses in the first 10 years of their career were more likely to leave their jobs. The increasing turnover rates of nurses contribute to workplace instability, which in turn leads to higher turnover.
Nurses are often celebrated as heroes, but their frustrations are rarely addressed through fundamental system changes. They feel underappreciated and under empowered. Predictably, this leads to resentment and dissatisfaction that manifests as burnout and turnover. A 2021 study found that a staggering 95%8 of nurses reported feeling burnt-out in their nursing position in the last three years, with 47.9% reporting that they are actively looking for a less stressful nursing position or considering leaving the profession all together. The previously noted inflexible schedules and short staffing certainly contribute to rising nurse burnout numbers.
- Short Staffing
55%9 of nurses say short staffing is the primary reason for wanting to leave their position, more than any other contributing factor. When a unit is understaffed, that places added pressure on the remaining nurses, leading to increased turnover. It is a vicious cycle that requires a focus on staffing projection and retention process improvement. Unfortunately, most scheduling solutions available today are based on averages, which doesn’t paint a true picture of actual staffing need fluctuations. Accurately forecasting clinical nursing needs includes anticipating turnover and being prepared to onboard qualified nurses before a deficit occurs. Overcoming short staffing is a complex and necessary undertaking to foster a healthy work environment that increases nurse retention.
- Rise of Travel Nursing and Contract Labor
The imbalance of supply and demand in the nursing profession has been compounded by the demands of the pandemic and short staffing due to ineffective staff forecasting. These forces have driven many hospitals to rely on short-term, emergency, and contract-based coverage. Nurses, in turn, have seized the opportunity to have more flexibility and higher compensation through travel nursing work. The influx of these opportunities has led to major turnover in more traditional nursing positions as the job market is increasingly talent-centric and flexible.
How Nurse Turnover Impacts Practice Culture and Patient Care
Nurse turnover has a direct impact on patient care quality and patient satisfaction. Studies show that nursing units with lower levels of turnover are less likely to have severe medication errors and poor nurse sensitive patient outcomes and more likely to have higher patient satisfaction10. It is relevant to note that the driving forces behind nurse turnover covered in the previous section also have negative impacts on practice culture and patient care because they lead to an unstable, short-staffed, overworked workforce. A recent study showed that more than half of nurses from medical-surgical units with the worst mean staffing gave their hospitals unfavorable safety grades, two-thirds would not definitely recommend their hospitals, and one third of patients rated their hospitals less than excellent11.
Beyond the impacts to patient care and experience, frequent nurse turnover takes a toll on unit leadership, teamwork, trust, and communication. Managing nurse turnover allocates precious nurse leadership resources toward recruiting and onboarding that may otherwise be spent on nurse engagement, mentoring, or patient care. On the nursing team level, nurses who are left behind when other nurses leave bear the brunt of the workload and are often burnt out to the point of finding a new position or new career path altogether themselves.
What is the true cost of nurse turnover?
In addition to the impact on patient care and practice culture, nursing turnover rates impact healthcare organization finances. The NSI estimates the average cost of nurse turnover is $46,10012 (with other estimates indicating costs upward of $82,000 per replacement13), adding up to $5.2m- $9.0m in average losses per hospital annually. Turnover costs include resources expended on:
- Advertising and recruitment
- Vacancy costs (e.g., paying for agency nurses, overtime, closed beds, hospital diversions, etc.)
- Orientation and training
- Decreased productivity
- Potential patient errors, compromised quality of care
- Poor work environment and culture, dissatisfaction, distrust
- Loss of organizational knowledge
- Additional turnover
List Source: The Costs and Benefits of Nurse Turnover: A Business Case for Nurse Retention – American Nurses Association
These costs impact every aspect of patient care since nurses are the face of hospital service. Their organizational knowledge is invaluable and a nursing staff that frequently turns over brings the chaos of change. That turbulence, and the financial, physical, and mental resources it takes to address it hampers a nursing team’s ability to build an effective team dynamic and nurse leader’s ability to focus on anything but keeping their unit effectively staffed.
Reducing Nurse Turnover: How can Healthcare Leaders Turn the Tide?
Addressing nurse turnover and controlling its impact is a complex challenge. No silver bullet will reverse the trend in short order. However, there are a few strategies healthcare leaders can employ to innovate and improve nurse staffing and retention. The first step is optimizing nurse staffing management. The more healthcare organizations take note of shifting nurse scheduling preferences and harness powerful technology to help forecast staffing needs the more they can reduce nurse turnover, positively impact patient care, improve nurse career satisfaction, and protect hospital finances.
Ensure Adequate Staffing Resources
Dialing in your staffing processes is the single most impactful investment your organization can make to improve nurse retention. An adequately staffed unit is associated with a healthy work environment and leads to relieved pressure on nursing staff. Not only that, but a well-staffed program allows nurses more time away from the bedside to enjoy career-developing activities such as cross-training, continuing education, and involvement in shared governance and process improvement. These opportunities are associated with nurse retention and are not possible when the unit is short staffed.
Offer Flexible Scheduling
Successful healthcare organizations and nurse leaders will view individual nurses not as a resource to fill a shift, but as a dynamic human being with unique personal and professional career aspirations. Today’s nurses want flexible, purposeful work. Healthcare leaders can address this by offering them more fluidity in their schedules. This flexibility has a positive mental impact on nurses and increases the likelihood that a nurse will remain in a long-term position rather than leaving for a travel nursing position.
Invest in Nursing Leadership and Career Development
The strength of the nursing leader sets the tone for the team. Optimizing staffing forecasting processes allows nurse managers to focus less on staffing and scheduling and more on things like providing career pathway development and continuing education. It also gives nurse leaders more bandwidth to maintain an open-door policy in which nurses are empowered to speak up about concerns and seek advice. Nursing units with a healthy work environment prioritize not only onboarding and training, but also ongoing nurse engagement and meaningful recognition. Nurse leaders can develop individual nurses by involving them in shared governance, evidence-based projects, and clinical studies of nurse-sensitive outcomes. This type of leadership elevates a shift-filling culture to a stimulating culture that keeps great nurses engaged in their work each day.
Optimizing your Nurse Staffing Practices, Reduce Nurse Turnover
Hospital leaders who prioritize reducing short staffing, innovate to offer more flexible scheduling options, and view nurses as dynamic individual professionals will have lower nurse turnover rates. Lower nurse turnover will lead to increased patient safety and patient care quality, better workplace culture, reduced nurse burnout, and a healthier bottom line.
Reduce Nurse Turnover with Trusted Works
Trusted Works gives you a bird’s eye view of your entire workforce—internal, external per diem, local, and regional float—to understand performance, spend, and trends across source pools. This enables a more flexible labor pool you can leverage to creatively solve staffing challenges, find the best-fit nurse for any open shift, and automatically apply incentives to shifts that need the most coverage. It also empowers nurses to sign up for shifts that best meet their preferences and needs, giving them the work flexibility and choice, they seek. Learn more about how Trusted Health Works can help your hospital reduce nurse turnover, streamline the source-to-pay process, and optimize labor costs at https://works.trustedhealth.com.
6 International Centre for Nurse Migration
7 Virkstis K, Herleth A, Rewers L. Closing nursing’s experience-complexity gap. J Nurs Adm. 2019;49(12):580-582.