The Cost of Nurse Turnover: A Breakdown

Poor nurse retention is a major issue for healthcare facilities, with the national registered nurse (RN) turnover rate standing at nearly 20%. According to the 2024 NSI National Healthcare Retention and RN Staffing Report, the average cost of nurse turnover is estimated to be $56,300 per every RN who leaves their job. For the average hospital, this can equate to roughly $3.9 to $5.8 million in losses per year.

Beyond the financial impacts, high turnover can also have rippling effects on company culture and patient care. In this article, we’ll break down all the costs of nurse turnover and outline strategies that can help you mitigate this issue at your facility.

What Is Nurse Turnover?

Nurse turnover occurs when nursing professionals leave their jobs or the profession altogether. This can include instances in which staff are involuntarily terminated from their positions, enter retirement, or choose to leave their roles for other reasons. Some of the most common reasons why nursing professionals willingly leave their jobs include burnout, feeling underappreciated, and a lack of peer support.

Turnover Rates and Costs in Various Nursing Roles

Before we break down the cost of nursing turnover, it’s important to note that national nurse turnover and cost estimates often only account for RNs. While it’s difficult to estimate a turnover rate that is representative of all levels of nursing, let’s take a look at how turnover rates and costs have been reported for other types of roles:

• The cost of nurse practitioner turnover is estimated to be $85,832 to $114,919 per episode, with the average turnover rate standing at roughly 10%.
• The cost of nurse managerturnover is estimated to be between $132,00 to $228,000 per episode, with some hospitals reporting that 50% of their nurse leaders intend to leave their jobs within 5 years.
• The indirect costs of replacing one certified nursing assistant (CNA) can range from $3,000 to $6,000, with turnover rates averaging as high as 50% in nursing homes alone.

What Contributes to the Cost of Nurse Turnover?

From these statistics, it’s clear that turnover costs can add up quickly if nursing professionals keep leaving their positions. But how exactly does turnover amount to millions of dollars per year? Here’s a rundown of what can contribute to both the economic and non-economic costs.

The Economic Cost of Nurse Turnover

There are several ways in which frequent turnover can lead to increased operational costs for facilities. We’ll review and summarize these costs below.

Costs of Vacancies

When a nurse leaves their position, facilities must spend excess money to compensate for vacancies and understaffing. This includes the costs of advertising the opening, hiring temporary staff, and paying existing staff for overtime. Facilities may even need to close beds and defer patients, which leads to diminishing returns.

Several studies have found that these factors combined can contribute to significant losses, accounting for anywhere between 44% to 83% of turnover costs. These costs also continue to rise the longer a position stays open.

Costs of Training

Each time a facility hires a new nurse, additional resources must be spent for onboarding and training. Research has suggested that training can account for roughly 7% to 9% of turnover costs, as preceptors are often given temporary salary raises to orient new nurses.

Facilities that invest in new nurse residency programs are also estimated to incur an additional training cost of roughly $2,041 per resident. Residency programs are often used as a strategy to improve new nurse retention. But if turnover remains high for other reasons, these programs can have a lower return on investment.

Costs of Productivity Loss

Studies have also shown that initial reductions in productivity can contribute to a large proportion of losses, accounting for roughly 45% to 88% of turnover costs. This is because facilities are essentially paying two nurses to do the work of one during training periods — with some preceptorships lasting months at a time.

Additionally, there can be variations in skill level when facilities use a mix of temporary staff. This means that managers may need to spend more time overseeing care, which also contributes to reduced productivity at the leadership level.

The Non-Economic Cost of Nurse Turnover

High turnover can also impact the overall workflow and culture at a facility. These non-economic costs are important to consider since they can, conversely, lead to more turnover and create a cyclical issue over time.

Poor Teamwork

High turnover means that the entire nursing team must frequently adapt to new personalities and workstyles. Studies have shown that this can worsen communication and collaboration, impacting the overall cohesiveness of the unit. This can also make it more difficult to retain new hires, since teams may come across as unsupportive.

Lower Quality of Care

When existing staff take on increased workloads to compensate for gaps in staffing, quality of care can go down. Some studies have even shown that high turnover can significantly increase the rate of medical errors, mortality, pressure ulcers, and length of stay.

Reduced Employee Morale

The fragmented communication and increased stress resulting from high turnover can also lower staff morale. This may contribute to burnout, which can cause even more nurses to leave their jobs if staff retention and job satisfaction aren’t made a priority.

How to Address Nurse Turnover at Your Facility

While there are many different causes of nurse turnover, studies have shown that nurses are four times more likely to voluntarily leave their positions than to get involuntarily terminated. This means that comprehensive measures at the institutional level are needed to retain staff and keep them satisfied in their roles.

Fundamentally, it’s important to engage your staff in conversations and identify the root causes of turnover at your facility. From there, you can apply more meaningful solutions that help your staff feel supported. This may include:

• Using sustainable staffing alternatives that allow for manageable workloads.
• Empowering nurses by giving them more control over their schedules and work.
• Creating a healthy work environment to prevent staff burnout.
• Providing transparent, consistent, and objective leadership.

Start Taking Measures to Stabilize Your Workforce Today

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