Nursing Turnover: Why it Happens and Retention Strategies

Nursing Turnover: Why it Happens and Retention Strategies

This post was updated in July 2020 with the most recent information on nursing turnover and retention.

With the current nursing shortage, hospital administrators have an added challenge: holding onto experienced nurses. The healthcare job market remains strong, which means that nurses continue to be in demand, yet turnover remains a problem for hospitals everywhere.

The annual NSI National Health Care Retention and RN Staffing Report published by NSI Nursing Solutions Inc. shares some startling statistics about the current nursing turnover rate:

  • The 2019 hospital turnover rate was 15.9%, a decrease of 1.3% from the year prior.
  • RNs working in pediatrics, burn care and women’s health recorded the lowest turnover rate.
  • Nurses working in behavioral health, step down and emergency services experienced the highest nursing turnover rate.

Nursing turnover is associated with insufficient staffing levels, which in turn can lead to job dissatisfaction and burnout among nurses and an increased risk for medical errors. The NSI Nursing Solutions study also shares that the average cost of turnover for a bedside RN is $44,400 and can range from $33,300 to $56,000, resulting in the average hospital losing $3.6 million to $6.1 million.

What Causes High Nursing Turnover?

There are many causes of high nursing turnover. Nearly 18 percent of new RNs resign from their first nursing job during the first year and a third leave within two years (according to a 2014 study, “What Does Nurse Turnover Rate Mean and What Is the Rate?”). That could be because of the high stress levels that are common among new nurses, the low autonomy when a nurse is new to a hospital or healthcare setting, or something else.

It’s no secret that nurses often have longer shifts, with many facilities typically requiring nurses to work for 12 hours at a time. The longer the shift length, the more likely that nurse retention is a top challenge, according to a 2017 HealthLeaders Media Nursing Excellence Survey.

Staffing can be a challenge for hospitals facing nursing shortages, which can lead to nurses working overtime or being asked to fulfill duties beyond their capabilities or skill levels. Hospitals or facilities that are short-staffed might lean heavily on the nurses they do have, which causes added stress.

Why is Nurse Retention Important?

Nurse retention can save a hospital the expense and cost of filling open nursing positions recently vacated. This expense includes advertising and recruiting costs, orientation and training costs, and the lower productivity of a newly hired nurse.

The NSI Nursing Solutions study referenced earlier in this blog shares that reducing turnover can improve hospital margins significantly. Each percent change in RN turnover will save the average hospital an additional $306,400 per year. When a hospital eliminates positions filled by supplemental staffing like travel RNs, it can also save money. For every 20 travel RNs eliminated, a hospital can save, on average, $1,412,000.

Strategies for Improving Nurse Retention

Improving the practice environment makes it easier for hospitals to reduce nursing turnover and retain nurses. Nurses who are mostly satisfied with the practice environment are less likely to suffer the effects of burnout.

How Hospitals Can Reduce Nursing Turnover

Here are a few strategies that hospitals can try to reduce nursing turnover:

  • Reducing overtime and eliminating mandatory overtime.
  • Developing shared governance programs that give nurses a voice in scheduling, workflows, and hospital policies.
  • Ensuring adequate nurse staffing levels and supporting acuity-based staffing tools.
  • Recognizing nurses’ need for work-life balance.
  • Encouraging and developing a workplace culture of collaboration between nurses and physicians.

What Leaders Can Do

What can leaders do to help minimize nursing turnover? Certainly, some of the above tactics are important, but leaders can also work to reduce conflicts in the workplace that lead to nurses leaving their hospitals or healthcare facilities.  

Check out our recent blog post, Conflict Resolution in Nursing: How Strong Leadership Can Help. In it, we discuss some of the most common types of conflicts in a typical nurse workplace and how nurse managers and leaders can confront and deal with those issues. These strategies are helpful for reducing workplace stress that can lead to high nursing turnover.

How Education Can Help with Nursing Turnover Problems

Nursing turnover is one of several challenges confronting the industry and something that needs to be dealt with carefully. It takes an educated nurse manager and leader to manage this issue successfully. 

American Sentinel’s online MSN, Nursing Management and Organizational Leadership program helps nurses prepare to face a variety of challenges throughout their careers, including helping their organizations develop, promote and retain nursing staff. Learn more about how this program or one of the other MSN specializations can help you advance your career and build the aptitudes needed in a dynamic healthcare organization.

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