Navigating the Nursing Shortage: The Cost of Nurse Turnover & How to Retain Nurses

Within the heartbeat of healthcare, a persistent challenge threatens to disrupt the rhythm of patient care and nurse well-being—nurse turnover. This pervasive issue, casting a shadow over healthcare systems worldwide, has implications that resonate far beyond the hospital walls. 

According to the 2023 NSI National Health Care Retention & RN Staffing Report, a survey by Nursing World., and a report by the WHO, here are some of those ripple effects:

Hospital Cost

• Each % change in RN turnover will cost or save the average hospital $380,600 per year.
• The average cost of turnover for a staff RN is $52,350
• The RN vacancy rate remains critical and is 15.7% nationally

Nurse Burnout 

• Almost two-thirds of nurses (62%) experience burnout
• 69% of nurses under 25 report feeling burnout

Patient Outcomes

• Above 50% of harm (1 in every 20 patients) is preventable; half of this harm is attributed to medication error
• Some estimates suggest that as many as 4 in 10 patients are harmed in primary and ambulatory settings, while up to 80% (23.6–85%) of this harm can be avoided 

In this article, we comprehensively explore the cost of nurse turnover, from its economic toll on institutions to its impact on nurse mental health and patient outcomes, all while charting a course toward solutions that prioritize a robust nursing workforce.

What is Nurse Turnover?

Nurse turnover refers to the rate at which nurses leave their positions within a healthcare organization, such as hospitals, clinics, or long-term care facilities, and are replaced by new staff. It encompasses both voluntary departures (nurses leaving of their own accord) and involuntary departures (nurses being terminated), and it is typically measured as a percentage of the nursing workforce.

Low retention rates and shortages of qualified nurses can affect many aspects of health care. A review found that determinants can be individual, job-related, interpersonal, and organizational.

Effects of Nurse Turnover

The effects of nurse turnover are far-reaching. They impact the whole spectrum of nursing staff, patients, and healthcare institutions. 

Declining Nurse Mental Health

Elevated Nurse-Patient Ratios: Nurse turnover often leads to understaffing, resulting in higher nurse-patient ratios. This affects patient safety as well as the mental health of nurses. 

Job-Related Stress & Burnout: The increased workload and pressure on remaining nurses can lead to stress, burnout, and reduced job satisfaction. Burnout can further contribute to higher turnover rates, creating a vicious cycle.

Poor Patient Outcomes

Poor Patient Quality of Care & Outcomes: High nurse turnover rates can result in inconsistencies in care, errors, and decreased patient satisfaction. A study found that “Managing nursing unit turnover within appropriate levels at the nursing unit is critical to delivering high-quality patient care.”

Detrimental Financial Costs

Recruitment and Hiring Expenses: Healthcare facilities must invest in advertising, recruiting, and interviewing processes to replace departing nurses. This includes expenses for job postings, HR staff salaries, and recruitment events.

Onboarding and Training: New nurses require orientation and training, which incurs additional costs in terms of staff time, materials, and resources.

Temporary Staffing: During the period between a nurse's departure and the arrival of a replacement, hospitals often rely on temporary or agency nurses to maintain patient care. These temporary staffing expenses can be significantly higher than regular nursing salaries.

Negative Organizational Impact:

Hospital Reputation: Hospitals with a reputation for high nurse turnover may struggle to attract both patients and qualified healthcare professionals. This can lead to a decline in the institution's standing within the healthcare community. 

Budget Constraints: The financial burden of nurse turnover, including recruitment and temporary staffing costs, can strain the budget of healthcare organizations. This can hinder investments in patient care technology, facility improvements, and staff development. A survey found, "Hospital managers admitted that nurse turnover disturbs hospital operations, further impacting the hospital’s revenue and costs.”

How to Reduce Nurse Turnover

The solutions are complicated and nuanced; there's no one size fits all. However, there are some actions that can be taken to address nurse turnover. 

Eliminate Mandatory Overtime: Eliminating mandatory overtime can help reduce the strain on nurses and improve their work-life balance. Excessive overtime can contribute to burnout and increase the likelihood of nurses leaving their positions. A study suggests nurse overtime leads to adverse consequences.

Hire Enough Nurses:  Research indicates that understaffing and high nurse-to-patient ratios are associated with increased nurse burnout and turnover. This can drive nurses to seek employment elsewhere. Healthcare organizations should conduct regular assessments to determine the appropriate nurse-to-patient ratios and hire enough nurses to meet these standards.

Offer Competitive Salaries: Competitive salaries are key to retaining qualified nursing staff. However, it's important to note that higher wages alone shouldn't compensate for low staffing ratios. Combining competitive salaries with other discussed aspects is crucial. Regular salary reviews to align with industry standards can boost retention.

Create Paths for Professional Advancement: Fostering professional growth through programs like career advancement, tuition reimbursement, and ongoing education benefits both nurses and elevates the nursing workforce's skills. Research indicates that nurses, especially those in mid to late-career, value opportunities for continuous learning to deliver the best patient care.

Prioritize Onboarding and Training: Comprehensive onboarding and training programs are critical for the successful integration of new nurses into the workforce. A well-structured onboarding process ensures that new hires are equipped with the knowledge and skills they need to excel in their roles. Investing in ongoing education and training opportunities for existing staff is equally important to keep them engaged and up-to-date with best practices.

A 2023 research study identified technology as one of the ways to intervene with nurse turnover. To onboard and train using technology, UbiSim immersive virtual reality is a great option. It’s a platform made by nurses for nurses. 

“The feedback from students is very positive because there’s this novelty factor. They're going to pay a lot more attention and get more excited because it's interesting for them. Our nurses have that sense of novelty every time they play.” Jeff Jacobson, SIMEngineering XR Project Manager at Boston Children's Hospital 
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Check out how Boston Children’s Hospital is using UbiSim for its onboarding and continuous training.