1. Lockhart, Lisa MHA, MSN, RN, NE-BC

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Q: What do we know about turnover?

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A: Hospitals are struggling to hold on to experienced and novice nurses alike. Eighteen percent of new nurses will change jobs or even professions within the first year after graduation. An additional one-third leave within 2 years. Nationally, the nursing turnover rate averages 19.1% and is expected to increase, with a nursing vacancy rate of 8%. Nursing turnover can be extremely costly for organizations. According to the 2019 National Healthcare Retention & RN Staffing Report, it costs between $40,300 and $64,000 to replace one clinical nurse, with the average hospital losing $4.4 million to $6.9 million each year.


Shift length is one of the most cited causes of nursing turnover, with organizations that utilize 12-hour shifts reporting challenges with retention. Becker's Hospital Review indicates that the three main reasons for nursing turnover are relationships, including peer-to-peer relationships on the unit and rapport with nurse leaders; staffing; and personal obligations. Although the cycle of turnover can seem overwhelming, there are obtainable solutions that can reduce turnover and increase nursing job satisfaction.


Improving orientation and role transitions can have a large impact on staff satisfaction. New graduate transition programs have been shown to increase retention and reduce burnout. Likewise, mentorship programs increase overall job satisfaction and retention. For example, Franciscan St. Francis Hospital and Health Centers in Indianapolis, Ind., implemented a preceptor and mentor program to help new graduate nurses during their first year of employment, which decreased the organization's turnover rate from 31% to 10% in 2 years.


Improving the workplace environment can also positively affect staff satisfaction, burnout, and turnover. Strategies to mitigate turnover include reducing weekly and incremental overtime and eliminating mandatory overtime. The development of shared governance programs that give nurses a voice in scheduling, workflows, and hospital policies can also help. As can maintaining adequate nurse staffing levels and fostering a culture that supports acuity-based staffing tools to ensure nurse and patient safety. A positive practice environment that recognizes work-life balance, in which there's a genuine respect for personal safety and zero tolerance for bullying, and where mutually satisfying collaboration between healthcare providers and nurses occurs, is key.




American Sentinel University. Nursing turnover and retention strategies. 2018.


Becker's Hospital Review. 3 biggest causes of nurse turnover. 2013.


Halter M, Pelone F, Boiko O, et al Interventions to reduce adult nursing turnover: a systematic review of systematic reviews. Open Nurs J. 2017;11:108-123.


NSI Nursing Solutions, Inc. 2019 NSI National Health Care Retention & RN Staffing Report.


University of New Mexico. The high cost of nurse turnover. 2016.