Hospitals pay high turnover costs due to the departure of registered nurses

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Due in large part to the COVID-19 pandemic, registered nurses are leaving healthcare, and many are retiring prematurely or simply leaving the profession for other activities, imposing turnover costs on hospitals. sky-high, according to a new report.

The 2021 NSI National Health Care Retention & RN Staffing Report found that since 2016, the average hospital has transformed about 83% of its nursing staff and 90% of its overall workforce, the cost of a nurse’s turnover at the bedside has been between $ 28,400 and $ 51,700 – enough to cost many hospitals between $ 3.6 and $ 6.5 million a year.

Overall, the healthcare job market continues to trend upward, with 37.4% of hospitals surveyed anticipating an increase in their workforce. But that upward trend is easing and is down more than 16% from the previous year, suggesting uncertainty caused by the coronavirus.

Hospitals’ turnover has grown by 1.7% over the past year and currently stands at 19.5%. Although hospitals did not meet their 2020 target of reducing revenue, they are now doubling their higher target, envisioning a 4.7% reduction in turnover.

Yet hospitals are experiencing a higher AI vacancy rate. Currently, it stands at 9.9%, up another point from last year. Less than a quarter of hospitals reported a RN vacancy rate of “less than 5%”, but more than a third (35.8%) reported a vacancy rate of more than 10%. In total, it takes three months to recruit an experienced nurse, according to the data.

Feeling financial stress, hospitals have expressed interest in reducing the need for additional staff, especially given the higher rates being charged due to COVID-19. The greatest potential to offset the squeeze in margins lies in the expense of labor.

For every 20 travel RNs eliminated, a hospital can save, on average, $ 3,084,000, according to NSI.


To better understand turnover, survey respondents were asked to identify the top five reasons employees quit. Participants were asked to choose from a list of 20 common reasons. Career advancement and relocation topped the list, while retirement was the third most common reason, rising two spots from 2019 and placing in the top three for the first time.

The top 10 reasons are: personal reasons (caring for a child / parent, marriage, disability, etc.); unknown; education; workload / staff ratios; work conditions; Planning; and salary.

An overwhelming majority of 94.8% of hospitals see retention as a “key strategic imperative”. Almost 81% have retention initiatives in place, but only about half have linked them to a measurable goal.

Meanwhile, the RN vacancy rate continues to be a concern and currently stands at 9.9%, almost one point higher than in 2020. A high rate has a direct impact on quality results, patient experience and leads to excessive labor costs such as overtime and travel / agency. use. In 2019, less than a quarter (23.7%) of hospitals reported a vacancy rate above 10%. Today, more than a third (35.8%) belong to this group.

This downward shift indicates that the nursing workforce shortage will continue to challenge hospitals. What is of great concern is that 62% of all hospitals have a RN vacancy rate above 7.5%. Given the economy and the impact of COVID, RNs no longer delay retirement, and many have returned to travel nursing, especially given the lucrative contracts. During the pandemic, travel nurse packages reached $ 10,000 per week.

Resigned RNs had the highest turnover rate in 2020 at 24.4%, followed by behavioral health nurses (22.7%) and emergency nurses (20%). In contrast, RNs in Women’s Health Services, Surgical Services, and Burn Care Centers experienced improved turnover rates. Among all RNs, the turnover rate was highest among those with two to five years of experience.

While hospitals expect to increase their hospital and nursing workforce, only 26% anticipate an increase in the recruiting budget and only 18% plan to increase their recruiting staff.

To strengthen results, hospitals need to build retention capacity, manage vacancy rates, strengthen recruitment initiatives and control labor spending, the report concludes.


A number of issues related to COVID-19 are affecting employment and turnover metrics, including nurse burnout, which has prevailed during the pandemic. Almost a third of nurses who quit their jobs in 2018 did so because of burnout, according to a JAMA Network Open study. Even among those who did not quit their job, 43.4% identified burnout as a reason that would contribute to their decision to quit.

According to the study, working in a hospital setting was associated with an 80% higher risk of burnout as a reason for quitting than for nurses working in a clinical setting.

The extra layer of the pandemic – and with it, higher levels of staff shortages and fears of exposure – has only made matters worse for healthcare workers. In fact, in the spring and summer of last year, 49% of healthcare workers reported feelings of burnout, while 38% reported suffering from anxiety or depression, and 43% suffered. work overload, according to an EClinicalMedicine study.

Twitter: @JELagasse
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