Nurses do incredibly important work in high-pressure conditions, and thanks to the levels of stress experienced by many nurses, the industry has an exceptionally high turnover rate. Since 2016, the average hospital has turned over 90% of its workforce and 83% of its RN staff. As well as impacting patient care and staffing levels, this significant turnover costs healthcare organizations millions of dollars, with the average cost of turnover for a bedside RN ranging from $28,400 to $51,700. Subsequently, with such large numbers of experienced nurses leaving their roles, hospitals are losing up to $6.5 million per year.
The Covid-19 pandemic has only made things worse. According to the U.S. Bureau of Labor Statistics, the annual quit rate for the healthcare industry between 2017 and 2020 ranged from 22.2% to 24.7%. In 2021, that figure rose significantly to 30.4%. With every percentage change in turnover costing or saving the average hospital around $262,300, this jump represents a substantial loss.
Reducing nurse turnover is therefore incredibly important for a hospital’s bottom line as well as its patient care. Finding ways to address existing issues and improve staff retention rates could help hospitals to save money and offer their patients the level of attention they really deserve.
Reasons Why Nurses Resign
There are lots of reasons why nurses leave their roles. The most common cited by nurses when resigning are burnout, nursing shortages, injuries and illnesses, work schedules, incivility, and stress. We dig into each of these below.
Nurse burnout is unfortunately nothing new. Nurses are often required to work long, unsociable hours in difficult conditions. Between 35% and 54% of the US nursing and physician workforce reports suffering burnout and it’s a major contributing factor to high RN turnover.
The challenging conditions nurses work in are often exasperated by staffing shortages. According to the 2022 NSI National Health Care Retention & RN Staffing Report, hospitals are experiencing a record vacancy rate of 17%. This is up 7.1 points compared to 2021.
The staffing gap is often plugged in by travel nurses. These temporary healthcare workers cost significantly more than full-time nursing staff, with hospitals in some areas paying up to $250 per hour for a single travel nurse. The high wages currently on offer to travel nurses are tempting more and more registered nurses to leave their roles, further adding to the staffing crisis.
Injuries and Illnesses
According to the Occupational Safety and Health Administration (OSHA), registered nurses and nursing aides suffer more injuries than almost any other occupation nationwide. A 2013 study found that, while the private sector workforce experienced injuries resulting in days away from work at a rate of 105 cases per 10,000, nursing aides experienced injuries at four times this rate.
Healthcare workers are also more likely to become ill than those working in other professions. During the Covid-19 pandemic, healthcare professionals experienced seven times as many severe cases of coronavirus compared to nonessential workers.
Because patients need care around the clock, nurses are required to work all hours of the day and night. While some nurse leaders may work 9 to 5, the majority of the nursing workforce operates in shifts. These shifts can be scheduled for nights, weekends, evenings, and other unsociable hours, making it difficult for nurses to balance their professional and private lives.
Violence and Aggression
Healthcare professionals experience a high level of violence and aggression in the workplace. The World Health Organization (WHO) estimates that around 38% of those in healthcare jobs will suffer physical violence at some point in their careers. This situation appears to be getting worse, with the number of injuries caused by violent attacks increasing by 67% between 2011 and 2018.
In fact, healthcare workers are around 5 times as likely to suffer workplace violence compared to workers overall. Most incidents are unreported, leaving employees to feel it is a part of the job. It is estimated up to 17.1% leave the industry due to not feeling safe.
Stress has a significant impact on nursing turnover rates. There are numerous factors that can make nursing stressful including irregular hours, the high-pressure environment, lack of support in the workplace, and the current nursing shortage. Stress can negatively affect both mental and physical health and take a real toll on nurses working in the healthcare system.
How Does Nurse Turnover Impact Your Organization?
A high nurse turnover can impact healthcare organizations in a number of ways. These may include lost wages, medical costs, temporary staffing, overtime pay, turnover costs, and decreased morale and productivity in the workplace.
According to the NSI National Health Care Retention & RN Staffing Report, it takes around three months to replace an experienced RN and costs an average of $46,100. When you add up the cost of nurse turnover, the effect on patient ratios, and the impact on staff morale, it’s easy to see that reducing turnover should be a priority for healthcare providers across the country.
How Do You Calculate Nurse Turnover Rate?
Before you can begin to address nurse turnover and improve staff retention, you first need to calculate the turnover rate in your organization.
You can calculate your facility turnover rate by dividing the total number of separations by the average number of employees (both full-time and part-time) the hospital had during the reporting period. You then multiply this number by 100.
So, for example, if you have 200 nurses and 20 of them left their roles during the previous year, you’d divide 20 by 200 to give 0.1, and then multiply by 100 to give a turnover rate of 10%.
Using this example and the average turnover cost above, that is a staggering cost of nearly a million dollars ($922,000).
What Can the Management Do?
There are a number of steps management can take to improve working conditions and reduce nurse turnover. While none of these measures will solve the issue overnight, they should help to retain existing RNs and boost the number of new nurses entering the profession.
A recent survey of nursing professionals found that 88.9% had experienced violence in the workplace. Improving security, and making nurses feel safer when they’re at work, could help the average hospital to reduce turnover and save money.
In a previous blog post, we discussed ways management can improve hospital safety and security. This can be done by investing in better lighting, more security staff, and more user-friendly communal spaces. These simple measures have been shown to help reduce patient aggression and keep healthcare professionals safe.
Investing in a wireless panic button system, like the wireless panic buttons for hotel workers that have already been introduced across the country, is another good way of boosting security. Wearable panic button systems allow nurses to silently call for help whenever they feel threatened. As soon as they press their button, their location is sent directly to the security team, allowing help to be summoned as quickly as possible.
Hire More Nurses
As stress and burnout are two of the main factors affecting nurse turnover, hiring more nurses – and therefore reducing the workload – could help to prevent resignations. The more nurses there are on the hospital floor, the easier it will be for the healthcare team to provide a high level of patient care. A larger workforce also helps to lighten the workload, reduce stress, and improve morale.
While hiring more RNs can seem like an expensive solution, it can actually be a more affordable option when you consider the average cost involved in replacing experienced staff. When you add in the benefits to overall staff morale and patient care, hiring more staff can be a good solution to your nurse staffing issues.
If your human resources department simply doesn’t have the budget to hire more staff, management can still help to stem the tide of resignations by offering existing RNs more support. Creating an environment in which nurses feel they have the support of their managers, and where they can ask for help when they feel overwhelmed or unsure, can go a long way to improving working conditions and minimizing turnover.
Offering opportunities for career advancement and specialist training can also help to keep RNs on the job. Most nurses want to be able to fulfill their potential, so it’s important to provide pathways to promotion wherever possible.
Nurse turnover is a serious issue for hospitals around the country, costing millions of dollars every year and taking a toll on patient care and staff morale. With the Covid-19 pandemic currently making the situation worse, management needs to take measures now to ensure their team isn’t left shorthanded.