Nursing Wiki

Nurse Turnover and Retention

Turnover is the share of a workforce that leaves in a year. In hospital nursing it is measured and priced more closely than in most occupations, because the replacement cost is large and the vacancy it leaves has to be covered at a premium.

The figures below come from the annual retention and staffing survey that hospitals benchmark against. Its 2026 edition covers calendar year 2025 and draws on 527 acute care hospitals across forty states and 262,405 registered nurses. Two limits belong with any use of it: hospitals report their own numbers and choose whether to take part, and the survey is published by a nurse recruitment firm. It is still the closest thing the field has to a scoreboard.

How the rate is calculated

A turnover rate is separations during a period divided by the average number of staff over the same period, expressed as a percentage. Three choices inside that formula decide whether two rates can be compared at all.

Whether transfers count. A nurse moving from one unit to another inside the same hospital is a separation for the unit and not for the hospital, which is why unit-level figures run higher than the organisation's own.

Whether the rate is total or voluntary. Total turnover includes retirements, dismissals and deaths. Voluntary turnover counts only resignations, and it is the figure a retention programme can actually move.

What the denominator is. A first-year turnover rate divides departures within twelve months by the number of people hired, not by total staff, so it is a different measure from the headline rate rather than a subset of it.

A hospital comparing itself against a published benchmark is comparing definitions first and performance second.

The rates

Registered nurse turnover rose to 17.6 percent, up 1.2 points on the previous year. Over the last five years the average hospital has turned over 102 percent of its nursing staff, meaning its entire nursing workforce, replaced once.

The vacancy rate fell to 8.6 percent, the lowest of the decade, from 9.6 percent, though the survey changed its calculation method that year so part of the improvement is methodological. An 8.6 percent average still leaves the typical hospital with 43 unfilled registered nurse posts, and a third of hospitals (33.1 percent) sit at 10 percent vacancy or higher. The spread is wide enough that the national figure describes few individual buildings: 16.5 percent of hospitals are under 5 percent vacancy while 10.1 percent are above 15 percent.

Hiring and departures nearly cancel out. Hospitals hired 377,650 registered nurses in 2025 and lost 324,090, a net gain of about 53,500 and an add rate of 2.9 percent, roughly half the 5.6 percent of the year before. For every ten nurses hired, more than eight replaced someone who left.

The cost

Each registered nurse departure costs the average hospital $60,090. Every percentage point of turnover is worth about $295,000 a year to a typical hospital's budget in either direction, which made the 1.2-point rise an extra $360,000. Turnover cost the average hospital $5.19 million in the year.

Filling the vacancy takes 78 days for an experienced registered nurse, two and a half months per hire.

First-year turnover

The most expensive turnover is the earliest. Some 22.7 percent of newly hired registered nurses left within their first year, and first-year departures accounted for 29 percent of all separations.

Put next to a 78-day time to fill and a $60,090 replacement cost, better than one hire in five buys the right to run the same search again within a year. This is why the first ninety days are treated as part of recruitment rather than as a separate operational problem. Around three quarters of hospitals (74 percent) now report a formal retention strategy, and nurse residency programmes are rated 3.9 out of 5 for effectiveness by the hospitals running them. See nurse residency programs for what a year-long structured transition contains and how to read its retention claims.

The step before that is selection: a poor fit on schedule, unit or growth is a first-year departure already in progress.

Why nurses say they leave

Two different questions produce two different answers, and conflating them causes bad decisions.

Reasons given on resignation, in order of how often they were named: personal reasons, relocation, retirement, career advancement, and scheduling conflicts. Salary ranked seventh, behind education. The survey counts how often a reason was named rather than how heavily it weighed, so this is a prompt to check assumptions rather than proof that pay does not matter. But most employers answer a resignation with money, and money is not near the top of this list.

Reasons given for intending to leave the profession, from the national workforce survey: retirement (61.4 percent), stress and burnout (41.3 percent), workload (32.8 percent), understaffing (26.0 percent), inadequate salary (21.8 percent), and workplace violence or bullying (12.3 percent). See nurse burnout and workplace violence in nursing.

Retirement is the item that separates this problem from an ordinary engagement problem. It cannot be prevented, and it is the only driver on either list that is fully predictable years in advance from data an employer already holds. The median American registered nurse is now 50 years old, and about four in ten working nurses say they expect to retire or leave nursing within five years. See the nursing shortage.

The loop

Understaffing raises burnout, burnout raises turnover, turnover raises vacancies, and vacancies produce understaffing. Each link in that sequence is separately documented, which is why staffing research treats retention as part of the same subject rather than a neighbouring one. See nurse staffing and patient outcomes.

The mechanism by which a vacancy reaches an individual nurse is the rota: an unfilled post becomes a short shift, and a short shift becomes a mandated extension. See nurse overtime and twelve-hour shifts.

Where the averages break down

By specialty, turnover runs from 22.5 percent in behavioural health, 20.7 percent in emergency, 19.5 percent in telemetry and 19.0 percent in step-down, down to 14.9 percent in surgical services and 13.4 percent in paediatrics. Over five years, telemetry, step-down and emergency departments replace their entire nursing staff in under four and a half years. A 19 percent rate is unremarkable on a telemetry unit and alarming in paediatrics.

By time to fill, telemetry is the hardest to recruit at 87 days. Even emergency, the fastest, takes 70. Across specialties the range runs from 56 to 102 days.

By region, turnover rose almost everywhere: the North-East by 3.3 points to 17.9 percent, the West by 2.3 to 18.4 percent, the South-East by 1.4 to 18.7 percent, with only the South-Central region improving, by 0.9 points. On speed, the West fills posts in 70 days and the South-Central in 74, while the North-Central is slowest at 82.

The substitution that makes turnover expensive twice

A vacancy still has to be covered. Travel and agency staffing is the most common answer and the costliest: an average travel nurse costs $189,758 a year against $123,676 for an employed registered nurse including a 25.8 percent benefits load, which is $66,081 more per nurse per year. Around seven in ten hospitals (70.7 percent) say they want to reduce agency reliance.

The arithmetic is unforgiving. Every dollar not spent filling a permanent post is spent roughly twice covering it. See travel nursing and nurse staffing agencies.

Recruiting capacity is not growing

Three figures from the same survey describe the squeeze: 71.8 percent of hospitals expect to grow their registered nurse workforce, 26.7 percent expect to increase their recruitment budget, and 6.8 percent expect to add recruitment staff. Hospitals run 0.26 recruitment employees per 100 workers.

Nearly three quarters plan to hire more nurses. Fewer than one in fourteen plan to add anyone to do it. Since headcount is not the variable being adjusted, the remaining variables are reach and speed: how many suitable nurses see an opening, and how quickly.

Employers that compete on the nursing environment rather than on pay alone often point to a credential for it, which is what Magnet recognition is and is not evidence of.

Sources

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