A little-known fact that lies in our medical communities is that registered nurse turnover is surprisingly high. In fact, according to the Survey of Newly-Licensed Registered Nurses, one in five newly registered nurses (RNs) leaves their first job within a year and one in three within the first two years. The COVID-19 crisis, as well as vaccine mandates, are adding to the nursing shortage.
The overall turnover for hospitals is lower than at other health care settings, but the overall cost of RNs leaving affects the quality of care and is expensive for hospitals. For example, organizational costs alone can be as high as $6.4 million for large acute care hospitals that offer emergency trauma services. In fact, turnover among healthcare providers is directly associated with an increase in patient falls, pressure ulcers and the use of physical restraints.
Voluntary termination accounts for approximately 91-percent of turnover. Participants in the 2016 National Healthcare Retention & RN Staffing Report, identified why RNs left their employment (pre-COVID 19). While relocation, personal reasons, salary, retirement and career advancement are dominating factors, additional reasons for departure include immediate management issues, education, commute, scheduling and workload to staffing ratios. Keep in mind that COVID-19 has increased nurse burnout substantially. In fact, hospital turnover increased 1.7 percent in 2021, making the total turnover an astounding 19.5 percent now.
According to The University of New Mexico, the following are the six top reasons why nurses leave their jobs:
- Moving
- Personal Matters
- Promotion
- Salary
- Retirement
- Burnout
For a couple of years, it seemed as though the RN vacancy rate was decreasing, but this latest report shows that the rate is increasing. The report also shows that a third of hospitals have a 10 percent or higher vacancy rate for RNs. This is an increase of 4.8 percent from 2012.
When the number of RNs in a hospital declines, the traditional approach has been to spend more money on overtime, travel nurses or agency staff to fill vacancies. These are costly strategies that can affect overall patient care.
The RN Recruitment Difficulty Index (RDI-RN) estimates that it takes 54 to 109 days to recruit an experienced RN (not counting RN specialties, such as ICU, labor and delivery, etc.). Specialty positions can take as long as 80 to 109 days to fill.
The report also shows that the average turnover for RNs costs from $37,700 to $58,400. This means that hospitals can lose $5.2 million to $8.1 million annually from turnover alone.
The costs associated with filling these vacancies can include:
- Job postings
- Employing in-house recruiters
- Hiring third-party staffing firms
- Applicant tracking systems
The number one preventable reason for nurses leaving is burnout. In this century, the number of nurses that cite burnout has substantially increased. The addition of documentation, new technology and electronic medical records has added even more stress to this pressure-induced occupation. Some of the reasons nurses experience burnout can include:
- Chaotic job atmosphere
- Lack of social support
- Inability to control assignments or schedules
- Imbalanced work and job life
Healthcare organizations can combat burnout by implementing:
- Self-scheduling
- Reducing overtime
- Mentorship programs
Nurses that work 12 hours or more in a single shift and more than 40 hours per week are more likely to leave the workforce within a year. Medical organizations should note that overtime should not be commonplace and nurses should not be pushed to work extra hours, otherwise registered nurse turnover will be high.
Creating programs and incentives for nurses will help alleviate registered nurse turnover, especially during the COVID-19 pandemic. This can include scholarships, tuition reimbursement, competitive salaries and benefits and even monetary incentives.
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