Are you facing frustrating nurse turnover at your healthcare facility and looking for effective retention strategies to keep your hardworking staff happy and motivated to stay? You're not alone.
The nurse turnover rate has become one of the defining operational and clinical challenges in healthcare, with ripple effects that impact many areas in your facility, such as:
- Patient safety
- Staff morale
- Financial performance
This article reviews the top causes of clinician turnover and presents you with concrete ideas and actionable steps you can take to improve nurse retention.
What is nurse retention?
Nurse retention refers to an organization’s ability to retain its nursing staff over time. It is often measured as the percentage of clinicians who stay at a facility during a specific period, typically on a monthly, quarterly, or annual basis.
A high nurse retention rate is a strong indicator of a positive and compassionate work environment. A high nurse retention rate typically means a facility provides outstanding patient care.
Strong nurse retention supports a number of foundational components of safe, high-quality patient care, including:
- Continuity of care
- Patient trust
- Prevention of tacit knowledge loss when staff leave
- Lower reliance on expensive travel contracts
- Higher staff morale and engagement
Due to the far-reaching, positive impacts of low turnover, nurse retention strategies and programs are a priority focus for many healthcare leaders and facility administrators. This means that if you understand why nurses want to leave, you can develop more effective strategies and implement any necessary changes to improve nurse retention in your organization.
Why is nurse retention important?
Nursing staff retention is essential because it directly affects:
- Patient outcomes
- Staff morale
- Financial health of a healthcare organization
Low nurse retention and high nurse turnover in a healthcare facility also drastically exacerbate the nursing shortage that has plagued the industry and the nation for decades.
Turnover costs are extremely high and have increased in recent years. The cost of turnover for replacing one bedside registered nurse ranged between $28,400 and $51,700 in 2023, according to an article published by the American Nurses Association. A 2025 report by NSI Nursing Solutions, Inc. placed the average cost of RN turnover at $61,110.
Hospitals and other healthcare facilities must prioritize nursing retention and implement strategies and changes to address the causes of turnover. Poor retention rates harm facilities, nurses, and the community members who depend on them for healthcare services.
Typical causes of high turnover
The nursing shortage is exacerbated by high turnover on two fronts:
- Turnover due to nurses leaving for other nursing jobs
- Turnover caused by nurses leaving the profession entirely
While not all nursing turnover is caused by job dissatisfaction, preventable factors should be addressed.
So what are nurses' most common reasons for leaving?
The following are some of the most common causes and pain points leading nurses to quit their jobs.
Burnout from heavy workloads
Nurse burnout is a state of physical, emotional, and mental exhaustion brought on by prolonged or chronic stress.
One major reason is the persistent short-staffing, which increases workloads and the need for working overtime.
High patient-to-nurse ratios have been the most frequently stated reason for resignation because nurses feel they cannot care for their patients safely under such heavy workloads. This overpressure not only undermines patient safety, but it also devastates the nurse's own well-being.
Compensation and recognition
While pay is important, compensation extends beyond hourly rates to include comprehensive benefits packages and a sense of being appreciated and valued.
The majority of nurses do not believe that their pay is commensurate with the complexity, risk, and emotional burden of their work. Additionally, a lack of genuine appreciation—both official and unofficial—can cause nurses to feel invisible and underappreciated, ultimately eroding loyalty in the long run.
Leadership and culture
The level of nurse leadership tends to make or break a unit. Poor or uncaring administration is a key reason for turnover. A poor work culture, often characterized by bullying and a lack of psychological safety, creates a toxic environment that no salary can overcome.
Nurses thrive in environments where they have a voice and are valued by clinical staff and leadership. Nurses also benefit from visible and empathetic leadership.
Lack of professional growth opportunities
Stagnation is the complaint that applies to every mid-career nurse. Unless institutions offer clear, defined paths for advancement, nurses will find other ways to develop and further their careers—in other places of employment.
The following are advancement opportunities that are attractive to nurses:
- Specialty areas
- Reimbursement for certification
- Leadership or education positions
Most nurses are lifelong learners, and a failure to invest in their continued education is a failure to invest in their future with the organization.
Work-life balance and flexibility
The taxing work schedule common in healthcare—12-hour shifts, nights, weekends, and holidays—is a big drain on nurses' personal lives.
When nurses lack control over their schedules, they cannot effectively attend to family needs, meet educational objectives, and recover from the physical demands of nursing.
Organizations that are able to offer flexible scheduling options, such as self-scheduling, reduced-hour contracts, or predictable shift schedules, are most likely to retain employees who value their time off from work.
Take a look at your present nursing staff. Of the list of common causes of turnover, which of the challenges apply to healthcare workers currently or previously employed in your facility?
7 Strategies to increase healthcare employee retention
Improving nurse retention is not an insurmountable task, but it requires certain qualities from the facility, such as:
- Commitment
- Willingness to listen
- Investment of time, energy, and resources
Here, we've compiled a list of 7 nursing retention strategies that can serve as a starting point for you as you tailor an approach unique to your work cultures and nursing staff needs.
1. Understand the root causes behind your nurse turnover
Conduct anonymous surveys to gauge job satisfaction. While asking outright may prompt some to speak up, anonymity from management and peers is more likely to gather robust information for you to analyze. Ask open-ended questions that cover topics such as the following:
- Communication: How is the communication at your facility among peers and between the varying levels of hierarchy?
- Work culture: Does your nursing staff feel appreciated, respected, and recognized?
- Nurse autonomy: Is your nursing staff empowered to practice to the full extent of their licensure, or are there facility policies in place that limit them?
- Nurse support: Does your nursing staff feel supported by management? Are they interested in a form of mentorship?
- Orientation: Does your nursing staff feel like the onboarding provided when they started was sufficient, or did they feel lost and alone in the beginning?
- Hiring: Does the facility's hiring process attract nurses with compatible values?
Exit interviews are another rich, yet often underutilized, tool. Ensure that such interviews are conducted by an objective third party, such as Human Resources, rather than the departing nurse's immediate supervisor. This structure provides a context in which the nurse will be comfortable providing candid feedback on the true reasons for leaving, thereby offering high-quality, actionable information on how to reduce turnover in healthcare.
2. Invest in staff nurse training and development
Explore how your facility can implement policies that support nurses in their education and professional development:
- Are there processes in place to support continued education?
- Do staff members receive time off work to attend nursing conferences?
- Is money budgeted to help with tuition reimbursement for BSN, MSN, or specialty certifications?
Investing in employee development clearly conveys the message that the company cares about the nurse's professional growth and achievements.
Consider developing an internal clinical ladder program to reward and recognize nurses for developing their skills and assuming greater clinical responsibilities. This creates a visible career path, leading nurses to want to stay to reach their next professional milestone.
3. Examine compensation and benefits
How content is your nursing staff with their compensation and benefits packages? Is what you offer comparable to what other facilities offer for similar positions and workloads? Aim to reduce the financial strain that might cause nurses to pursue other opportunities.
An exhaustive evaluation should compare your compensation, PTO, retirement contributions, and health insurance with those of area peers. Subsidized daycare or student loan repayment are not the only offerings that can serve as strong incentives to draw nurses at any point in their lives.
In a competitive market, a static compensation system is a formula for out-of-control turnover. Therefore, attractive compensation packages are part of the overall strategy for the recruitment and retention of nurses.
4. Offer retention incentives or bonuses
Consider other monetary benefits, such as a nurse retention bonus. A reward system based on years of experience may encourage nurses to stay longer in institutions, hence increasing the level of expertise among your nursing staff. This strategy may also address the need for senior personnel to receive appreciation or recognition for their crucial role in mentoring and grooming newer employees.
In addition to financial incentives, determine what non-monetary benefits establish an appreciation culture. These include, for example, flexible scheduling arrangements for long-service employees, extra PTO days, or tailored "thank you" recognition programs. These gestures go beyond the paycheck to demonstrate that the organization values and recognizes the nurse's sustained dedication.
5. Improve communication and feedback channels
It's crucial that successes and progress are regularly reported and shared across the organization. For example, if a nursing retention initiative reduces turnover in a unit, the success should be shared broadly with the workers who contributed to it.
Ensure that downstream communication is honest and consistent, and develop channels that enable nurses to be heard and have their views taken seriously.
Don't forget that transparency also fosters trust: transparency underpins successful staff-management relationships. Nurse leaders must commit to being transparent about the factors that have direct implications for frontline staff, such as:
- Staffing levels
- Finances
- Organizational decisions
6. Offer wellness programs and mental health resources
Consider how your facility can support the mental health and wellness of your employees by posing the following questions to yourself:
- Do you have reporting, training, and intervention procedures for workplace bullying?
- Are policies and procedures in place equipped to handle workplace violence?
- Do you screen for burnout on a regular basis and offer resources and support?
- Does your facility have a mentorship program for new staff?
- Do you offer nurse wellness programs?
Work to enhance workplace safety and develop plans to address conflict and bullying. A Press Ganey report indicates that 57 nurses are attacked on average each day, and numerous nurses report being bullied in the workplace.
To respond to this issue, consider the following strategies:
- Establish and enforce a zero-tolerance policy for bullying with clear consequences
- Hire sufficient security staff
- Offer support to nurses who have been subjected to violence or bullying
- Provide staff with de-escalation training—especially in emergency departments and psych units
Beyond physical protection, offer confidential, easily accessible mental health services, including an Employee Assistance Program (EAP) with professional grief and trauma counseling for healthcare professionals. Mandatory debriefing after major incidents also works to prevent the long-term psychological impact of traumatic experiences.
7. Reduce heavy workloads with flexible staffing solutions
Did you know it takes around 95 days to hire a registered nurse? With vacancies and shift call offs, your nursing staff’s workload and patient-to-nurse ratios increase, leading to increased burnout and turnover.
Short-term, flexible staffing, such as per diem nurses sourced through platforms like Nursa, can alleviate burdens, protecting core staff from burnout and supporting retention. This strategy protects your core staff from the burden of constant mandated overtime and unsafe patient assignments—2 of the fastest ways to lose a good nurse.
Common retention pitfalls and how to avoid them
Despite the best intentions, organizations fall into the same traps when they try to improve retention. Recognizing these traps is the first step in formulating an effective retention plan.
Fixating only on compensation
Although raises can help facilities remain competitive in the labor market, they will not solve the root causes that may be workload- or culture-driven. The concept of only offering high pay to keep unhappy employees from leaving is not maintainable. High-paying jobs in a toxic work environment often result in high turnover rates.
An effective retention strategy must address the non-monetary drivers that make a job meaningful and a work environment supportive.
Making changes without the support of stakeholders
Leverage shared governance and co-creation to come up with solutions for the underlying source of frustration for staff nurses. To co-design the initiative, you can involve, for example:
- Nursing leadership
- Human resources
- Finance
- Frontline nurses
A lack of buy-in from all levels, particularly middle management, can dilute even the best-planned initiatives. Stakeholder buy-in ensures alignment of effort and resources.
Lack of measurement
Without tracking key metrics, you won't be able to determine if efforts are effective or require further investment. Here are some common metrics to measure:
- Nurse retention rate: The percentage of nurses who remained employed during a given time period
- Cost of turnover per nurse: Total cost (recruitment, hiring, training, lost productivity) of replacing one nurse—used to build the case for investing in retention initiatives
- Engagement and satisfaction scores: Data collected by employee surveys to quantify staff emotional commitment and job and workplace satisfaction—used to identify non-monetary drivers of turnover
- Absenteeism rates: The proportion of nurses away from work (e.g., missed shifts)—a crucial measure of burnout and morale problems
- Nurse-to-patient ratio stability: Reports on how frequently the actual patient-to-nurse ratio is higher than the facility's target or minimum safe level—helps monitor the immediate effect of staffing shortages on workload
Tracking these metrics on a recurring basis helps facilities better understand when retention efforts actually work to keep nursing staff satisfied and engaged.
Overlooking nurses’ career-stage needs
Failing to recognize that nurses have different needs at each stage of their careers is a common mistake. Different career stages have different motivators. A retention strategy that compares a new graduate to a nurse with 20 years of experience is flawed in itself. Let’s analyze the different stages and some common needs nurses might have in each.
Early career nurses
The majority of new nurses leave in their first year due to "reality shock" (the difference between academic visions and clinical reality). For these nurses, focus on:
- Transition support
- A robust nurse residency program
- Mentorship
- Realistic expectations
These nurses need structure, high-touch support, and a safe environment to gain confidence. Offer learning opportunities to become proficient with basic skills.
Mid-career nurses
These nurses are generally seeking career progression or specialism. You can offer them:
- Leadership training
- Ongoing education opportunities
- Flexibility
- Cross-training into new specialties
These nurses will likely be balancing professional aspirations with home commitments. They want to have a clear career path for progression.
Senior and late-career nurses
Senior nurses will seek greater recognition, part-time work, or mentorship roles. Engage them in sharing knowledge by teaching or orienting new staff. They are a storehouse of tacit knowledge and clinical wisdom. Offer lighter workload or non-bedside duties (e.g., clinical informatics, case management) to preserve their skills but reduce physical wear and tear.
Returning nurses
Offer refresher training, flexible scheduling, and supportive reorientation programs to ease re-entry. A "Welcome Back" program with a dedicated mentorship for the first 90 days can be extremely effective.
Nurses at various stages may also wish to participate in internal float pools to gain additional experience.
At any stage, it is always useful to ask the nurse about their needs.
Tailor your approach to retaining nurses
How to retain nurses is a complex problem.
There is no one-size-fits-all solution to employee retention. Work culture, geographic location, compensation, and staffing levels lead to different situations and unique challenges. Retention strategies require planning and adaptation to your facility's needs.
What is the single most critical driver of turnover in your unit or overall facility, and what specific action will you take to tackle it?
Address your short-term staffing shortages right away by posting shifts on Nursa. As per diem nursing staff help alleviate the workload, you can focus on the needs of your full-time nursing staff and develop strategies tailored to keep them where you want them—happy, healthy, and working at your facility.
Sources:
.png)
.png)
