The art of keeping care: Strategies for improving nurse retention

A close up of a female nurse in scrubs placing a comforting hand on the hand of an elderly female patient on a bed in a long term care facility bedroom.

Why nurse retention matters 

Nurse retention is crucial for healthcare facilities, as a cohesive, experienced team can help to ensure consistent, quality patient care. Yet, nurse turnover rates have never been higher, and they're projected to increase in the coming years.  

As the number of nurses entering the industry continues to decrease and the over-65 population burgeons, it's more important than ever for facilities to implement nurse retention strategies that center their nurses' health, well-being and engagement.

Understanding nurse retention

“Nurse retention” refers to a facility’s ability to retain internal nursing staff over an extended time frame. A facility with high nurse retention rates holds onto its most skilled nurses, which benefits patients by ensuring continuity of care and minimizing the medical errors associated with new nurses. Tenured nurses also possess organizational knowledge and can mentor junior nurses.

Conversely, high nurse turnover rates can lead to a host of problems, including excessive recruitment costs. When a nurse leaves a facility, it typically costs between $11,000 and $90,000 and takes an average of 95 days to replace them. NSI reported that, as of 2023, the national vacancy rate for RNs was 15.7%, and 75.4% of hospitals surveyed said that their vacancy rates were in excess of 10%. As of this writing, the 2024 turnover rates were 49.5% for RNs and 52.7% for nursing staff, according to CMS.

Vacancy rates can lead to compromised patient care by increasing the burden on a facility’s remaining team, which can lead to increased errors due to stress, exhaustion and burnout. Exhaustion and burnout have been linked to turnover, which perpetuates the cycle.

Factors that contribute to low nurse retention

Workload and burnout

Around the country, nurses have been going on strike to bring attention to the issues of high patient loads, workforce shortages and burnout. A 2021 study found that 54% of nurses are experiencing burnout and concluded that nurse burnout is a significant predictor of turnover. In our 2024 survey, 62% of respondents said they were currently at risk of burnout and 81% reported having experienced it previously.

Primarily what we experience in healthcare is burnout and fatigue, which doesn't come from our patient care at all. The stresses come from the corporate environment, the management environment, the staff environment.


Maryann Alexander, Ph.D., RN, FAAN and chief officer of nursing regulation at NCSBN, co-authored a study that projects one-fifth of registered nurses will leave the workforce by 2027. She places the future of the U.S. healthcare system at an “urgent crossroads.” That study, which included 29,472 RNs and 24,061 LVNs/LPNs, also revealed that 50.8% of nurses feel emotionally drained, 56.4% feel used up, 49.7% feel fatigued and 45.1% feel burned out — anywhere from a few times a week to every day.

The pandemic has stressed nurses to leave the workforce and has expedited an intent to leave in the near future, which will become a greater crisis and threaten patient populations if solutions are not enacted immediately.

Maryann AlexanderPh.D., RN, FAAN and chief officer of nursing regulation at NCSBN

The U.S. Surgeon General has also dubbed burnout a public health risk.

Lack of professional development opportunities

In 1943, Abraham Maslow identified two kinds of needs: deficiency needs and growth needs. Professional development can be categorized as the latter, but it’s still considered an inherent human need.

The data bears that out: In an American Psychological Association study, 91% of respondents considered having learning and development opportunities somewhat or very important. Only 47% of them were able to secure those opportunities at work. On the healthcare front, a 2016 British Journal of Nursing study found that more advancement opportunities were correlated to a lower turnover rate.

Poor organizational culture and workforce morale

Organizational culture” pertains to a set of norms, values and beliefs shared within a group. MIT Sloan Management Review reported that one in 10 employees find their company’s culture toxic. They also state that employees who feel that their culture is toxic are more likely to experience stress, anxiety and burnout. Toxicity is problematic at the team level too.

“Workforce morale” pertains to the attitudes, emotions and behaviors of an organization’s employees. A 2020 study points to a body of research that links high morale with higher-quality patient care. In the study, morale among nurses was found to be “the degree to which an employee exhibits a positive or motivated psychological state.” The study further defined it as an “attitude of confidence in the mind of the individual where they identify with a group, accept group goals and work towards achieving them collectively.”

It’s important to note that high-stress environments, of which healthcare is one, have been linked to low morale.

Nurse retention strategies

A robust nurse retention plan can lower recruitment costs and help facilities cultivate a team of experienced nurses who can provide quality care, enhancing patient outcomes in the long run. It can also foster a positive work environment, leading to greater employee engagement and patient satisfaction.

Creating a positive work culture

  1. Hold senior leadership accountable and implement coaching programs. Recognize that senior leadership shapes culture, whether the leader is the CEO or a manager. Coaching is proven to correct some toxic behaviors; however, knowing which subcultures are toxic is hard unless employees can provide safe, anonymous feedback (see point 5).
  2. Encourage teamwork and collaboration. Teamwork has been correlated with higher job satisfaction, which, in turn, has been correlated to improved nurse retention rates and patient safety, along with higher quality of care.
  3. Recognize and reward accomplishments. Recognition is one of the most effective non-incentive nurse retention strategies, and it doesn’t have to be public to be effective — private verbal and written feedback ranked second and third for preferred forms of recognition. Monetary rewards tend to be favored, so most facilities will need to strike a balance between financial incentives and recognition programs.
  4. Promote work-life balance. When nurses can take time off and choose whether or not to work overtime, they can create better work-life balance. Strategically using PRN shifts to maintain adequate workforce levels can help reduce reliance on mandated overtime, and the strategic use of PRN shifts has enabled facilities to increase census (and revenue) while providing team members with more flexibility.
  5. Foster open, transparent communication with management. Up to 68% of nurses have had negative experiences with their managers. However, if the relationship is positive — meaning that it’s respectful, supportive, encouraging and empowering — it reduces burnout and emotional exhaustion.

Enhancing professional development

In implementing a learning and development strategy, organizations should first consider their business and talent goals. For example, if an organization needs more RNs, it could assist CNAs and LPNs in becoming nurses. If it aims to train junior nurses, it could implement a mentorship program.

  1. Continuing education programs. In some states, continuing education is mandatory, while in others, it’s voluntary. Mandatory or not, when companies take an active, supportive role in continuing education, nurses report feeling more valued, especially when program participation is built into the nursing schedule.
  2. Leadership development initiatives. More than 50% of nurse managers and other administrators intend to leave within the next five years due to a lack of advancement opportunities or job dissatisfaction. Offering a clear career development path can help. Additionally, providing management training to clinicians who have been promoted to management may help them to succeed in their new roles.

Mentoring programs. Inexperienced nurses are far more likely to leave the industry than experienced nurses due to burnout. Mentors help ease the transition from school to the workforce, and they can also help new nurses adjust to organizational culture. Mentorship programs benefit experienced nurses as well and may reinvigorate their passion for nursing or desire for leadership opportunities.

Promoting work-life balance

To decrease turnover and increase nurse retention, organizations need to reduce burnout. Supporting nurses in finding work-life balance can help.

  1. Implement nurse-friendly scheduling practices, such as limiting 12-hour shifts to three consecutive days and not rotating shifts within 24 hours.
  2. Offer flexible scheduling. Allowing nurses to schedule themselves and trade shifts as needed gives them more autonomy, one of the biggest predictors of work-life balance. With flexible hours, nurses can work shorter shifts, which provides them flexibility, the other major predictor of work-life balance. Facilities can use PRN shifts strategically to offer employees more flexibility and scheduling apps like OnShift Schedule X to provide them with more autonomy.
  3. Provide adequate rest periods. Although rest breaks have been shown to significantly lower acute fatigue, 35% of nurses report that they don’t take them. Without recovery, acute fatigue can lead to chronic fatigue. Some nurses feel guilty about taking breaks because they don’t know how patients and residents will get care if they do. (Some organizations have implemented shorter “lunch shifts” that ensure nurses feel good about taking their breaks.)
  4. Offer employee assistance programs. Investing in wellness programs, such as organizational-sponsored gym memberships, mental health services or even fitness or meditation apps, can go a long way in supporting nurses’ mental health.
  5. Support self-care initiatives. Self-care initiatives range from in-depth mental wellness programs to unlimited PTO to care packages. Surveys can help administrators decide which employee assistance and self-care programs are most important to their nurses.
  6. Solve workforce shortages. Workforce shortages are potentially the most critical issue facing healthcare organizations today. It affects not only nurse retention rates but also patient outcomes. To truly solve short-staffing issues, facilities need to be able to increase coverage on demand without relying on employees who are already at risk of burnout.

How organizations use ShiftKey to improve nurse retention and reduce burnout

Among the strategies discussed for improving nurse retention rates, overcoming workforce challenges and helping nurses find better work-life balance are critical. Fortunately, ShiftKey can help.

More than 6,000 facilities use ShiftKey to connect directly with licensed, independent professionals who are ready to work as needed, enabling them to offer their employees more flexible schedules and a better work-life balance. Some are even using PRN shifts as part of a comprehensive growth strategy.

Learn More about Shiftkey