This guide covers what nurse retention is and why it has become a financial and operational priority for healthcare leaders. It also explores what affects retention rates across acute, post-acute and behavioral health settings and toplines six nurse retention strategies with strong evidence behind them.
What is nurse retention?
Nurse retention is a facility’s ability to hold onto licensed registered nurses (RNs) over time. It’s typically measured as a percentage rate, and it’s the inverse of nurse turnover.
High nurse retention rates help facilities lower workforce costs: According to the 2026 NSI National Health Care Retention and RN Staffing Report, the loss of a single bedside RN averages $60,090, and the average hospital loses between $4.2 million and $6.2 million to RN turnover every year. Facilities with high nurse retention rates experience less care team disruption (which contributes to healthcare professional burnout) and also preserve their institutional knowledge.
What is a good nurse retention rate?
There is no universal benchmark for a “good” nurse retention rate, but context can help facilities set their own.
According to the 2026 NSI report, the national average RN turnover rate was 17.6% in 2025, meaning the average RN retention rate across hospitals sits at 81.4%. Long-term and post-acute care facilities tend to run significantly higher turnover. “Skilled Nursing News” reported that, while turnover for all skilled nursing professionals decreased in 2025, RN turnover was 36.53%, LPN turnover was 35.29%, and CNA turnover was 42.34%—all well above the hospital average.
Behavioral health settings face compounding challenges that tend to push turnover above the acute-care average. NSI reports that RN turnover in behavioral health is 22.5%, higher than all other acute-care settings surveyed.
Why nurse retention is a financial, operational and patient-safety priority
Low nurse retention rates can lead to patient-safety and balance-sheet consequences. A 2025 cross-sectional study of 8,584 U.S. acute care hospital units found that higher nurse turnover (lower nurse retention) was indirectly associated with higher patient fall rates (Mauricio, 2025). A retrospective longitudinal study of NHS acute trusts found a similar pattern: Higher nurse turnover was associated with increased 30-day all-cause mortality (Moscelli et al.,2024; U.K. sample). Neither finding is causal, but the direction is consistent: Facilities with lower nurse turnover (higher nurse retention) report better performance on measurable patient safety outcomes.
Operationally, every nurse departure triggers a replacement cycle that is both costly and disruptive. Facilities unable to fill coverage gaps with team members must spend more to engage external workers. According to the 2026 NSI report, 73.5% of hospitals projected reducing travel nurse utilization in 2025 yet still relied on it as a primary shortage response, at an average cost of $91 per hour. If team nurses are required to work overtime to fill gaps, their risk of burnout is increased. Burnout leads to turnover, and the cycle starts over again.
Those operational costs compound into a significant balance-sheet problem. The same NSI report found that hospitals lost an average of $5.19 million to RN turnover in 2025 alone, and that every 1-percentage-point change in turnover represented approximately $295,000 in annual cost or savings. Direct costs (recruiting, onboarding, temporary coverage) are measurable. Indirect costs, including productivity loss during transition, the effect on team morale and disruption to care continuity, are typically harder to capture. Yet less than half of NSI survey respondents tracked the causes of nurse turnover.
For post-acute operators, the financial stakes are compounded by reimbursement pressure: low nurse retention rates in skilled nursing settings directly affect the care quality metrics that determine Medicare and Medicaid star ratings, which in turn affect reimbursement rates.
For more information about CMS Quality Measures, download ShiftKey’s “The Administrator’s Guide to Five-Star Quality Measures.”
Tracking nurse retention rates and setting internal benchmarks
Organization-wide retention figures can mask low retention/high turnover concentrated in specific units or roles, so many facilities track nurse retention at the unit or department level as well.
To set an internal benchmark, examine these trends:
- Is your nurse retention rate improving or declining year over year?
- Is first-year turnover (the single strongest predictor of long-term retention) improving or declining?
What does a 1-percentage-point change in nurse retention look like for your organization?
- Start with the number of nurses who work in your facility.
- Multiply that number by your current nurse turnover rate or use your setting’s average (17.6% for hospitals).
- Multiply that number by $60,090 (the average cost of replacing one bedside RN). This is your baseline nurse turnover cost.
- Multiply your baseline turnover cost by 1%.
- That’s how much your facility stands to save or lose for every percentage-point change in nurse retention.
Learn more about nurse turnover costs in our free guide, “The Real Cost of Nurse Turnover.”
What causes low nurse retention rates?
High nurse turnover leads to low nurse retention rates. The root causes of turnover differ in intensity across settings, but six categories appear consistently across acute, post-acute and behavioral health healthcare.
1. Burnout and unsustainable workload
Burnout remains the most cited driver of nurse turnover across all settings. In ShiftKey's “Solutions to Healthcare Burnout” survey, 62% of 1,000 respondents said they were currently at risk of burnout and 81% reported having experienced it in the past.
Of 800,000 RNs surveyed in NCSBN’s “2024 National Nursing Workforce Study,” more than 138,000 had left the workforce since 2022, with burnout and intent to leave closely correlated (41.6% cited stress/burnout as the root causes behind the decision to depart).
Our “2025 Senior Care Survey Report Workforce 360” surfaced that a significant minority of senior-care professionals intend to leave the industry (41% of employees), with 57% citing burnout and stress as the reasons for leaving.
When experienced nurses leave, remaining team members absorb additional patient load, which raises burnout risk among those who stayed. In turn, this raises the probability that the remaining nurses will leave, perpetuating a cycle of burnout that can be difficult to end.
Setting note: Burnout pathways differ by context. In acute care, high patient acuity and unpredictable census drive stress. In behavioral health, sustained emotional labor results in increased emotional exhaustion (Chen et al., 2023). In “Who’s Taking Care of the Mental Health Workers,” the research uncovered that nearly all (93%) of behavioral health workers have experienced burnout. Behavioral health professionals also have more exposure to workplace violence — 10 times higher than other hospital settings. Professionals in long-term care settings see 75% more workplace violence than hospital teams (Hulenpacker and Gold, 2022). Long-term care professionals also face chronic unfilled shifts, which can cause burnout to build over time.
2. Poor onboarding and early-tenure turnover
Early-tenure turnover rates run roughly twice as high as all-tenure rates across specialties, according to AONL and Laudio in “Early-Tenure Nurse Retention: Trends and Leader Strategies.” This appears to be connected to a lack of mentorship for early career nurses, compounded by a high turnover rate for nurse managers, which is explored more extensively in point five.
3. Limited career growth and advancement pathways
Low investment in career development drives low nurse retention rates. A 2025 Harris Poll survey of 1,504 frontline healthcare workers found that only 1 in 5 feel their employer is invested in their long-term career success. Sixty-three percent say tuition support would make them more likely to stay.
Among GenZ, career development is an expectation: In NHSS's 2026 Career Interest Survey, 66% of high school students said gaining skills and professional development was the most important part of the work experience. In the Harris Poll, 61% of Gen Z healthcare employees cited education benefits as a reason they stay with their current employer.
4. Scheduling rigidity and lack of autonomy
When nurses have limited input into their schedules, face unpredictable rotations or encounter administrative friction when trying to trade shifts, the effects show up in satisfaction and retention.
A cross-sectional study of 616 nurses in the Netherlands found that when job demands outpace nurses' ability to meet their personal need for autonomy, work-life balance deteriorates — and with it, intention to stay in the profession (Brouwer, André & Renting, 2025). Qualitative research from NYU Rory Meyers College of Nursing reinforces this in a U.S. context: Scheduling challenges contributed directly to work-family conflict, compromised health and well-being, and increased turnover intention among staff nurses. Flexibility, transparency and autonomy emerged as the primary factors separating satisfying schedules from ones that drove nurses toward the exit (Witkoski-Stimpfel et al., 2025).
Both studies measure turnover intention rather than actual turnover — a validated predictor of departure, not a direct measure of it. The evidence identifies scheduling rigidity as a consistent, modifiable driver of dissatisfaction.
The work-family conflict identified by NYU’s research is supported by our “Solutions to Healthcare Burnout” survey. In it, 81% of healthcare professionals said they have personal caregiving duties, and 94% said they make significant sacrifices for their careers — even missing weddings, graduations, and funerals because of work. Ninety-seven percent said they thought healthcare professionals need more schedule flexibility.
5. Manager relationships and organizational culture
Manager relationship quality is one of the strongest predictors of nurse retention. But nurse managers themselves are a retention risk, likely to leave their posts in the first four years. Nurse manager turnover peaks at 12% by year three and hovers around 10% during years two and four (Laudio Insights).
When nurse managers go, they take their teams with them. Another Laudio report, conducted alongside AONL in 2024, found that team turnover increases by roughly two percentage points in the 12-month period after a nurse manager departs. Since 57% of nurse managers are promoted from within the same department, the replacement manager will likely be at elevated risk of leaving for the next several years, restarting the cycle.
Conversely, each year a manager stays is incrementally more valuable to the teams they lead. Managers who stay beyond year four possess direct knowledge of the team, the facility culture, and the department's operational rhythms that cannot easily be replaced.
Nurse retention strategies with strong supporting evidence
Nurse retention is complex, and it requires a multifaceted, strategic approach. Structured onboarding and early-tenure support, career ladders and internal advancement pathways, schedule flexibility and shift autonomy, manager accountability and leadership development, retention programs, and psychological safety are all nurse retention strategies with strong evidence behind them. Details on each to follow.
1. Structured onboarding and early-tenure support
Manager-conducted check-ins at six or nine months improve first-year nurse retention by 10 percentage points, according to AONL-Laudio's 2025 analysis of early-tenure retention trends. Earlier check-ins help too — those at 30 or 45 days improve first-year retention by six percentage points. Who conducts the check-in matters as much as when: Delegating check-ins to an assistant manager drops retention by six percentage points.
This finding is supported by prior research: A 2023 systematic review in MDPI Healthcare analyzed 55 studies and identified onboarding programs, mentoring, and social support as among the most effective retention interventions in hospital settings (De Winter et al., 2023).
With time in short supply for many healthcare leaders, who often spend their days buried in documentation or battling workforce issues, long-term strategy may be out of reach. Organizations that invest in resources (including technology) to reduce administrative burden and, instead, refocus leadership teams on workforce development programs are likely to see better nurse retention rates.
Setting note: Behavioral health professionals experience a high rate of workplace violence. Consider including trauma-informed support resources and peer connection structures in onboarding programs. In post-acute care, onboarding is often underfunded relative to acute-care systems due to their reimbursement and economic structures, which increases early-tenure vulnerability for new nurses entering high-demand, lower-resource environments.
Onboarding and mentorship program framework:
- Extend formal onboarding to at least 90 days with phased learning milestones. Both theDe Winter 2023 systematic review and the AONL-Laudio Spring 2025 report emphasize extended, structured early-tenure support as a nurse retention driver.
- Pair new nurses with mentors for months, not just weeks. A 2025 UNC NC Health Workforce brief synthesizing three separate systematic reviews concluded that one-year nurse residency programs and individualized mentoring significantly decrease the likelihood of nurse turnover (UNC NC Health Workforce, 2025).
- Schedule regular structured check-ins between new nurses and managers. Regular check-ins throughout a nurse’s first year have been proven to increase retention rates. (AONL-Laudio, Spring 2025).
- Deploy regular surveys to identify dissatisfaction signals before nurses leave. Surveying nurses (of all tenures) regularly gives facility leaders the data they need to make smart investments in retention programs. It may also surface organizational issues.
3. Career ladders and internal advancement pathways
Nurses who see a clear career path progression (with defined advancement criteria) are less likely to leave than those who experience their role as terminal. A 2025 umbrella review published in "BMC Health Services Research" synthesized the body of systematic reviews on nurse retention interventions and found that the availability of a clear clinical ladder reduced nurse turnover by 11%.
Setting note: In post-acute and behavioral health settings, career ladders are less standardized and often less visible than in acute care. That means facilities with these programs may use them to differentiate themselves from their competitors. In acute care, career programs are common enough that execution quality matters.
4. Schedule flexibility and shift autonomy
A cross-sectional study of 616 nurses in the Netherlands found that work-life balance — shaped in part by how well job demands align with nurses' personal need for autonomy — was significantly associated with greater intention to stay in the profession and reduced work-family conflict (Brouwer, André & Renting, 2025). Qualitative research from NYU Rory Meyers College of Nursing reinforces this in a U.S. context: Flexibility, transparency and autonomy were the primary factors separating satisfying schedules from those that drove nurses toward the exit (Witkoski-Stimpfel et al., 2025).
Setting note: In post-acute care, facilities operating below adequate workforce density cannot offer meaningful scheduling flexibility without creating coverage gaps. A 2024 peer-reviewed study in “Health Services Research” identified system-wide drivers perpetuating skilled nursing workforce shortages, including burnout (Leland et al., 2024).
5. Manager accountability and leadership development
“Transformational leadership” — the ability to inspire a shared vision, encourage innovation, recognize individual contributions and create a sense of purpose and belonging — produces statistically significant improvements in nurse retention, according to a 2025 meta-study (Pub Med Central, 2025). That makes senior leadership behavior a retention variable.
Transformational leadership includes fostering a healthy work environment. AONL-led nurse manager interviews found that work environment is the primary factor managers weigh when deciding whether to stay in their roles. Designated days off, flexible scheduling and a peer coverage culture were cited as the specific structural supports that make the role sustainable (Laudio Insights, 2025). Senior leaders who do not create those conditions may accelerate frontline turnover.
Clinicians promoted into management roles without formal training are structurally set up to replicate the dynamics that drove nurses away from less effective managers. After implementing a formal nurse manager mentoring and residency program, one organization saw first-year retention improve from 94.3% to 98%, with 12% of participants earning promotions to nurse manager positions. Key design features included mentor selection by the participant, which built trust and fit from the start, and a structure that provided accountability (AONL Compendium 2.0).
Once a healthy work environment and manager pipeline training programs have been established, facilities may find that holding managers accountable for unit-level turnover makes sense as part of their overall nurse retention strategy.
Setting note: In behavioral health, managers need tools to support team members after critical incidents, normalize help-seeking, and model sustainable work practices in a high-stress environment. In post-acute care, investments in administrator efficiency and prioritization matter as much as skill development: An overwhelmed administrator cannot execute a retention program regardless of program quality. In acute care, management development programs exist at the health system level in many organizations. But accountability belongs at the unit level, where retention is actually won or lost.
6. Recognition programs
Recognition programs reduce turnover intention and increase satisfaction across generational cohorts shifts, and roles, and they are among the lowest-cost retention interventions available to healthcare facilities.
Recognition preference varies by generation: Baby Boomers prefer that it be formal, and GenX wants it to be "timely” and “pragmatic,” while Millennials and GenZ desire frequent, tech-forward feedback.
To work, retention programs should be operationalized but also allow room for unit/team creativity. Consistency and inclusivity are also critical determinants of success. (Nurse Leader, 2025).
7. Psychological safety
Psychological safety (the shared belief that speaking up about concerns, errors or dissatisfaction is safe) is a precondition for most other strategies in this article. Some surveys only generate usable data if nurses believe anonymity is real. Mentorships only build retention value if new nurses feel safe disclosing early struggles. A 2025 review of six studies comprising 4,984 nurses found a consistent inverse relationship between psychological safety and burnout across nursing settings in the U.S., China, Pakistan, Japan and South Korea (Sato et al., 2025). Psychological safety is built through consistent leadership behavior over time. Facilities build it when they take visible action on nurse-reported concerns and communicate what changed. They erode it when they solicit feedback and then do nothing.
Measuring whether your nurse retention strategy is working
Here’s a basic measurement framework for any setting.
Baseline metrics to capture before implementation
- Overall RN and nursing staff turnover rate (annual)
- First-year turnover rate (nurses who leave within 12 months of onboarding)
- Unit-level turnover (to identify high-turnover concentrations)
- Mandatory overtime hours per nurse, per month
- Engagement survey scores, where applicable
Lagging indicators (re-measure at six and 12 months post-intervention):
- Turnover rate by unit and role
- Time-to-fill for open nursing positions
- First-year turnover rate
Leading indicators (re-measure monthly or quarterly):
- Overtime utilization trend
- Stay interview completion rate and recurring themes
- New-team member check-in completion rate at 30, 60 and 90 days
- Manager relationship scores
If turnover has not improved after 12 months, the first question is whether the program ran as designed. If implementation was high and turnover still did not move, the problem is likely structural; for example: workplace conditions or manager-quality issues that require intervention.
Frequently asked questions about nurse retention
How do you calculate your nurse retention rate?
Nurse retention rate is the inverse of nurse turnover rate, so if you know your nurse turnover percentage, subtract it from 100% to find the percentage of nurses you’re retaining.
You calculate nurse turnover rate by dividing the number of nurses who have departed during the measurement period by the number of nurses on your team at the beginning of the measurement period.
To calculate nurse retention rate from scratch, first define the measurement period. Then, divide the number of nurses on your team at the end of the measurement period by the number of nurses at the beginning of the period.
What percentage of nurse departures are preventable?
More than four in ten, based on cross-industry Gallup research, but a nursing-specific figure at this scale has not been established in peer-reviewed literature. Gallup's 2024 analysis found that 42% of voluntary leavers said their departure could have been prevented, and that 45% had no proactive conversation with their manager in the three months before leaving.
Which nurse retention factors are within a facility's control — and which aren't?
Most causes covered in this article are at least partially within facility control: onboarding quality, career pathway clarity, scheduling practices, manager development and recognition programs are all categories facilities can affect directly.
Regional workforce shortages and reimbursement-constrained compensation sit largely outside any individual facility's control.
Burnout is more complex. Its intensity is shaped by patient acuity and market-level workforce shortages that no individual facility can fully control, but its progression is influenced by facility decisions around workload distribution, scheduling and manager support.
What's the difference between a leading and lagging indicator in nurse retention?
Leading indicators, such as engagement scores, stay interview themes, overtime utilization and check-in completion rates, reflect current conditions and respond earlier than nurse retention figures do. Lagging indicators (turnover rate, time-to-fill and first-year departure rate) measure outcomes that accumulate over time. When evaluating programs, notice whether leading indicators are improving. If they are, stay the course, and measure the lagging indicators once a full measurement cycle has been completed.
Does scheduling actually affect whether nurses stay or leave?
Yes, though the evidence is more precise than the common framing. The specific mechanisms identified in peer-reviewed studies are dissatisfaction, work-family conflict and compromised well-being. Scheduling rigidity contributes to all three, and all three are associated with higher turnover intention.
How do I know if manager behavior is driving turnover?
A few signals are diagnostically useful. If turnover is concentrated in specific units rather than distributed evenly across the facility, manager behavior is a more likely driver than organization-wide factors like compensation or benefits. Stay interview themes that cluster around poor communication, lack of recognition or feeling unsupported (rather than workload or pay) point in the same direction.
Manager instability (which may stem from issues beyond the manager’s control) measurably drives turnover as well. Research from Laudio found that manager departures increased team turnover by approximately two percentage points in the following 12 months.
Key takeaways
- Nurse retention is a financial metric with direct consequences for operating margins. Losing a single bedside RN costs approximately $60,000 on average; a 1% improvement in turnover saves the average hospital roughly $295,000 annually.
- Nurse retention carries measurable patient safety consequences. U.S. research links higher nurse turnover to increased patient fall rates in acute care hospital units; a large U.K. study links it to higher 30-day mortality risk for emergency admissions. Both findings are correlational rather than causal, and support the case for investment in nurse retention.
- The root causes of turnover (burnout, compensation gaps, poor onboarding, limited career growth, scheduling rigidity and weak manager relationships) are structural. Programs that address these issues can help increase nurse retention.
- Post-acute and behavioral health settings face compounding challenges that make standard acute-care retention playbooks insufficient without adaptation: constrained compensation, higher workplace violence exposure and less-defined career pathways require setting-specific strategy.
- Effective retention strategies establish baselines, track leading indicators, and distinguish between implementation failure and strategy failure before changing course.
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