Nurse turnover is one of the most financially significant workforce metrics in healthcare: Replacing a single bedside RN costs an average of $60,090, and the average hospital loses between $4.2 million and $6.2 million to nurse turnover every year. Every one-percentage-point change in RN turnover represents approximately $295,000 in annual cost or savings.
This guide covers what nurse turnover costs facilities, the root causes driving it, and how it affects patient care — with links to evidence-based retention strategies and primary data sources for facility leaders who want to go deeper.
What is turnover in nursing?
Nurse turnover is the rate at which nurses leave a facility and must be replaced, typically measured as an annual percentage. It’s the inverse of nurse retention (a facility with a 20% turnover rate retains 80% of its nursing workforce).
Turnover is either voluntary or involuntary. Voluntary turnover, nurses who resign, is the category most within a facility's control and the primary focus of a retention strategy. Involuntary turnover includes terminations and role eliminations. The interventions are different for each: Voluntary turnover can be reduced through changes in scheduling, culture, career development and workload; involuntary turnover requires workforce planning that accounts for demographic and market-level trends (PubMed, 2025).
Facilities may track turnover at the organization level or at the unit/department level. Because high turnover concentrated in a single unit can be obscured by stable performance elsewhere, unit-level tracking can help leaders identify where and why nurses are leaving.
How high is the nurse turnover rate right now?
The national RN turnover rate was 17.6% in 2025, a 1.2-percentage-point increase from the prior year, according to the 2026 NSI National Health Care Retention and RN Staffing Report, a survey of 527 acute care hospitals. Hospital-wide turnover across all employees was 18.5%. Those averages shift by setting and specialty.
Turnover averages by care setting:
- Hospitals: RN turnover at 17.6% (NSI 2026)
- Behavioral health: RN turnover at 22.5%, the highest of any acute-care specialty surveyed (NSI 2026)
- Skilled nursing facilities: RN turnover at 36.53%, LPN turnover at 35.29%, CNA turnover at 42.34% (Skilled Nursing News, 2025)
Turnover averages by nursing specialty (acute care):
- Lowest turnover: pediatrics, surgical services and women's health
- Highest turnover: behavioral health, emergency services and telemetry (NSI 2026)
These benchmarks serve two purposes for facility leaders. First, they establish where an organization stands relative to others. (A 20% RN turnover is higher than average in a hospital but lower than average in a skilled nursing facility.) Second, specialty-level benchmarks help leaders determine whether the problem is specific to their organization or mirroring industry-wide trends.
What does nurse turnover cost?
According to the 2026 NSI report, replacing one bedside RN costs an average of $60,090, and the average hospital loses between $4.2 million and $6.2 million per year. The report puts the per-percentage-point cost at $295,000 per year, meaning a facility that moves its RN turnover rate from 20% to 18% saves roughly $590,000 annually.
Nurse turnover carries both direct and indirect costs. Direct costs are measurable: recruiting fees, onboarding time, training and temporary coverage. Indirect costs are harder to quantify. They include lost productivity during the transition period, the effect on team morale when experienced nurses leave, and disruption to care continuity.
Each RN departure has operational consequences: The national RN vacancy rate stands at 8.6%, with a third of hospitals reporting vacancies of 10% or higher. When a position does open, it takes an average of 78 days to find a replacement (NSI 2026).
Even so, fewer than half of NSI survey respondents tracked the root causes of nurse turnover. Leaders who do track them know which retention strategies are likely to have the most impact for their teams.
For a full breakdown of turnover costs, see our guide “The Real Cost of Nurse Turnover.”
What causes turnover in nursing?
Nurse turnover has multiple overlapping causes. Six appear consistently across acute, post-acute and behavioral health settings, and most are at least partially within a facility's control.
Burnout is the most consistently cited turnover driver. Among 800,000 RNs surveyed in the NCSBN's 2024 National Nursing Workforce Study, 41.6% who had left the workforce cited stress and burnout as the primary reason. When experienced nurses leave, remaining team members absorb additional patient load, which elevates burnout risk among those who stay and increases the probability of additional departures.
Early-tenure turnover runs roughly twice as high as all-tenure rates across nursing specialties, according to AONL and Laudio research, meaning facilities frequently lose nurses before recouping hiring costs.
Limited career growth pathways signal to nurses that their current role is terminal. Only one in five frontline healthcare workers feel their employer is invested in their long-term career success, according to a 2025 Harris Poll survey of 1,504 frontline healthcare workers.
Scheduling rigidity and lack of autonomy. The level of alignment between a nurse’s personal need for autonomy and work demands has been correlated to their intention to stay—or lack thereof (Brouwer, André & Renting, 2025). Scheduling challenges may also affect nurse health and well-being, drive work family conflict, and contribute to turnover (Witkoski-Stimpfel et al., 2025). Nurses are also making significant personal sacrifices for their work. Almost all nurses (96%) we surveyed for our Solutions to Healthcare Burnout Report had missed at least one major event due to work commitments, such as major holidays (73%), birthdays (73%), vacations (55%), anniversaries (41%), weddings (38%), graduations (34%) and even funerals (33%).
Manager relationships and organizational culture are among the strongest predictors of whether nurses stay. Nurse manager turnover peaks at 12% by year three (Laudio Insights), and when a manager leaves, team turnover increases by roughly two percentage points in the following 12 months — a compounding effect that can persist for years if the replacement manager is also at early-tenure turnover risk.
External pull factors account for some departures that retention strategy cannot prevent. For example, the RN median age is 50, and 40% of nurses say they intend to leave the field in the next five years, a demographic level shift.
How does nurse turnover affect patient care?
Turnover appears to negatively impact care quality. A 2025 cross-sectional study of 8,584 U.S. acute care hospital units indirectly associated higher nurse turnover with higher patient fall rates (Mauricio, 2025). A retrospective longitudinal study of NHS acute trusts in the UK found that higher nurse turnover was associated with increased 30-day all-cause mortality (Moscelli et al.,2024). Both studies point to a directional pattern of lower nurse turnover leading to better performance on measurable patient safety outcomes.
What can facilities do about nurse turnover?
Reducing nurse turnover requires addressing its root causes with evidence-based interventions. Six strategies have the strongest research:
- Structured onboarding and early-tenure support: Manager-conducted check-ins at six or nine months improve first-year nurse retention by 10 percentage points (AONL-Laudio, 2025).
- Career ladders and advancement pathways: A clear clinical ladder is associated with an 11% reduction in nurse turnover, according to a 2025 umbrella review in BMC Health Services Research.
- Schedule flexibility and shift autonomy: Flexibility and autonomy are the primary factors separating schedules that retain nurses from those that drive them toward the exit (Witkoski-Stimpfel et al., 2025).
- Manager accountability and leadership development: Transformational leadership — which includes recognizing individual contributions and creating a sense of purpose — produces statistically significant improvements in nurse retention (Pub Med Central, 2025).
- Recognition programs: Recognition reduces turnover intention across generational cohorts, shifts and roles, and is among the lowest-cost retention interventions available to healthcare facilities (Nurse Leader, 2025).
- Psychological safety: 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).
Frequently asked questions about turnover in nursing
What is the current nurse turnover rate?
The national RN turnover rate was 17.6% in 2025, according to the 2026 NSI National Health Care Retention and RN Staffing Report, with behavioral health showing the highest unit-level turnover at 22.5%. Hospital-wide turnover across all employees was 18.5%. In post-acute settings, rates run significantly higher: RN turnover in skilled nursing facilities was 36.53% in 2025.
How much does nurse turnover cost a hospital?
Replacing one bedside RN costs an average of $60,090, and the average hospital loses between $4.2 million and $6.2 million to RN turnover annually (NSI, 2026). Every one-percentage-point change in RN turnover represents approximately $295,000 in annual cost or savings, making turnover rate one of the highest-leverage financial metrics in workforce management. Those figures cover direct costs such as recruiting and onboarding. Indirect costs such as productivity loss, morale impact, and care continuity disruption are real but harder to capture.
What is the most common reason nurses leave their jobs?
Burnout and stress are the most consistently cited drivers of voluntary nurse turnover across settings. In the NCSBN's 2024 National Nursing Workforce Study, 41.6% of nurses who had left the workforce cited stress and burnout as the primary reason. Other significant factors include scheduling inflexibility, limited career advancement, poor manager relationships and insufficient compensation. In many cases, multiple factors are present simultaneously.
What is the difference between nurse turnover and nurse retention?
Nurse turnover is the rate at which nurses leave a facility; nurse retention is the rate at which they stay. They are inverses of the same metric: a 10% turnover rate equals an 90% retention rate. Retention strategy focuses on the structural and cultural factors that make nurses choose to stay, such as career development, scheduling, leadership quality and workload, rather than on backfilling the positions of those who have already left.
Which nursing specialties have the highest turnover?
Among acute care settings, behavioral health, emergency services and telemetry report the highest RN turnover rates. Pediatrics, surgical services and women's health report the lowest, according to the 2026 NSI report. In post-acute care, turnover across all nursing roles substantially exceeds the acute-care average: CNA turnover in skilled nursing facilities reached 42.34% in 2025, with RN and LPN turnover both above 35%.
What is a good nurse turnover rate?
There is no universal benchmark, but the 2026 NSI report provides useful reference points. The national hospital RN turnover average is 17.6%. Top-performing hospitals — those in the 90th percentile — report turnover of 13.8% or below. For skilled nursing facilities, any rate below 36% represents above-average performance relative to current national figures. Facilities setting internal benchmarks should prioritize year-over-year improvement and first-year turnover rate (the strongest leading indicator of long-term retention) over comparisons to a single national average.
Support your workforce without burning out your team
By creating more flexible coverage options, facilities can reduce root causes of turnover in nursing while improving patient care. Over 10,000 facilities use ShiftKey’s platform to connect directly with a deep marketplace of independent professionals who fill coverage gaps and relieve pressure on existing teams. Schedule a demo today to see how ShiftKey can help your facility, or explore our Burnout Resources Hub for more strategies you can use to support your team.
