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October 6, 2021

Why so many nurses are quitting (and what to do about it)

Daily Briefing
    By Junhong Peng and Lauren Rewers

    How did Covid-19 impact nurse turnover—and what steps should executives take to stabilize the workforce in the long-term? We know that nursing shortages are top of mind right now for health system executives, and while definitive projections of national nursing supply are still yet to come, there is one variable that leaders can use right now to gauge the stability of their frontline workforce: turnover.

    Our take: Building a flexible nursing workforce

    The pandemic is driving bedside RN turnover to new heights

    With an uptick in travel nursing demand, early retirements, high sign-on bonuses, and bedside RN burnout, 2020 had no shortage of workforce challenges. And according to the Advisory Board’s annual survey of over 200 health systems, average bedside RN turnover in 2020 rose to an all-time high of 18.6%. This jump, up nearly 2% from 2019, also represented the largest annual increase in seven years.

    While RN turnover rose across the board, certain segments of the workforce were hit harder than others.

    • Regional differences: While average United States turnover rates typically vary by region, 2020 spikes were concentrated in areas with traditionally strong retention. For example, 2019 turnover in the South East Central and South West Central United States hovered at 20% and remained stable or decreased in 2020. Meanwhile, turnover in the North East Central (14.5% in 2019) and North West Central (13.3% in 2019) regions rose nearly 5%. So, while the United States as a whole had relatively consistent turnover in 2020, certain regions experienced more dramatic shifts.
    • Specialty differences: According to NSI Nursing Solution’s analysis, certain RN specialties—step down, telemetry, emergency, and behavior health in particular—also saw a higher turnover rate. For example, step-down nursing saw an increase of nearly 6% from 2019, compared to the flat growth of med/surg. One likely reason for this variance is that these specialties took on the brunt of treating Covid-19 patients and experienced some of the highest burnout during the pandemic. For health system executives, these positions will also be among the hardest to fill, as they require more experienced nurses in especially short supply.

    Rising nurse turnover challenged employers long before Covid-19—and it will persist post-pandemic

    While alarming, this spike in turnover belies an even more insidious problem: rising instability in the nursing workforce over the past decade. Turnover rose for six years preceding the pandemic, from 13.5% in 2013 to 16.7% in 2019. So even as the pandemic wanes, leaders should expect even more acceleration in turnover for two reasons:

    1. Structural issues within the work environment remain unresolved

      A 2021 survey of nurses indicates that 22% of nurses intend to leave their jobs within the next year. The top reasons nurses cited for their intention to leave were related to long-term challenges within the work environment, including the following:

      • Insufficient staffing levels and demanding nature/intensity of workload;
      • Emotional toll of the job and not feeling listened to or supported at work;
      • Family needs and/or competing life demands; and,
      • Insufficient compensation.


    2. Sign-on bonuses create motivation to leave

    With the highest Covid-19 peaks behind most United States communities, frontline nurses now have the breathing room to reevaluate their employment and seek new jobs. Combined with a tighter labor market, skyrocketing sign-on bonuses, and fierce recruitment tactics, nurses that are feeling disengaged or ambivalent in their current roles now have powerful motivation to leave.

    How health care leaders can stabilize their workforce

    Employers looking to stabilize their workforce—both in the short-term and long-term—will need to move beyond sign-on bonuses to addressing those structural issues, including the following:

    • Embrace team-based care as a permanent solution to staffing shortages;
    • Implement a competitive entry-level worker strategy;
    • Augment staffing and experience shortages with virtual care technology;
    • Redesign RN total rewards to appeal to changing RN needs; and,
    • Communicate the value proposition of working at the inpatient bedside.

    Here’s the bottom line: Covid-19 exacerbated the workforce crisis, but historical turnover indicates that there were pre-pandemic underlying issues that contributed to the decade-long trend of rising RN turnover. This instability will not improve unless health systems address the structural challenges at the heart of RN disengagement.

    Looking for more information on the future of nurse staffing? Join us on Tuesday, November 2nd for our meeting, Hard Truths for CNOs: The Current & Future State of the Nursing Workforce. Our team of experts will discuss the hard truths and executive mindset shifts needed to adapt to the current landscape of the nursing workforce—as well as provide guidance on how to approach the growing supply-demand imbalance.

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