The health care industry has seen high staff turnover amid the "Great Resignation." Median bedside RN turnover rose to 18.0% in 2021, up from 14.8% in 2020—double the historic low we saw in 2010. We've also heard anecdotal evidence that RNs have reached their breaking point and are leaving the profession entirely.

Hard truths on the current and future state of the nursing workforce

According to McKinsey's latest research, 32% of RNs say they may leave their current role in direct patient care. These projections raise huge concerns for provider organizations—but are there enough roles available for these RNs expressing intent to leave? Read on to find out.

It's a great reallocation of RNs, not a great resignation

While almost every provider organization is feeling the strain from high rates of RN turnover, the fear that RNs are leaving the bedside in droves to pursue indirect care roles is unfounded. Indirect care roles are jobs within the health care ecosystem that do not involve interactions between a health care provider and patient. These roles are found with provider organization, but also with payers, biotechnology and pharmaceutical companies, etc.

The state of the post-acute workforce

We analyzed supply and demand projections for indirect care roles and found there simply are not enough of these roles. In 2020, there were three million RN roles available in the U.S. Of those available roles, about 6%, or 190,000 positions, could be categorized as indirect care roles.

Several recent analyses proclaim that anywhere from 30% to 70% of RNs intend to leave their current role for an indirect care role. Taking this range into account, this would leave an excess of 735,836 to 1,967,876 nurses above the market demand for indirect care roles.

Current RN staffing challenges are brought on not by a great resignation of RNs from the profession, but by a great reallocation of RNs within the health care ecosystem. Nurses are shifting to different direct care roles, different sites of care, and different employers to maximize their benefits. They are leaving.  They're just not going where you think they're going.

The reality is: it's a candidate's market, and RNs are going to go elsewhere if their organization is not meeting their expectations. Organizations can either choose to meet RN needs or lose them to other employers that will.

Address unresolved structural issues to slow RN turnover

To slow down RN turnover rates, health care employers must address the underlying structural challenges that have persisted for the past 20+ years. A 2001 study on the top reasons RNs cited for their intention to leave patient care included the following:

• Stressful/physically demanding job
• Inflexible hours/schedule
• Compensation/benefits
• Safety concerns (both for patients and RNs)

These structural challenges listed above are the same we're hearing today. For example, the McKinsey study previously cited found that the most influential factors for whether RNs stay in their current role included safety, flexibility, work-life balance, compensation, and feeling valued.

The great reallocation of RNs will persist unless health systems get at the heart of RN disengagement. Employers looking to stabilize their workforce—both in the short-term and long-term—will need to address these underlying structural issues. Listed below are our latest insights and resources to help support, retain, and recruit your nursing care teams:

• Embrace team-based care as a permanent solution to staffing shortages;
• Create flexibility by offering nontraditional nursing roles and schedules;
• Augment staffing and experience shortages with virtual care technology; and
• Redesign RN total rewards to appeal to changing RN needs.