Understand how we got here — and how to move forward.


September 14, 2021

How to fight the 'nursing exodus.' (Hint: It isn't $40,000 sign-on bonuses.)

Daily Briefing

By Carol Boston-Fleischhauer

    By Carol Boston-Fleischhauer, CNO and Managing Director

    Over the past couple of months, I’ve consulted with dozens of CEOs, CFOs, and CNOs about the severe workforce shortages their health systems are experiencing. And from these conversations, I can confidently say that the biggest crisis in health care right now isn’t Covid-19 spikes or economic uncertainty—it’s the dire state of the frontline clinical workforce, particularly RNs.

    Sept. 15 webinar: Retain experienced nurses by meeting their workforce needs

    With demand for direct patient care jobs increasingly outpacing supply, the competition for nurses is fierce. This is especially true for RNs willing, able, and available to work in inpatient care. Recruitment strategies normally reserved for crises are now the norm; for example, offering sign-on bonuses upwards of $40,000, or extending travelers’ contracts indefinitely. While these tactics may keep your hospitals running tomorrow, here’s the problem: these band-aid solutions are unsustainable and will do nothing to stabilize your clinical workforce in the long-term.

    For myriad reasons, the current RN shortage will not reverse itself. C-suites and leadership boards must be prepared to confront hard truths regarding what it will take to stop the exodus of RNs from hospital-based care. Beyond budgetary impact, failing to invest now will affect quality and safety while eroding your organization’s capacity to advance growth and expand market share. Read on for must-do strategies for C-suite leaders working to turn the tide of the RN exodus.

    Take an all-hands-on deck approach to retaining top talent

    Presume every provider in your market is working to steal your clinical talent. With that in mind, an all-hands-on deck approach to retaining top talent must be your C-suite’s immediate priority.

    First, leaders should re-prioritize best practice retention tactics, many of which were understandably suspended during the height of the pandemic in 2020. For example, stay interviews, a renewed focus on vulnerable engagement drivers, relevant recognition, and professional development should be non-negotiable and flawlessly executed. Other retention drivers that demand heightened focus are solidifying employee resilience as a core organizational competency versus ad-hoc crisis support, guaranteeing workplace safety, and re-scoping the frontline manager role so these leaders can succeed as chief retention officers of their units.

    Address RN turnover drivers—but prepare to use staffing strategies in sync with diminished supply and emerging employee needs

    While legacy retention strategies must be prioritized, they will not be enough. Addressing what nurses themselves say is driving them to leave their current positions is critical to reversing this untenable RN turnover trend. Now, more than ever before, the voice of the frontline nurse; including concerns about their role and their work environment, must be heard and acted upon.

    A 2021 McKinsey survey highlighted key reasons why RNs leave their current jobs, including insufficient staffing levels, intense workloads, and the physical toll of the job. These findings, along with increasing expectations for some form of employment flexibility, compel leaders to implement alternatives to legacy staffing strategies.

    With insufficient numbers of RNs available, some form of team-based care is inevitable as well as the development of an aggressive entry-level pipeline of employees to offload various care activities from your RNs. The use of virtual care technology to augment staffing challenges leverages existing digital care technology investments beyond ambulatory and remote care access. Scheduling options other than the traditional 12-hour shift must also be offered to provide requested work/life balance. Admittedly, these strategies disrupt status quo operations, but the predicted longevity of the current RN shortage will require this level of investment as pivotal to reducing RN turnover while effectively staffing units. 

    Redesign total rewards that appeal to emerging RN demands

    Finally, a fundamental reworking of your entire rewards program for clinical staff; both benefits and compensation must be carefully considered. Case in point: McKinsey reports that only 10% of U.S. hospitals provide any type of childcare support despite a significant number of RNs with young children unable to find affordable childcare. Beyond a market competitive salary structure, including base rates, relevant shift differentials, and significant merit increases, some organizations are further differentiating RN pay according to the care site within a system—recognizing that hospital-based nursing is significantly more stressful and labor-intensive than outpatient services. When competing for clinical talent, redesigning your total rewards strategies in sync with contemporary employee needs will differentiate your organization as the employer of choice.

    The bottom line

    Reversing the exodus of RNs from inpatient care is not just the job of the chief nurse executive; it is the job of the entire C-suite to ensure commitment of the brain power and the resources needed.

    The Advisory Board’s Nurse Executive Center stands ready to further consult executives on these and other here-and-now tactics to address the nursing shortage, including a critique of your current workforce plan’s strengths and vulnerabilities. We can be reached at

    To learn more about how nurse executives are preparing for future staffing instability, register here for our 2021 Virtual National Meeting, Hard Truths for CNOs: The Current & Future State of the Nursing Workforce, on November 2 at 1 pm EST.

    Retain experienced nurses by meeting their workforce needs


    Over the past year, experienced nurses have been leaving the bedside because their roles or shifts conflict with their personal safety or home life. This trend, in combination with expected baby boomer retirements, will leave organizations with fewer experienced staff. Retaining these nurses, albeit in nontraditional ways, is necessary to provide safe patient care.

    Join us on Wednesday, Sept. 15, to learn tactics you can use retain this subset of staff who can’t otherwise continue to work – as well as guidance on which one is right for your organization.

    Register now

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