What you need to know about the forces reshaping our industry.


June 7, 2022

Nurses keep quitting. What can you do about it?

Daily Briefing

    The median number of years nurses have been working at their organizations dropped from 3.58 in 2021 to 2.78 in 2022, according to a new study by Epic Research—reflecting the continuation of significant nurse turnover.

    Radio Advisory episode: Supporting RNs by changing the structure of nursing

    Study details and key findings

    For the study, researchers analyzed data for more than 26 million 12-hour nursing shifts from 539,765 RNs at 189 U.S. health care organizations.

    To measure turnover, the researchers calculated the median length of time nurses have been at their current organizations. Overall, the researchers found that the median tenure for nurses dropped from 3.58 years in March 2021 to 2.78 years in March 2022—an almost 20% decline over the course of the past year.

    Although this decrease in median nurse tenure was seen across the United States, it was most prominent in the West, which saw a 32.2% decline in median tenure between March 2021 and March 2022. In comparison, the Northeast, Midwest, and South saw a 17.7%, 16.4%, and 11.3% decline, respectively, over the same period.

    In addition to median tenure, the researchers also measured nurse turnover by calculating the percentage of shifts covered by new nurses, or a nurse who started working at an organization in the last 30 days.

    The shifts covered by new nurses increased in all U.S. regions, with the largest increases seen in the South and West. In the South, the percentage of shifts covered by new nurses peaked in September 2021 at just under 5%. In the West, the percentage of shifts covered by new nurses peaked in February 2022 at around 5.5%. In March 2022, 3.4% of shifts in the South were covered by new nurses, followed by 2.9% in the Midwest, 2.6% in the West, and 2.6% in the Northeast.

    The researchers also analyzed the distribution of shifts based on a nurse's tenure at an organization. Nurses who had less than one year of tenure worked the largest number of 12-hour shifts, and this number increased by 55.5% between March 2021 and March 2022. This change occurred across all U.S. regions, but was most prominent in the South and West. (Davis, HealthLeaders Media, 6/6; Thayer et al., Epic Research, 6/2; Cacciaglia, Epic Share, 5/9)


    Advisory Board's take

    Now is the time to fully leverage the RNs you have, while you have them—here's how

    In recent months, our research team has had candid conversations with health care leaders who consistently share how difficult it is to retain long-term bedside RN talent. While previous generations of nurses stayed at the bedside for years, it is clear today's nurses don't plan to do that.

    Multiple factors have contributed to this decline in RN tenure, including an increasingly complex care environment where RNs deliver advanced care to sicker patients in shorter timeframe. These demands—coupled with insufficient staffing levels intensified by the pandemic—have exacerbated burnout. As a result, RNs are changing organizations more frequently and some are even leaving the profession entirely.

    Ultimately, organizations must accept the reality of RNs' increased mobility—a lack of experienced RNs and high bedside RN turnover is the new normal. To compete in today's labor market, leaders must develop a workforce strategy that doesn't rely on waning RN loyalty.

    We recommend the following strategies to tap into your existing RNs and position them to lead, delegate, and care for patients most efficiently:

    • Revamp clinical ladders to reflect accomplishments, not tenure: Leaders must ensure clinical ladders respond to the reality of shorter bedside RN tenure instead of trying to fight it. Start by redesigning RN clinical ladders to reflect annual awards and recognition based on performance, rather than gradual or cumulative awards based on tenure.
    • Support top-of-license practice to maximize the value of each nursing hour: To fully leverage RNs, leaders must support top-of-license practice. Time spent on care activities that other staff could safely execute prevents RNs from spending their time where they are most needed.
    • Use virtual care to scale the impact of RNs: One way to support inexperienced RNs and retain experienced RNs, while simultaneously reducing cost and improving quality, is to provide virtual nursing opportunities. In addition, these positions make organizations more competitive with virtual RN roles offered by out-of-industry employers.

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    Here are five paths nurse leaders are taking to support safe and effective care delivery.

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