What's driving nurse turnover?

In 2024, over 287,000 nurses left their position, and another 1.6 million said they intend to leave within five years. When a nurse leaves, hospitals lose continuity of care, unit-level knowledge, and crucial working relationships that help high-stress clinical units function effectively.

Writing in the Harvard Business Review, business operations experts Diwas KC, Blair Liu, and Bradley Staats and Michael Fundora, an associate professor of pediatrics at Emory University School of Medicine, highlighted their recent study examining the causes of nurse turnover.

For the study, the researchers followed 420 full-time nurses who worked in the ICU of a large U.S. hospital system for 26 months. The researchers analyzed EHR, staffing, scheduling, and HR data to identify nurses' care activities, work hours, and potential decision to leave.

According to the researchers, cumulative workload over time had a U-shaped relationship with the likelihood of voluntary attrition. Emotional fatigue from patient deaths and burnout from overtime shifts also increased the likelihood of voluntary attrition. One additional incident of emotional fatigue increased the odds of attrition by 54.3% while one more overtime shift increased the odds by 58.5%.

The researchers also found that support from coworkers helped to mitigate the negative impact of working overtime and sustained work pressure. When nurses actively helped each other during a shift, the odds of overtime-induced attrition fell by 40% while the odds of work-pressure-related attrition fell by 22%.

"In nursing, support from coworkers lightens the load while also changing the experience of work," the researchers wrote. "A hard shift feels different when others simply step in and share the burden."

2. Build redundancy and support into your workforce model

Ensuring that nurses have support with their work reduces the likelihood that they will leave their roles due to excessive workloads. Having additional nurses available to assist bedside nurses helps address workload imbalances, reducing frustration and resentment.

When making staffing decisions, leaders need to ensure that nurses have enough flexibility to help each other during intense periods. They should also recognize and reward supportive behavior instead of just treating it as incidental.

"Nursing is a team sport, and when nurses don't feel like they are part of a team, it compromises both patient care and their willingness to stay," said Ali Knight, a research director and RN at Advisory Board.

3. Treat retention as an operational (not HR) problem

Since turnover is impacted by daily decisions made at the frontline, managers, not HR, should be in charge of scheduling, role design, and contingency planning to address any retention issues. Many organizations already have the operational data they need to identify any pressure points and make changes to strengthen their staffing systems and improve retention.

Effective leaders will go even farther by partnering with nurses to create new workforce models instead of just implementing them without input. "The people most affected by these decisions have the clearest view of where the pressure points are and what would actually help," the researchers wrote.

Although their study focused on nurses, the researchers noted that the findings can also be applied to skilled workers in other high-stakes, high-pressure environments.

"The lesson is clear for leaders of organizations with highly skilled workforces that experience high levels of burnout: Don't just focus on how to reduce the workload of staff; explore how you might design work so that employees feel both trusted and supported," they wrote.