Inadequate staffing, violence drives nurses away

As hospitals become more efficient with staffing and hospital beds, nurses are facing more intense and less predictable workloads. They're also seeing sicker and more medically complex patients who often require intensive monitoring and care coordination with multiple specialists.

Nurses also face mounting frustration from patients as wait times for beds in EDs continue to grow. According to an analysis of records from 1,500 hospitals, ED wait times increased significantly during the pandemic and remained high through 2024, the most recent data available. During winter months, when hospitals are busiest, almost 5% of patients wait over 24 hours for a hospital bed.

"You have people in their most vulnerable times of their life, and their call button's not getting answered because the nurse is overworked, their loved one's not being seen," said Amy Stimpfel, associate professor at Villanova University's M. Louise Fitzpatrick College of Nursing. "It's bubbling up from a system that's sort of broken."

"The nurse is the face of the hospital, and we're constantly blamed for things outside our control," said Juliet Etienne, a 29-year-old nurse. 

Inadequate staffing and persistent violence are driving more nurses away from the profession, even though they remain in high demand overall. According to data from NSI Nursing Solutions, bedside RNs had an 18% turnover rate in 2025, increasing again after initially declining after the COVID-19 pandemic.

In a 2024 survey of 800,000 nurses, around 40% said they planned to leave the workforce or retire in the next five years, with many citing stress, burnout, and understaffing as reasons. Similarly, a 2026 survey from Nurses.org found that 43% of nurses said they were likely to leave bedside roles within the next year, up from 38% the year before.

"There is no shortage of nurses in this country," said Jeff Doucette, CNO at Press Ganey. "There's a shortage of nurses that want to work in the current environment."

How nurse turnover is impacting hospitals

As more nurses leave the bedside, hospitals are facing a variety of issues, including a growing experience gap, patient safety concerns, and higher expenses.

According to Dustin Bass, president of the Emergency Nurses Association, he used to be able to rely on his most tenured nurses to run triage. These nurses, who had a decade or more of job experience, could quickly assess situations and determine who was experiencing a heart attack or another health issue.

However, many experienced nurses have now left bedside care. "Now you have nurses running massive emergency rooms with 133 care spaces, and they've only been working for two or three years," Bass said. 

With fewer senior nurses bringing clinical intuition and operational expertise, hospital leaders say that patient safety is also impacted, increasing the risk of patient falls, medical errors, and missed cues.

Nurse turnover also has significant financial costs for hospitals. For example, it costs Emory Healthcare around $78,000 anytime a nurse leaves. Costs can also grow when hospitals fill staffing gaps with more expensive, often contract workers and have to recruit and train full-time replacements. 

Some hospitals are also working to address growing rates of violence against nurses with new safety protocols, including panic buttons, metal detectors, or even armed private security forces. Although nurses say these safety measures are helpful, they should only be one part of a broader tool kit, which includes unit-specific safety plans, adequate staffing, and more.

"Everyone in the country is trying to roll these out as best and fast as they can," said Maribeth McLaughlin, chief nurse executive at the University of Pittsburgh Medical Center.

Commentary

Overall, "[t]he distinction between a shortage of nurses and a shortage of nurses willing to work in the current environment is an important one," said Sherilynn Quist, senior director of margin transformation at Optum Advisory*. "Health systems cannot recruit their way out of this challenge."

Instead, health systems "need to focus just as much on the work environment itself: aligning staffing with demand and acuity, reducing unnecessary burden, strengthening team-based care, improving safety, and creating sustainable career paths," Quist said. "Retention needs to become as much of an operational strategy as recruitment."

Separately, Ali Knight, a research director at Advisory Board, noted that hospitals "can't address the shortage of nurses willing to work in acute care by looking at nursing alone."

"When support roles are reduced, either intentionally through cost-cutting or because there is high turnover, their work often shifts to nurses without staffing being adjusted to account for it," Knight said. "If we treat the nursing shortage as simply a nursing problem, we miss some of the systemic issues driving retention."

*Advisory Board is a subsidiary of Optum. All Advisory Board research, expert perspectives, and recommendations remain independent.