Protecting Workforce Strength and Reputation: Nurse Retention as a Leadership Priority

The ancient Greek philosopher Heraclitus is commonly quoted as saying, “The only constant in life is change.” Organizations in every industry deal with change and turnover. In 2025, Mercer found that the average voluntary turnover for the US as a whole was 13%. Healthcare, on the other hand, was much higher. Hospitals reported the least turnover with 19.5%, while at-home care providers and nursing homes reported 65% and 94% turnover, respectively.

That much “constant change” can not only have an effect on morale, but can also affect patients and the company’s bottom line. It shows up in closed beds, diverted ambulances, already stretched-thin teams covering double shifts, and patients who can feel the difference when a nurse is new, inexperienced, or just absent.

Nurse turnover and burnout aren’t just a hospital issue; it’s one that spans across all of healthcare. It’s time to stop treating it as a recruitment problem and have leadership teams make it a priority.

Why Nurse Retention Is a Strategic Leadership Issue (Not Just an HR Problem)

Just like it’s easier to keep a customer than it is to get a new one, it’s also better to keep your best employees than to try to constantly be hiring new ones. Retention allows you to stop plugging holes and start solving problems.

The True Cost of Nurse Turnover

Employee churn can become a source of heartburn for not only HR teams but the company as a whole. To understand the true cost of employee turnover, it’s important to look at the direct costs and the indirect costs.

Direct costs

Direct costs can be things like posting a job, screening candidates, time to interview them, onboarding, and training a new hire. The 2025 NSI National Healthcare report found that the cost of an RN turning over is approximately $61,110, and it can take an average of 83 days to recruit an experienced RN. Training a new nurse can account for anywhere between 7% to 9% of the turnover costs.

Indirect costs

Indirect costs are the invisible costs that start to add up quickly during the vacancy. Whenever an employee leaves, that means someone has to fill that shift/role. That means hiring temporary staff, paying for traveling nurses, or paying overtime to your existing staff. 

These indirect costs can have a huge impact. That same NSI report found that for each percentage point change in Registered Nurse turnover would cost or save the average hospital $289,000 PER YEAR!

Capacity, Coverage, and Clinical Operations 

Nurse turnover can also mean fewer patients. If you don’t have the nurses to care for the patients, that means having to close beds or turn patients away. The NCSBN's 2024 National Nursing Workforce Study found that over 138,000 nurses left the workforce between 2022 and 2024, and roughly 40% of currently active RNs intend to leave or retire within the next five years. When that many nurses are eyeing the exit, scheduling instability becomes the norm. Remaining staff pick up extra shifts, leading to the exact burnout that drives more departures. It is a cycle, and it spins faster with every resignation letter.

For leadership, that means keeping nurses means more beds open. More beds lead to more patients, which means more revenue. This isn’t a problem that will fix itself, but will require executive-level buy-in and resources.

Reputation, Accreditation, and Employer Brand 

High nurse turnover can have a long-standing impact on your reputation and brand. Negative Glassdoor reviews can make it hard for exceptional nurses to want to work there. Nursing schools and residency programs may steer students away from working at your hospital because of its reputation.

There can also be more formal consequences. A Magnet designation is the gold standard credential for nursing excellence. It is what healthcare teams dream of. These are organizations that demonstrate strong retention, professional development, and nurse satisfaction. High turnover generally means low nurse satisfaction and a poor experience. 

The Business Case for Nurse Retention 

Nurse retention isn’t just an employee and patient morale issue. It can have a direct impact on a hospital or nursing home's bottom line. To make sure that you have the resources needed, here are some ways to frame your case.

Financial and Operational ROI 

The AMN Healthcare 2025 Survey of Registered Nurses found that only 39% of nurses plan to be in their current positions in 12 months. That means that 61% of nurses plan to be in a different job, department, or make a career shift. 

To find the turnover cost per nurse, you can follow this formula:

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Turnover cost = the Facility’s Nurse Headcount X Turnover Rate X Cost Per Separation.

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According to NSI, a reasonable cost per separation is between $50,000 to $73,000 per nurse. For an average hospital with 300 nurses, that could equate to hundreds of thousands of dollars a year in lost revenue. If you take a 300-nurse hospital with a 16% turnover rate and a conservative $50,000 cost per separation, that can come out to $2.4 million in turnover costs. Now, if you save just 2 percentage points, that means retaining 6 nurses and an estimated $300,000 saved.

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Turnover cost = 300 Nurses X 16% turnover X $50,000 Cost Per Separation

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You can use that same formula at your organization. Replace the 300 with your headcount and swap the national turnover (16%) with your hospital's turnover rate. Then model out what a 1 to 3 percentage point change would do for your team. That’s the number you bring to the board.

When you can go to the C-suite and board of directors and frame retention as cost avoidance rather than a new expense, then the budget conversations change entirely. It’s much easier to advocate for programs and tools that will help you save time, money, and people.

Quality, Safety, and Patient Experience Outcomes 

Not only does it have an impact on the hospital's bottom line, but there’s also extensive research linking nurse satisfaction and retention to patient outcomes. A landmark study in 2024 looked at the HCAHPS (Hospital Consumer Assessment of Healthcare Providers and System) performance at over 500 hospitals. They found that hospitals whose nurses reported better working environments generally and strong staffing ratios (aka retaining nurses) had higher patient satisfaction scores. 

Risk, Compliance, and Board Oversight 

The board of directors is generally concerned with three main areas: financial sustainability, clinical quality, and risk. Nurse turnover can fall into two of those categories. High turnover among nurses can cause a deteriorated patient experience and poor quality. It can also lead to increased costs with overtime pay, hiring new nurses, and training them, while putting a strain on the finances.

A major skill to develop is the ability to translate what you’re seeing into a language that the board speaks. Instead of just saying, “We have a 23% turnover rate with our nurses,” use language like: “Our current RN turnover rate represents an annualized financial exposure of $x million and a capacity risk of Y closed beds per quarter.” Risk language speaks louder to board members than fluffy “culture” numbers.

What Actually Drives Nurse Retention Today 

Knowing the impact of nurse turnover is crucial to understanding how to keep them. Here are the vital categories to dig into so you can learn the “why” behind nurse turnover and how to fix it.

Core Drivers of Nurse Commitment and Loyalty 

There’s a common phrase that if you put two lawyers in a room, then you’ll get three opinions. Luckily, though, with nurses, the reasons that they stay are very consistent. An extensive review by BMC Health found that while pay is important to nurses, some of the top reasons that they stay are because they feel valued, supported, and heard. 

One of the strongest drivers of nurse retention is the role of frontline managers and charge nurses. A recent study by McKinsey found that strong nurse managers can have a 68% increase in frontline-nursing retention. That same study found that among frontline nurses reporting that they were likely to leave their roles, the top drivers causing them to leave were:

1. Looking for a better job (53%)
2. Feeling undervalued by leaders (41%)
3. Feeling undervalued by the organization (40%)

That’s a huge portion of nurses who could be retained by showing them that they are valued and appreciated.

Generational and Role-Based Nuances 

A first-year nurse and a 30-year nurse have different reasons to stay or to look for a different role. Your retention strategies will have to be tailored to the demographics of your hospital and clinic. An estimated 30% of new hires leave within their first year. Nurses who are early in their career generally prioritize mentorship, feedback, and understanding where their career trajectory could go. 

The American Organization for Nursing Leadership’s 2025 report found a strong link between new hire check-ins by managers and retention of first-year nurses. They found that when managers conducted 30-45-day check-ins, it improved retention by 6 percentage points, and 6 or 9-month check-ins improved retention by 10 percentage points. When assistant managers did it, retention dropped by 6 points.

Burnout is also becoming a major issue for Gen Z and Millennial nurses. Nearly half of all nurses report mental health impacts from their work. A 2024 study by Nurse.com found that Gen Z nurses had the highest rates of burnout, moral injury, and compassion fatigue.

More experienced, longer tenured nurses are more likely to stay for autonomy, respect, and schedule control. They’ll leave if they feel micromanaged or if they feel that their years of experience are being undervalued. Retention strategies need to account for these differences rather than applying a one-size-fits-all approach.

Work Environment, Staffing Models, and Burnout 

Burnout is a major issue for nurses. AMN Healthcare found that 58% of nurses report feeling burned out most days. That’s not a fringe issue. That’s something that the majority of the workforce is telling you. In fact, the National Council of State Boards of Nursing (NCSBN) in 2024 found that the top reason for nurses leaving the workforce was stress and burnout. It also found that approximately 40% of nurses intended to leave the workforce by 2029. That is a huge wave of impending turnover.

There are several changes that you can make to reduce the impact of burnout among your nurses. Ideas can include a team-based model to help distribute the workload, a thorough debrief after serious incidents, autonomy to make their decisions, highlighting and recognizing their contributions, and streamlining work to limit repetitive tasks.

Measuring Nurse Retention and Experience 

It is impossible to improve something when you’re not measuring it. To know if your strategies are impacting retention, you’ll need to carefully measure and track some key metrics to get a real-time pulse on how your team is doing.

Key Metrics Every Leadership Team Should Track 

At this point, you can measure pretty much anything. However, not every metric is one worth tracking and reporting to your leadership team. Some metrics will be lagging indicators, and some will be leading indicators - knowing the difference can help you spot trends and make crucial changes to your strategy.

Lagging indicators - Lagging indicators are metrics that tell you what has already happened. These can include things like turnover rate, voluntary vs. involuntary turnover, vacancy rate, etc. Understanding these metrics will let you know how your current and past policies have affected your retention rate. It’s also important to, wherever possible, measure rates against themselves and national benchmarks. For example, the national vacancy rate is around 9.6%, while about 40% of hospitals are over 10%.

Leading indicators - Leading indicators are metrics that can help you forecast what is going to happen. For nursing and healthcare, you might want to watch for things like % of shifts swapped, absenteeism trends, overtime spikes, and engagement score trends. When you can identify absenteeism spikes or a large influx of shift swapping, that can give you key insights into a potential undercurrent of discontent or frustration.

Listening to Nurses Beyond the Annual Engagement Survey 

It is vital for you to hear from your nurses what their stressors are. The annual engagement survey is a great way to hear from them. Think of it like your annual physical at the doctor’s office. You can go deep into certain areas and come up with a game plan on how to address problem areas. However, one of the main drawbacks of the annual engagement survey is that it is only once a year. You’re taking a snapshot in time and won’t know if what you’re doing is having a positive or negative effect for 12 months. 

One of the first steps to combating this is to gain additional context on what your employees are saying. With the engagement surveys, admins can use SafeTalk to follow up on comments that employees left in the survey. This shows employees that their comments are being read and acted upon, while still protecting the employee’s anonymity.

Another common tool that teams will use is eNPS and pulse surveys. eNPS is usually done on a quarterly or semi-annual basis so that you get a more frequent check-in on how things are going. This allows you to see your employees' satisfaction scores with the company. Tools like Nectar Engage also allow you to add custom questions to your eNPS survey so that you can turn the standard format into a pulse survey and ask questions about other topics like benefits, change management issues, leadership initiatives, and more.

The success of all of these tools relies on closing the loop with employees. Take time in your townhalls, monthly updates, and team meetings to let nurses know what you’re hearing from them and what you’ve decided to act on. Closing the loop with them will build trust that their voices aren’t just going into a black hole and that no one is listening to them.

Avoiding Measurement Pitfalls 

Survey fatigue is real. Over-surveying your employees will burn them out, and you’ll stop getting feedback from them. One tactic that can help with that is incentivizing your survey with points. After nurses complete a survey, they can earn points that they can redeem for gift cards, swag, or other rewards. 

In high-paced environments, like nursing, it’s also important to keep surveys short so that your team has time to complete them. Long-winded surveys are taxing. Having one of those a year is okay, but keep the other surveys shorter and quicker so it’s easy for them to complete and get back to work.

Building a Nurse Retention Strategy That Leaders Actually Own 

Retention isn’t a team issue; it’s an organizational issue. To have real, meaningful change, you’ll need the support from leadership, the C-suite, and the Board of Directors. Here are some tips to help you get everyone aligned.

Securing Executive Sponsorship and Governance 

Have you ever been passionate about an idea only to have it die by committee? Nine times out of ten, it’s because you don’t have an executive sponsor who will help clear roadblocks for you. Having executive buy-in makes it a priority not only for you, but for the entire leadership team. 

For any initiatives related to nurse retention, you’ll want to get the buy-in of your Chief Nursing Officer (CNO). They’re on the same level as the CEO, COO, and CFO, and can help you speak the verbiage that will resonate with them (e.g., Dollars vs feelings).

It’s also important to establish clear ownership across the different teams that you’re working with. As you loop in HR, finance, operations, and other teams, you’ll need to quickly and clearly lay out who is responsible for each item. While it may be frustrating at times to work with different departments, the UNC Health Workforce found that organizations that see the strongest success are those with cross-functional governance.

Equipping Nurse Managers and Leaders 

A good manager can make or break an employee. Managers can account for 70% of the variance in an employee’s engagement scores, according to Gallup. That means having a great manager can either push employees to become great or push employees out the door.

Start by tracking overall turnover - broken up by voluntary and involuntary turnover. Then start going deeper and looking at the department and team level. This will provide a clearer picture of what is happening with your nurses. This isn’t so that you can point blame, however. This is so that you can learn what tools and resources your managers need. A 30, 60, and 90 day action plan for how they should work with their teams can be a great beginning step. The peer-to-peer recognition guide is also a helpful resource for teams to start implementing employee recognition across the organization.

Designing a Multi-Layered Retention Roadmap 

Unless you have a magic wand, you won’t fix your retention issues overnight. This will be a long project; however, there are some things you can do to triage turnover and provide some relief.

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Short-term (triage) actions

These are actions that you can do in the first 90 days to reduce turnover. Start with staffing adjustments, immediate manager check-ins with at-risk nurses, and quick-win recognition efforts. Help your nurses see that they’re valued and that you’re working to make changes quickly.

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Long-term actions

This will vary by hospital and your nurses' needs. Over 80% of nurses said that flexible schedules would convince them to stay longer in the profession. Some employees may value established career pathways and professional development programs. The feedback and insights you gather from your engagement surveys and check-ins with employees will help you build your long-term strategies.

Recognition as a Scalable Retention Lever 

If there is one tried and true retention lever, it is recognizing your employees. Research has shown time and time again that feeling valued at work is one of the largest indicators of job satisfaction and a buffer against burnout.

A recent study of the Daisy Award found that 53% of nurses who strongly agreed that recognition impacted their job satisfaction had no intent to leave. The best recognition programs are not top-down, annual, or generic. They are peer-to-peer and leader-led, frequent and specific, tied to values and patient impact, and visible across the organization.

Common Nurse Retention Challenges (And How to Solve Them) 

We’ve discussed the pain of nurse turnover, how to get buy-in from leadership, and how to build a roadmap to fix the issues. Now, let’s identify some of the root causes of nurse turnover and some remedies for how to fix them.

Chronic Staffing Shortages and Vacancy Cycles 

When you’re short staffed it's hard to think about fixing the bigger issues when you’re just trying to keep your head above water. Stabilize key units with cross-training programs, internal float pools, and creative staffing models (per-diem tiers, weekend-only positions, retired-nurse re-entry programs). Partner with nursing schools and residency programs to build a pipeline, and invest in those new grads with structured onboarding that research shows can reduce first-year turnover from over 30% down to 13% when residency programs are in place.

Manager Burnout and Change Fatigue 

As was mentioned earlier, your managers are the key to the success of any program. If they’re burnt out they won’t have the energy to get their nurses to buy-in, let alone have the energy for themselves. Look for ways to reduce their administrative burden. Whether that’s new tools, additional support staff, or other ways to make their life easier. A charge nurse who feels invested in will be more likely to support the changes you want to implement.

Cultural Cynicism and “Initiative Fatigue” 

If nurses roll their eyes at your latest initiative, then anything you try to implement is dead on arrival. That is indicative of a trust problem, and that problem is because past initiatives were all done top-down. There was no feedback and buy-in from your frontline employees.

The antidote is co-design. Work with your nurses and bring them in early on in the process so that they feel heard about their concerns. Then build the initiative together. Whether that’s quick-win items like an updated breakroom, or longer-term initiatives like career path frameworks. Seek transparent communication with them throughout the process so that everyone is bought in from the beginning.

Budget Constraints and “We Can’t Afford It” Pushback 

This is one of the most common objections and one of the easier ones to combat with basic math. If the average cost of replacing a nurse is $61,000, then if you can retain one nurse by implementing a recognition and rewards program, it practically pays for itself. Multiple Nectar customers have reported the positive impacts of their recognition programs and the financial impacts they’ve had because of it.

Nurse Retention Across Organizational Stages and Settings 

A 50-person clinic will have different needs than a 1,200-person hospital. Each setting will have different dynamics, organizational roadblocks, and challenges that they’ll need to overcome.

Community Hospitals, Academic Medical Centers, and Health Systems 

Community hospitals and academic medical centers are like mom-and-pop stores vs big brands. Community hospitals thrive on their culture and team connection. They offer nurses smaller teams where they know each patient and everyone on the team. Academic medical centers rely on the prestige and the potential for career advancement for their nurses. 

It’s important for each group to rely on its strengths. If you are a community hospital, lean into the tight-knit culture and personalized leadership that large systems cannot replicate. If you are an academic center, build a robust clinical ladder and research participation pathways.

Outpatient, Ambulatory, and Home Health Settings 

Retention challenges outside the inpatient environment are underappreciated. Ambulatory nurses often work in smaller teams with less peer support. Home health nurses face isolation, unpredictable travel, and variable schedules. Outpatient nurses may feel invisible compared to their acute care colleagues when it comes to recognition and career development.

A healthcare-specific recognition program can help unify recognition across inpatient and outpatient teams. For teams that are out in the community (e.g., home health nurses), look for ways to get patients involved. Nominate them for the Daisy Award or allow patients to send shoutouts through a community recognition program.

Periods of Growth, Change, and Crisis 

There will be periods of growth, turmoil, change, mergers, acquisitions, and all sorts of chaos. The key to all of this is to make sure that you communicate clearly and frequently with your nurses so that they stay in the loop. Be transparent about what is changing and why. It’s okay (and appreciated) to acknowledge the disruption honestly.

Tools, Templates, and Resources for Nurse Retention 

Ideas and strategies are great, but what are the tools that you need to actually get the job done? Here are some helpful tools and resources that you can use as you start to implement your retention strategies.

Nurse Retention Metric Dashboards 

Your internal dashboard doesn’t need to be anything fancy. You can use a tool like Google Looker, Excel, or Google Sheets to create a simple dashboard. The goal of this retention dashboard is to monitor three internal metrics.

1. Where are we losing nurses?
2. Why are we losing them?
3. How much is this costing us?

Knowing these three will help you quickly identify hotspots within your organization and visualize trends. It will help you prioritize where leaders should focus their resources the most. 

Stay Interview and Check-In Guides 

Stay interviews shouldn’t feel like HR mandates, but should feel like authentic, genuine questions from managers. This helps when managers and employees have a strong bond. If the manager and employee have a “rocky relationship,” that can be an opportunity for additional coaching. 

Check-in guides are a great tool to help managers conduct the stay interviews. Train managers to ask open-ended questions, so that it elicits better feedback and responses. Some typical questions that you should ask are:

• How are you feeling about your current workload?
• Is there anything making your job harder than it needs to be?
• Do you feel recognized for the work you’re doing?

Recognition and Appreciation Program Templates 

Strive to make your recognition program fair and inclusive for all of your nurses. It helps to build your program into layers so that everyone has an opportunity to participate. Establish peer-to-peer recognition so nurses and staff can shout each other out on a daily and weekly basis. Create top-down recognition like monthly core value nominations or quarterly awards for longer-running objectives. Finally, build out a larger, more robust annual award to highlight extraordinary contributions.

Technology and Platform Evaluation Criteria 

Your recognition and rewards program will most likely sit on top of your HRIS system. That means that it’ll need to integrate so that it can automatically add new nurses and deactivate nurses from the system.  Some other key features that a lot of healthcare teams look for in their recognition software are:

• Mobile accessibility for nurses on the floor or home health nurses
• Community recognition so patients can recognize their nurses and staff
• Real-time analytics and reporting
• Work anniversaries, birthdays, and milestones are so important dates that aren’t forgotten
• Alignment with company mission and values

The Future of Nurse Retention 

Healthcare is the largest employment sector in America, and it continues to grow. In 2023, nearly 11% of the U.S. workforce is employed in healthcare - that’s up from 7.5% in 1990. As healthcare continues to grow, the nursing field will too. Nearly 1 out of every 5 healthcare professionals is a nurse.

Evolving Workforce Expectations 

The workforce today is much different than the workforce of 1990. Expectations have shifted - on the nursing side as well as the management side. Nurses expect defined career paths, flexible scheduling, and career customization. The Cross Country Healthcare 2025 report found that older, experienced nurses are worried about burnout and fatigue. While younger, freshly graduated nurses are excited about their futures. Hospitals and clinics that can bridge this gap will win the retention war.

Digital Tools, AI, and Predictive Insights 

Data-driven retention is no longer a “nice-to-have” option. It’s a foundational piece in your building blocks of success. AI tools can now analyze vast amounts of data sets to analyze patterns in scheduling, absenteeism, engagement, survey responses, and much more. Predictive models can take this data and flag units or employees where burnout is accelerating, and employees at risk of turnover. 

These tools allow you to spot potential turnover risks before they even realize it. Technology alone isn’t enough. Your nurses need to trust that the data isn’t being used to surveil them, but it’s being used to make their lives better. Transparency about what you’re tracking, why you’re tracking it, and how it informs decisions will go a long way in earning their trust. The organizations that get this right will have an enormous competitive advantage. The ones that get it wrong will add "my employer is tracking my every move" to the list of reasons nurses leave. 

Building a Reputation as a Destination Employer for Nurses 

The long game of nurse retention is employer brand. Becoming "the place nurses want to work" does not happen through a marketing campaign. It happens when your current nurses tell their friends, former colleagues, and nursing school classmates that your organization is different. That it actually walks the talk on staffing, recognition, and professional growth.

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At the end of the day, nurse retention comes down to a deceptively simple question: Have you built an organization where nurses can do their best work, feel genuinely valued, and see a future for themselves? If the answer is yes, retention follows. If the answer is "we're working on it," the clock is ticking. With 40% of the nursing workforce considering an exit within five years, the time to act is not next fiscal year. It is now.

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