Some turnover in healthcare is inevitable. But left unchecked, it can be costly, both in dollars and in intangible costs, like impacts on productivity, teamwork, culture, and most importantly, the patient experience.
The challenge, then, is to minimize turnover. Unfortunately, that is proving increasingly difficult, especially in the healthcare industry where demands and related stressors are high.
There’s good news, though. According to Becker’s Hospital Review, the average rate of turnover in healthcare in the US dropped from 20% in 2022-23 to 18% in 2023-24. Nursing is experiencing the highest level of turnover in healthcare, at 24%, compared to nonclinical professionals, at 13%.
Still, these numbers are high.
The high costs of turnover in healthcare
Some degree of turnover is normal and even expected. According to Mercer’s 2025 US Turnover Surveys, the average voluntary turnover rate in the US from 2024-25 is 13%.
As Becker’s Healthcare reports, “the average cost of turnover for one staff RN grew from January through December 2024 to $61,110.” That’s for one staff RN. Each percentage point change in RN turnover, Becker’s says, can either cost or save an average hospital $289,000 a year.
That’s a figure worth pursuing.
In addition to the costs of recruitment advertising and recruiter/agency fees, additional costs include the costs of background screening and credentialing; onboarding, training, and orientation; temporary staffing to cover openings; overtime costs; and reduced productivity.
That’s in addition to the intangible effects of chronic understaffing, like team disruption, loss of institutional knowledge and impact on patient care. Left unchecked, these issues could cause other providers to leave, creating a cascading effect of chronic understaffing, high turnover, and even worse— understaffing.
So what can healthcare organizations do to impact the costs of turnover and drive those costs down?
Hiring right
Hiring the person who meets your requirements and the expectations for the role can have a dramatic positive impact on reducing turnover.
Finding employees with the right background experience and credentials is essential. But you also need to confirm that the employee will be a good fit with your organization — that they’ll adapt to the culture, feel a sense of belonging, and feel proud to work as part of the team. That’s especially important in high stakes environments like emergency care or surgery.
To boost the odds that you’re making impactful hires, consider:
- Assessing for cultural alignment. Don’t just assume that an employee will be a good fit. Use tools like structured behavioral interviews to explore situations specific to your culture and how candidates react to them. Involve other team members in the interview and screening process to help ensure a multifaceted view.
- Be transparent about the reality of working in your organization. Too often, employers have a tendency to “hide their warts” when wooing new candidates. That impulse is understandable, but it becomes counterproductive if you’re continually choosing candidates that leave in just a few months.
Because you don’t want them to choose you if they really won’t be a good fit. Be honest — and create an environment that encourages candidates to consider their fit for the role more critically. For instance, when planning interviews, think about the most important characteristics that someone in the role needs to possess, then ask behavioral questions prompting candidates to speak about those qualities (for instance, how someone handles stressful situations or ambiguous instructions). Virtual tours, shadowing opportunities, and conversations with staff members can help to provide a balanced and realistic perspective.
- Be rigorous with your background screening. Background screening is particularly important in the healthcare industry because of the interactions that staff have with patients and their access to very sensitive patient information. Verifying credentials, licensing, education, and employment history thoroughly and accurately is critical to help you select candidates that meet your needs and avoid early departures.
Onboarding sets the stage for success
After a hiring decision has been made, and the applicant has accepted your offer, the next moment of truth occurs during onboarding.
As new employees begin their careers with your organization, their early experiences and impressions have a significant impact on their future success and likelihood of staying with your organization.
It’s important to devote the time and attention to developing and delivering an onboarding program designed to fully acclimate new employees to the organization, its culture, and their roles. That means more than a one- or two-day session.
More structured, longer-term programs can have a marked impact on retention, according to research from the National Institutes to Health (NIH), in one case reducing turnover from 23.9% to 7%.
In addition to a formal onboarding program, assigning new employees a mentor can also help make the transition smoother and more successful.
Another important impacting employee tenure is the effectiveness of their direct supervisors or managers. The best managers can help junior employees make a strong start, form a more structured training and development plan, and even prevent burnout. So to minimize turnover, make sure your managers are properly trained and have access to the resources they need to be supportive.
Supporting effective management
The Peter Principle observes that people in a hierarchy tend to rise to “a level of respective incompetence”: employees are promoted based on their success in previous jobs until they reach a level at which they are no longer competent, as skills in one job do not necessarily translate to another.
This holds true in many healthcare organizations: Many people who are promoted to supervisory or management roles don’t have formal experience in these types of roles. Instead, they’ve been effective contributors in other staff positions and are promoted because of these successes. But being a successful nurse, for instance, doesn’t mean that someone will be an effective manager.
It’s important to ensure that those hired or promoted into management roles have the skills and resources they need to be successful—and to help their staff succeed. Managers need to understand and follow organizational policies and practices that support the culture. They need to have the time and resources to provide employees with clear direction and appropriate feedback. They need to be adept at coaching, counseling, and developing employees.
We’ve already mentioned the stress that can be inherent for employees in the healthcare industry. For management employees, stress can be heightened as they take on responsibility for others while also providing high-quality, compassionate patient care.
Burnout can be high if managers don’t have the support they need. When they’re burned out, their employees feel the impact. Assigning manageable workloads, providing mental health resources, monitoring for signs of stress, and focusing on maintaining a healthy work/life balance are important best practices to minimize both management and frontline staff burnout.
Minimizing turnover in healthcare
Organizations can’t make real improvements if they’re not regularly measuring KPIs around retention, like overall retention rate, voluntary turnover rate, involuntary turnover rate, average tenure length and more.
Start with a baseline, by department, role, length of service, and other factors, so your organization can assess your turnover problem and prioritize specific initiatives.
Establish measurable retention goals for your organization and track progress regularly.
Also collect, evaluate and act on the reasons employees decide to leave your organization. Stay interviews can be one way of doing this. Regular pulse surveys can also help to monitor emerging concerns or issues.
Every percentage point reduction in turnover can have a dramatic effect on the bottom line, and your organizational culture. Hiring right, onboarding effectively, and supporting effective management can go a long way toward addressing the high costs of turnover in healthcare and helping you deliver the best care possible.
