Why are nurses leaving…and what can hospitals do?

By Maureen Medlock, principal, and Harish Patel, manager, Deloitte Consulting LLP

Staff retention might be the top issue facing hospitals and health systems today. Last spring—before the delta variant took hold in the US—one-third of registered nurses were already thinking about leaving their jobs, according to a survey of 1,000 nurses.¹ That percentage appears to have doubled. A recent survey of 6,000 critical-care nurses found that 66% have considered quitting.² However, there are a steps hospitals and health systems can take to curb the hemorrhaging of current employees while attracting new talent.

High turnover rates among nurses can have a significant financial impact on hospitals and health systems and can put patients at risk. The estimated cost of turnover for a bedside nurse averages $40,038 per position. High turnover can cause hospitals to lose anywhere from $3.6 to $6.1 million per year.³ The cost of recruiting and hiring new talent includes advertising the position, interviewing candidates, conducting background checks and compliance checks, and training for new employees. Moreover, nurses typically come into a new job with a wide range of backgrounds. A newly hired nurse, for example, might not have the training or certifications necessary to administer chemotherapy treatments. The health system will likely need to spend money on training, and the unit could experience a temporary loss in productivity. Even when a floor is short-staffed, nurses still are expected to deliver high-quality care to the same number of patients, which can further impact productivity and result in avoidable mistakes and medical errors. In addition, some patients are having to wait longer in emergency rooms before being admitted; staffing shortages have prompted some facilities to temporarily shutter units.⁴

High turnover can also have repercussions on employee morale, creating a snowball effect that could encourage more nurses and other staff to leave. High turnover can also discourage new talent from joining. Some hospitals have turned to travel nurses to fill the void. In 2018, travel nurses cost an average of $83 per hour. Some nursing agencies are now charging more than double that amount (or much more) in some areas.⁵ Staff nurses are typically paid significantly less than travel nurses, which can lead to some negative feelings.

Why are they leaving?

Nurse turnover and retention are nationwide problems. Here are a few key reasons nurses are leaving their jobs…or their profession:

• Burnout: While burnout has long been a challenge in nursing, it was amplified by the pandemic. Most nurses work long shifts, typically around 12 hours. But working around people infected by a potentially deadly virus made the job more stressful. Staffing shortages might lead to even longer shifts with fewer days off. Moreover, nurses might be asked to fill gaps in care delivery, which could require skills that they don’t have or are not comfortable using. The pandemic also prompted some hospitals to implement hiring freezes. This practice, when coupled with overcrowding from pent-up patient demand, has caused the nursing workforce to be stretched even further.
• COVID vaccination status: A growing number of hospitals and other clinical settings are requiring their employees to be fully vaccinated. However, some nurses have been reluctant to comply. During the initial vaccine roll-out, 11.2% of nurses were hesitant to get the vaccine and 5.1% were unwilling, according to one cross-sectional survey.⁶
• Hot job market: Nursing is not immune from what has been dubbed “the Great Resignation.” Some people have a new-found leverage, particularly in markets where it is difficult to attract talent. This means employers might need to offer bonuses, higher pay, and other benefits. Some nurses are taking advantage of the booming job market. 

Where are they going?

Nearly 20% of health care workers have quit their jobs since the pandemic began, according to a recent poll of 1,000 health care workers.⁷ Here are three career paths they might follow:

• Other clinical settings: Some nurses who worked on inpatient units have transferred to out-patient settings where work conditions might be less stressful. The shifts in out-patient settings are generally shorter and typically don’t require nurses to work nights, weekends, or holidays. The job itself is usually less physically demanding and patient cases tend to be less complex than in a hospital. Some nurses are also choosing to get advanced degrees, such as nurse practitioners, which can drain resources from a hospital’s bedside nurse pool.
• Adjacent health care sectors: Many nurses have experience with a wide range of therapies making them well positioned for a second career in the pharmaceutical or health-insurance sectors. After years working in a hospital, many nurses have amassed a deep and valuable knowledge base. For example, some nurses might offer a unique value-add to a pharmaceutical company if they have experience with the products and the patients who use them.
• Non-clinical settings: Some nurses have taken jobs in non-clinical areas such as business consulting, start-ups, and corporations outside of health care. The allure of better pay, the prospect of better mental wellbeing, potentially easier working conditions, and a desire to make a broader impact on health care is often enough to push individuals away from patient care. 

What can hospitals and health systems do about it?

Hospital and health system leaders should try to be proactive about nurse retention. Consider these strategies:

• Redesign the work using technology tools: Nurses tend to spend much of their time on paperwork and other duties not directly related to patient care. Off-loading administrative duties to other employees could relieve some pressure. Technology and automation could help reduce or eliminate mundane or repetitive tasks. This could help ensure that nurses work at the top of their license and can spend more time providing care to patients. Hospitals might also look for ways to reduce on-call time, allow some types of training to be completed from home, or provide more paid time off. Artificial intelligence (AI) and data-driven solutions could help hospitals and health systems proactively identify employees (by quantifying workload and measuring patient complexity) who might be in danger of feeling burned out or who might be at risk of leaving. That could provide leaders with time to intervene.
• Create a more humanized clinician experience: Some hospitals and health systems might need to restructure existing policies to ensure that employees feel like their manager (and the organization) is invested in their professional and personal goals on a consistent basis. This can provide nurses with more autonomy early in their career, help innovate new workflows, and provide feedback to leadership. In an April blog post, our colleagues Courtney Sherman and Colleen Bordeaux explained how human-centered design could reduce burnout and improve the work experience for nurses.
• Motivate and mentor: Mentorships between experienced nurses and new hires could help create loyalty and improve retention. Nurses should also have an opportunity to advance professionally within the organization. Leaders should also try to identify ways to help nurses achieve a better work-life balance, which could help them keep from feeling burned out. Data could provide leaders with greater insight into their retention challenges.

It is possible for hospitals and health systems to reduce burnout and retain nurses. This is a difficult issue that won’t resolve itself. It will likely require swift and thoughtful interventions from leaders to meet their employees where they are today. Many health care and hospital systems are still reeling from the pandemic. Not being able to retain some of their essential employees could impact the bottom line even further. Now is the time to act!

1. One year into COVID-19, one-third of nurses are considering leaving the bedside, American Association of International Healthcare Recruitment, April 6, 2021

2. Hospitals are spending more money to hire and retain health care workers during the pandemic, MarketWatch, October 11, 2021

3. Evidence-based practice guideline: Nurse retention for nurse managers, National Center for Biotechnology Information, October 11, 2019

4. COVID-19 reported patient impact and hospital capacity by state timeseries, HealthData.gov, November 4, 2021; California hospital workers strike over critical staffing shortages, Business Insider, October 16, 2021

5. Hospitals spend millions in race to hire traveling nurses, Indianapolis Business Journal, October 8, 2021

6. COVID-19 Vaccine Hesitancy and Uptake among Nursing Staff during an Active Vaccine Rollout, National Center for Biotechnology Information, August 4, 2021

7. Nearly 1 in 5 Health Care Workers Have Quit Their Jobs During the Pandemic, Morning Consult, October 4, 2021

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