RN turnover rates reached nearly 30% in 2021, a significant increase from previous years that is adding to hospitals' growing labor challenges, according to a new report from NSI Nursing Solutions.

Nurse turnover has risen significantly

For the report, NSI surveyed 272 hospitals from 32 states about their staff turnover, retention, vacancy rates, and more in 2021. In total, 589,901 health care workers and 166,087 RNs were included in the study.

Overall, NSI found the national hospital turnover rate was 25.9% in 2021, an increase of 8.4% from the year before. Over the last five years, the average hospital turned over 100.5% of its staff.

Historically, RN turnover has been lower than the hospital average—but this changed in 2021. In 2021,

the turnover rate for all staff RNs was 27.1%, a significant increase from 18.7% in 2020. Among hospitals, 61.2% said they had RN vacancy rates that were greater than 15%.

RNs in certain specialties, including step down, telemetry, and emergency services, also had higher turnover rates than the national average. Over the last five years, RNs in these three specialties, along with behavioral health, saw a cumulative turnover rate between 101.3% and 111.4%. "Essentially, every five years, these departments will turn over their entire RN staff," the report states.

When asked about the top reasons why RNs resigned, respondents said personal reasons, career, advancement, relocation, retirement, and scheduling were the most common. Other reasons included salary, commute times, workload/staffing ratios, and working conditions.

As RN turnover rises, hospitals will also see their staffing costs grow. In general, the cost of an RN turnover ranges between $33,900 and $58,300, with an overall average of $46,100 in 2021. In comparison, the average cost of an RN turnover was $40,038 in 2020.

Because of the increased RN turnover rate in 2021, the average hospital lost roughly $7.1 million in 2021. For each percent change in RN turnover going forward, hospitals could either save or lose $262,300 per year.

However, many hospitals are experiencing difficulties recruiting new RNs to fill open positions in a timely manner. According to the RN Recruitment Difficulty Index, it takes an average of 87 days to recruit an experienced RN to fill a vacancy. The time it takes to recruit a new RN is expected to remain elevated going forward due to labor shortages and growing competition.

"The health care industry continues to be a cornerstone of our economy and must be ready to adapt to the changing landscape," NSI writes. "The expanding healthcare [roles], the aging population, the mandate on quality & safety, the squeeze in reimbursements, the competition for patient volume, the shift in the delivery of care, the shortage of physicians, nurses & allied professionals and a world-wide pandemic have all stressed the industry."

"To strengthen the bottom line, hospitals need to build retention capacity, manage vacancy rates, bolster recruitment initiatives and control labor expenses," NSI writes. "Building and retaining a quality workforce is paramount to navigate the shifting paradigm." (Gamble, Becker's Hospital CFO Report, 10/13; NSI National Health Care Retention & RN Staffing Report, accessed 10/14)