While RN turnover rates decreased by nearly 5% in 2022, the average hospital lost between $6.6 million and $10.5 million due to RN turnover, according to a new report from NSI Nursing Solutions.
For the report, NSI Nursing Solutions in January asked more than 3,000 hospitals nationwide to participate in the "NSI National Health Care Retention & RN Staffing Survey," which covers healthcare turnover, retention initiatives, vacancy rates, recruitment metrics, and staffing shortages.
In total, 273 hospitals from 35 states reported data from January through December 2022. Overall, the survey covered 736,021 healthcare workers and 202,502 RNs.
While hospital turnover remains elevated overall, employee exits decreased in the later part of 2022, leading to a 3.2% annual decrease in hospital turnover. The average hospital turned over 105% of its workforce over the past five years.
Meanwhile, RN turnover remains elevated and comparable to overall hospital averages. 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.
However, RN turnover decreased by 4.6% in 2022, with a national turnover rate of 22.5%. Over the past five years, the average hospital turned over 101.4% of its RN workforce.
In addition, RN turnover across certain specialties, including step down, telemetry, critical care, medical/surgical, and emergency services, had turnover rates higher than the national average.
Over the last five years, RNs in step down, telemetry, behavioral health, and emergency services had a cumulative turnover rate between 108.7% and 115.2%. "Essentially, these departments will turn over their entire RN staff in less than five years," the report states.
"When we consider the average age of nurses and the anticipated wave of retirements about to break, we need to keep in mind that some specialties will be impacted at a quicker pace," the report adds. "This is particularly true for surgical services, behavioral health and women's health."
Ultimately, the high cost of turnover can have a significant impact on hospital margins. According to the survey, the average cost of turnover for a bedside RN was $52,350 in 2022, marking a 13.5% increase from 2021. In 2022, the average hospital lost between $6.6 million and $10.5 million due to RN turnover.
For every percent decrease in RN turnover, the average hospital will save an additional $380,600 annually. "Managing retention should be a strategic imperative, particularly given the high cost of turnover and the ongoing RN staffing crisis," the report states.
In particular, the report calls on hospitals to build retention capacity, manage vacancy rates, bolster recruitment initiatives, and control labor expenses. "Building and retaining a quality workforce is paramount to navigate the staffing paradigm," the report notes. (NSI National Health Care Retention & RN Staffing Survey, accessed 4/10)text
By Carol Boston-Fleischhauer, Donald Malott, and Jennifer Bierhoff
In the current healthcare climate, staffing and clinical workforce issues remain a top priority for C-suites. NSI's newly released data shed some welcome light on key progress areas, including overall hospital workforce and RN turnover declines.
However, these data also reflect continued and emerging challenges. In particular, they highlight the increased time it takes to fill vacant RN positions — despite 70% of organizations expressing interest in growing their RN workforce. The increased cost of RN turnover amid margin shortfalls, as well as the continued out-migration of novice or early career nurses from front-line acute care delivery roles, are also substantial challenges.
Notably, pay rates for travel nurses are also declining. However, nearly 80% of respondent organizations predict their agency use will not change in 2023.
Adding to the narrative is newly secured data from Advisory Board's 2023 Workforce Survey, which was conducted to gauge top RN workforce concerns from nurse leaders, along with their perceived ability to influence these issues.
We will soon release a full analysis of our survey, but preliminary results help paint a picture of nurse leaders' key concerns, including a lack of access to qualified RN candidates, an academic pipeline that is unable to keep up with demand, and the inability of their organizations to recruit unlicensed, entry levels workers and compete with non-hospital employers for RN talent.
As unresolved clinician burnout levels and substantial reports of workplace violence continue to increase, data indicate that leaders need to prioritize continued investments in the following areas:
1. Align retention efforts with market realities
A solid recruitment strategy is necessary. However, given the current RN supply/demand imbalance, organizations should heighten retention investments over recruitment efforts in key markets, including enhanced efforts to address clinician burnout and violence directed at staff.
2. Redesign comprehensive staffing models
Organizations are urged to redesign and implement a comprehensive staffing model that accurately reflects the current workforce supply. To successfully redesign a comprehensive staffing model, leaders must optimize technology, streamline RN work, address what "meaningful" work looks like for RNs, and be creative with non-RN care team roles.
3. Control labor costs
Compensation for permanent employees will continue to strain labor budgets. The most significant opportunity to control labor costs lies in reducing travel utilization through purposeful efforts to further stabilize turnover, particularly among novice and early career nurses.
4. Create an employee value proposition
Organizations should take steps to ensure that they are controlling the public narrative about acute care careers for RNs. To highlight professional opportunities, achievements, and the value of acute care practice, organizations should maximize all communication venues, including public and social media sources. The time is now to confirm and communicate your organization's employee value proposition.
Smart investments to further stabilize the clinical workforce are essential. A full analysis of our 2023 workforce survey and a complete list of updated insights will soon be available to help further inform existing planning efforts and investment priorities. In the meantime, here is a listing of other resources available:
• Confronting clinician burnout calls for a two-pronged approach
• 3 things technology should (or shouldn’t do to support clinical staff)
• 6 hard truths about the nursing shortage the entire C-suite needs to know
• 5 ways to support safe, effective staffing amid the nursing shortage
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