Nursing is a challenging profession mentally, emotionally and physically. Nurses work in a fast-paced environment, providing patient care, assuring family members and keeping up with the newest techniques and procedures. Because of the stress involved in nursing, many healthcare organizations have a high rate of nurse turnover. Recent graduates are at the highest risk for nurse burnout. The costs and consequences of burnout and turnover are significant. The good news is that there are ways for both nurses and hospital administrations to combat nurse burnout.
The Cost of Losing Nurses
The cost of nurse turnover can have a huge impact on a hospital's profit margin. According to the 2016 National Healthcare Retention & RN Staffing Report, the average cost of turnover a nurse ranges from $37,700 to $58,400. Hospitals can lose $5.2 million to $8.1 million annually.
The turnover rate for RNs continues to rise. Turnover statistics for bedside RNs in 2014 were 16.4 percent, and they rose to 17.2 percent in 2015. Behavioral health and emergency medicine and surgery nurses also have a high turnover rate, but certified nursing assistant (CNA) nurses recorded the highest rate at 23.8 percent.
As of March 2016, Streamline Verify ranked healthcare third of the top three industries with high turnover rates. Streamline Verify also found that 43 percent of newly licensed nurses who work in hospitals leave their jobs within three years. Additionally, 33.5 percent resign after two years and 17.5 percent work for only one year.
The overall vacancy rate for nurses is a little over 7 percent. When nurses leave a healthcare organization, they create a vacancy that can affect the cost of operation. The vacancy is also costly to other nurses, who may have to work overtime and can experience burnout due to long hours and a high patient load. A report published by Nursing Solutions, Inc. found that the average period of time it takes to fill a nursing position is 85 days – and more than three months for a specialized nursing position.
The costs associated with filling a vacancy can include the following:
- Employing in-house recruiters.
- Job postings.
- Applicant tracking systems.
- Hiring third-party staffing firms.
According to the Journal of Nursing Administration, it may cost $82,000 to replace a nurse. Afterward, onboarding and training require additional time and money.
Reasons for Nurse Turnover
The reasons why nurses leave their jobs can be voluntary or involuntary. The top six causes for turnover are as follows:
- Personal matters.
In addition, nurses may leave the workforce because they are dissatisfied with their jobs or they want to return to school. Other reasons may include the closure of their healthcare facilities or personal health issues.
It remains difficult to quantify and compare turnover rates for nurses because changes in the economy and the number of job openings can influence the rate. A high number of job opportunities can increase turnover rates because nurses who are unhappy can easily find different positions. Conversely, during an economic downturn, nurses tend to hold onto their jobs, so there are fewer jobs available, resulting in less turnover.
Burnout in Nursing
Over the last 10 to 15 years, the number of nurses experiencing burnout has risen. The introduction of new technology and electronic medical records and documentation has added more pressure to an already-stressful occupation. Several factors can cause burnout in nurses:
- Lack of social support.
- Inability to control schedule or assignments.
- Chaotic job atmosphere.
- Imbalanced job and work life.
The Stages of Burnout
Burnout can occur because of the physical strain involved with caring for patients, especially in understaffed facilities, which can extend a nurse's shift beyond 12 hours. Typically, there are four stages to burnout:
- Physical and mental exhaustion.
- Shame and doubt.
- Cynicism and callousness.
One of the most severe types of burnout is compassion fatigue. Nurses can feel emotionally and physically drained when they deal with traumatic situations on a daily basis. Nurses with compassion fatigue may feel despair, hopelessness, apathy and anxiety. Some nurses with severe compassion fatigue may even fall into depression. They may suffer from insomnia, become accident-prone and lose interest in work. Nurses who suspect they are suffering from compassion fatigue should seek help from a mental health professional.
Combating Nurse Burnout
Healthcare organizations can take measures to decrease the risk of burnout:
- Reduce overtime.
- Allow self-scheduling.
- Implement mentorship programs.
Nurses who work more than 12 hours in a single shift and more than 40 hours a week are likely to leave the nursing workforce within a year. Overtime for nurses should not be commonplace. Instead, hospitals and other healthcare organizations should reduce the length of shifts and the number of hours in a workweek. Hospital administrators should not push nurses into working extra hours.
Nurses also have obligations outside of their careers. By allowing nurses to self-schedule, healthcare organizations can offer staggered shift times and varying shift lengths to let nurses choose a schedule that fits their availability.
Nurses going through a job transition can benefit from mentorship, which can improve retention. At the Franciscan St. Francis Hospital and Health Centers in Indianapolis, Kathy Fox, MSN, RN, started a program to address the turnover rate of first year RNs. New graduates work with a preceptor and mentor. The preceptor helps the nurses perfect their clinical skills while the mentor instructs them about their role in the healthcare system for a full year. The program has reduced turnover rate from 31 percent to 10.3 percent in just two years.
To eliminate nurse turnover, healthcare organizations must create programs and incentives that increase retention. They can do this by offering monetary incentives such as competitive salaries and benefits, profit sharing, scholarships and tuition reimbursement.
Hospitals that achieve Magnet status have higher rates of nurse retention due to job satisfaction. Moreover, healthcare systems that promote continuing education and encourage an appreciative and respectful working environment tend to retain nurses.
Learn about the University of New Mexico's online RN to BSN program.
Baerholdt, M., PhD, MPH, RN, & Mark, B. A., PhD, RN, FAAN. (2013, March 25). The nurse work environment, job satisfaction and turnover rates in rural and urban nursing units.
Drenkard, K., PhD, EN, NEA-BC, FAAN. (2010, March). Going for the gold: The value of attaining Magnet recognition.
Eubanks, B. (2015, May 19). The Hidden Cost of Nursing Turnover.
Fink, J. L. (n.d.). 5 Signs of Burnout.
Kerfoot, K. (2015, August 20). Four Measures that Are Key to Retaining Nurses.
Punke, H. (2016, March 21). Infographic: What's the cost of nurse turnover?
Stokowski, L. A., RN, MS. (2014, December 16). Nurse Turnover: The Revolving Door in Nursing.
Trossman, U. (2016, September 6). Better Prepared Workforce, Better Retention.
Wisniewski, L., RN, CSMC. (2013, February 5). What is Nursing Stress, Burnout, or Compassion Fatigue?
Witkoski Stimpfel, A., Sloane, D. M., & Aiken, L. H. (n.d.). The Longer The Shifts For Hospital Nurses, The Higher The Levels Of Burnout And Patient Dissatisfaction.
Have a question or concern about this article? Please contact us.