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The State of Healthcare Retention

The fifth annual NSI Nursing Solutions, Inc. report on job retention in the healthcare field shows the rate of turnover for registered nurses increased over the year before, as did turnover among all hospital staff. The most recent report released in 2014 covers the calendar year 2013.

The National Healthcare & RN Retention Report, a comprehensive survey on RN turnover and hospital worker retention was based on surveys completed by 113 organizations across the U.S. and represents data on 332,417 healthcare workers and 75,281 registered nurses during 2013.

NSI Nursing Solutions reports an average national turnover rate among all hospital healthcare workers of 16.5%, which is an increase from 2012’s rate of 14.7%. For RNs alone, the turnover rate increased to 14.2%, with the highest turnover among Medical/Surgical nurses, at 24%.

High turnover rates can severely impact a hospital’s profitability. According to the study, the average cost of turnover for a bedside RN ranges between $44,380 and $63,400.

Each additional percentage point increase in turnover costs the average hospital another $359,650. While nearly 90% of organizations surveyed agreed that retention is a “key strategic imperative,” fewer than half have a formal retention strategy.

The study also showed on average it took hospitals a range of 36 to 97 days to hire a replacement for an experienced RN who left. This could indicate a nursing shortage is returning, the study said.

Traditional strategies to offset staff departures such as mandatory overtime and using travel nurses can be costly and may lead to problems with patient care, employee satisfaction and physician satisfaction. Focusing on a long-term retention strategy is a better plan, the study said.

NSI Nursing Solutions said that only about 40% of hospitals were close to full staffing levels for registered nurses, compared to 2012 when nearly 60% of hospitals were close to a full complement of RNs. This trend, the study said, is another sign a nursing shortage may be on the horizon.

Some factors that may contribute to a shortage of RNs include:

  • RNs no longer delaying retirement
  • RNs reconsidering travel nursing
  • Part-timers taking fewer shifts
  • Increasing demand for RNs

Turnover by Specialty

Average RN turnover rates for 2013 vary by nursing specialties. Surgical Services and Pediatrics were below the overall average of 14.2% and Surgical Services was the only unit that recorded no change in turnover for 2013. It was the lowest rate among nursing specialties.

All other specialties reported increases. Medical/Surgical and Emergency nurses have experienced consistently higher rates of turnover than other specialties in previous years and remain over 20%, the report said. In 2013, Step Down saw a big jump in turnover from about 14% to 23%.

If these rates continue, hospital ER, Step Down and Medical/Surgical units can see their entire RN staff turn over every four to five years, according to the report. Meanwhile, the study found it took an average of 72 days to replace an ER nurse and 81 days to replace a Medical/Surgical nurse.

Other specialty turnover rates were:

  • Critical Care                14.8%
  • Telemetry                   16.5%
  • Women’s Health         17.5%
  • Behavior Health          19.2%

RN Retention is Imperative

Nurse turnover rates tend to vary year to year, depending on the state of the economy and the healthcare industry, as well as other factors. Tracking nationwide nurse retention offers hospital administrators valuable insights into the stability of the nursing profession.

Most hospitals view retention as an important initiative, but only 43.5% of those surveyed have actually implemented formal retention strategies though that figure is slightly higher than in 2010.

Retaining experienced, skilled nurses allows hospitals and healthcare systems to provide stable patent care, build stronger care teams and reduce costs. Lower turnover rates also lead to higher job satisfaction.

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