Every Time a Nurse Leaves, it Costs You $50K. What Are You Doing About It?

Nurse Leaves

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There’s no doubt that staff turnover is one of the most challenging issues facing healthcare today.  The typical expense associated with the replacement of a bedside

Registered Nurse averages $40,038, with a variance spanning from $28,400 to $51,7001.

Furthermore, on average, the duration to fill a vacant RN position, regardless of specialization is 87 days. In essence, this implies that hiring an experienced nurse typically necessitates a three-month vacancy.

In the realms of value-based care, post-acute care, hospital at home, and even during transitions in care it is routinely a nurse that stands as the primary point of contact for a patient’s care, acting as the conduit between the patient and the physicians supporting them, as well as supporting the immediate family.  Disruption and added expense associated with fulfilling and supporting this critical role can be the difference between success and failure in terms of both clinical outcomes and finances. 

These statistics and factors reverberate with profound implications for patient outcomes, as well as organizational sustainability, particularly in post-acute care. Organizations like SNFs are already pressed for sustainability in terms of economics, with turnover emerging as a predominant factor. Moreover, the proposed minimum staffing rules necessitate that nursing homes guarantee a minimum of 0.55 hours of care per resident from a registered nurse, which also adds to this burden2.

If organizations are constantly preoccupied with the burdens of hiring, rehiring, training, and financial management, how much time, energy, and resources remain available for the primary focus—the provision of patient care leading to improved patient outcomes? 

While the majority of organizations struggle with recruiting nurses and other healthcare professionals, perhaps we should be digging a bit deeper into addressing the root cause of the issue;  why the persistently high rate of turnover?  

What systemic failures contribute to this alarming statistic? Wouldn’t investing in preventing turnover by improving staff satisfaction be more efficient?

Let’s encapsulate too often overlooked underlying issues that cause RN turnover and consider a definitive corresponding solution.

See also  Reduce Burnout in Order to Retain Healthcare Staff

Role Clarity at “Top of License”

One common complaint of nurses is the expansion of non-patient-care-specific tasks.  Similar to the complaints of physicians related to the growing need to document in the EHR rather than to treat patients, nurses are similarly being challenged with ‘tangential’ activities.  In other words, not practicing at the “top of license.”

Perhaps a first step for organizations wishing to address turnover would be to empower the nurse with a clearly defined role, balancing what leads to their job satisfaction and the needs of the organization.  This may result in the creation of new. non-clinical (and less expensive) roles to be filled by others. 

Empowerment or Ambiguity

A second complaint is a lack of authority.  It has been found that complaints oftentimes are based on nurses (and other allied caregivers) feeling that while they know what to do (as evidenced by their licenses and certifications), they are not authorized to do those things without the express direction of a physician or a superior.  This then leads to a sense of devaluation and loss of purpose.  Compounded by challenges in accessing and communicating with the physicians needed to render direction or even just feedback promptly nurses and others oftentimes feel stuck between a rock and a hard place; knowing what to do in the best interests of the patient or the organization, and being able to do it on time.  

It’s about instilling confidence to navigate patient care complexities effectively. Whether it’s communicating with families, seeking clarity from physicians, or deciphering complex orders essential for patient care, nurses need to know “I’ve got this!”. With improved skills and confidence, better patient outcomes play a major role in staff retention and job satisfaction.

Implementing regular feedback mechanisms and enabling more efficient communication by fostering open dialogue for clarification and support can be a simple but powerful way to address this.

The Hidden Cost of Work Place Stress- Moral Injury

A stress-laden work environment within a healthcare institution often stems from a siloed culture that breeds a lack of trust and collaboration among coworkers. This toxic combination invariably leads to higher turnover rates. 

See also  5 Key Strategies to Combat Burnout and Improve Staff Retention

When a nurse is unable to effectively communicate their concerns about patient care with other caregivers, i.e. a physician or management, they feel isolated and unsupported. Not to mention, the absence of a cohesive team dynamic which further distresses the work environment. This leads to “Moral Injury,” the deep wound caused by knowing that you are not able to do the right thing in your current environment.

Investing in an organizational culture that allows for connection among all caregivers, can foster transparent communication, collaboration, and trust, thereby alleviating stress and cultivating a healthier work environment conducive to retention and enhanced patient care.

Beyond The Badge; Prioritizing Nurse Well-Being

Turnover impacts the entire care team, not just the departing and new staff members.  During those 87 days before a new nurse settles in, existing staff is taking the brunt of extra hours, and extra shifts.  This can lead to burnout of those staff members. A nurse is beyond a badge, he/she is a person with a family life. They need their time away from the patient and the job as well. And it’s not just about the hours. Empowering a nurse or other staff member to ‘leave work behind’ with the confidence of knowing “their” patients are well looked after, is crucial. Scheduling a reasonable shift, keeping in mind or being understanding the staff’s personal lives demands as well. 

AVOIDING BURNOUT Can We Design A Better System?

All the aforementioned challenges ultimately converge to create the most significant driver of nurse turnover: burnout. Burnout is not just physical or emotional exhaustion but also about job satisfaction.  All of these are impacted by unclear roles, access to support from colleagues and team members, and a culture of collaboration In the absence of a work environment that exudes a relaxed, safe, and collaborative environment where nurses and other staff can optimize their time and energies for better patient outcomes; nurses burn out.

See also  Seven Ways Healthcare Leaders Can Reduce the Cost of Physician Burnout (~$5 Billion+)

In routine and critical scenarios involving a patient, perhaps when a nurse urgently requires instructions from a physician or nurse practitioner, a pharmacist, or other licensed clinician, traditional communication methods like phone calls or texts can lead to delays. These delays risk compromising patient care, especially when timely medication administration or medication reconciliation is crucial. 

However, with communication technology, such as real-time messaging, streamlined and perhaps automated task assignments, and optimized notification alerts, nurses can promptly connect with physicians and other professionals in almost real-time, ensuring they receive the guidance they need, precisely when it’s needed, including clear directives as to which physician or specialist to contact. 

As Mark Dubovick, Health Services Administrator at The Admiral at the Lake (an assisted living facility in the Chicago area), emphasizes, ‘A secure messaging platform streamlines communication across care professionals, which lowers the administrative burden of having to identify who is on call and reach the right provider quickly.'” 

It’s this efficient and effective communication that prevents unnecessary hospitalization, for example. The avoided hospitalization not only benefits all stakeholders, but raises a nurse’s sense of achievement and purpose in serving the patient; likely the core reason they entered the profession.  Or perhaps it’s needing to communicate with the family about their loved ones condition before it’s too late. Having a means to do so again benefits all parties including the nurse who now has a relationship with the patient and their family.

By integrating advanced, purpose-built communication tools in conjunction with a cultural commitment to helping nurses and all caregivers to practice at “top of license”, healthcare facilities enable their nursing staff to deliver swift and efficient care, ultimately ensuring patient well-being and optimizing operational efficiency. 

Investing in your nurses is not just a strategic financial move but a moral imperative that leads to better patient outcomes and a more sustainable future for your organization.




  1.  https://www.beckershospitalreview.com/finance/the-cost-of-nurse-turnover-by-the-numbers.html
  2. https://www.cms.gov/newsroom/press-releases/hhs-proposes-minimum-staffing-standards-enhance-safety-and-quality-nursing-homes

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