New Nursing Workforce Realities - Emerging Nurse Leader

By Rose O. Sherman, EdD, RN, NEA-BC, FAAN

“Is it this bad everywhere?” It is a question that I am often asked during the retention workshops that I have been doing since July of 2021. My answer earlier in 2021 was it was not, but now it seems that no healthcare organization is escaping from the new nursing workforce realities. Recent data supports what I have been hearing anecdotally from nurse leaders. The recently released NSI_National_Health_Care_Retention_Report (1) paints a concerning picture of what we are seeing in nursing and healthcare today. Data collected from a sample of 3000 hospitals nationwide indicates the following:

Nursing turnover skyrocketed across 2021 and the beginning of 2022, increasing 8.4% to an average hospital RN turnover rate of 27.1%
RNs exited the bedside at an alarming rate, and hospitals shed 2.47% of their overall RN workforce.
27.7% of nurses left positions within one year – by the five tenure year mark, that number had risen to 74.5%
The average cost of turnover for a bedside RN is $46,100 resulting in the average hospital losing between $5.2m – $9.0m in turnover costs alone.
The average RN vacancy rate is 17%, climbing by 8% in one year.
81% of hospitals in the US now report RN vacancy rates above 10%.
The RN recruitment index climbed to an average of 87 days to recruit an experienced nurse.
The average hospital turnover of all employees was 25.9%.
Reporting hospitals hope to reduce turnover by 6.9% by 2023.
The highest turnover rates for RNS are in telemetry, stepdown, and emergency departments.
CNA turnover in hospitals was 35.5%, and PCT turnover was 38.1%.
63.5% of hospitals reported a need to expand their RN numbers as an outcome of volumes and new services.

These stunning numbers indicate a severe and potentially long-term structural labor shortage challenge, especially in acute care environments. We can’t quickly backfill against these levels of vacancies. Most healthcare systems had hoped to bring on large numbers of new graduates this spring and summer but their recruitment numbers have fallen very short of their targets. These shortfalls are not surprising given the level of competition.

Some executive leaders are moving ahead with plans to expand services and add hospital beds like this is not happening or they can beat the competition. Others are choosing to retire because they see the handwriting on the wall.

It is important to have radical candor right now about how serious this situation really is. On a recent webinar, a young charge nurse told me that new graduates no longer believe her when she tells them that staffing will improve. Instead, they vote with their feet she reported, and quickly leave when they don’t see improvements in their workload or are unhappy with their compensation. The data in this report seems to support her observation.

We need to be honest with ourselves, our nurses, and the public. The Surgeon General was right in his May 23rd advisory to the public – healthcare is not in a good place right now and we must all work to improve it.

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