How Retention is the New Recruitment


A looming wave of retirements, both planned and unexpected, will accelerate the current nurse shortage. The U.S. Bureau of Labor Statistics projects the need for 1.1 million new RNs in 2022, with more than 500,000 expected to retire in 2022. That’s planned retirement. Signs also point to younger nurses leaving the profession. A 2021 survey by Vivian showed that 43% of respondents were considering leaving healthcare1. When asked the same question a year before, just 20% said they were considering leaving.

Why? In part, it’s because of their mental health. The Washington Post found that 29% of healthcare workers are considering leaving the field because of Covid-related burnout, and 6 in 10 say stress from the pandemic has harmed their mental health. While this isn’t ideal, help may be on the way, as Health and Human Services recently announced a $103 million plan to try and reduce burnout among healthcare workers.

So, who will replace them? There has been an increase in nursing school interest, evidenced by a nearly 6% increase in baccalaureate nursing programs last year2. However, nursing programs still turn away qualified applicants due to resource and faculty constraints. Program growth will not outstrip the potential departures, as the average age of nurses in America is 513.

The Total Cost of Turnover

The average cost of turnover for a bedside RN is $40,038 and ranges from $28,400 to $51,700, resulting in the average hospital losing between $3.6m – $6.5m/yr.4 This can also lead to increased administrative burdens on remaining staff. The need to fill these positions creates more work for HR services, workplace training and occupational health risks. “Brain drain” creates another significant soft cost, as clinicians with decades of experience are being replaced by those with less experience. Turnover caused by overworked nurses and employee burnout can have serious implications for patient care if not properly managed.

Contingent staffing, particularly with the right managed services partner (MSP), can provide experienced clinicians to help address this gap. But, that MSP must have not just a high fill rate, but also a high completion rate (preferably 90% or higher). Clinicians who don’t complete their assignment can create more expensive “churn.” Using clinicians is most effective when they complete their assignment, accept extensions, or even fill a position permanently.

Care For Caregivers to Win the Staffing Battle

Retaining quality clinicians must be a priority for quality patient care. When asked, 94.8% of hospitals say they view retention as a “key strategic imperative” and to a lesser degree, is evident in operational practice/planning. Almost all hospitals have retention initiatives (80.7%), however, only half (51.4%) have tied these to a measurable goal4. Measurable goals need to be a component of retention strategies.

The pandemic has revealed pain points and provided some “must have” elements for any retention strategy, to address the ‘Great Resignation’ in the healthcare sector. Some steps to increase retention include reducing burnout and fatigue, supporting flexible work arrangements, creating a better culture, introducing proactive communication, and having a proactive strategy that can deliver travelers who fit.

  • Reduce burnout and fatigue. Offer mental and emotional support for employees and balance your staff with traveling clinicians as needed. Consider practical changes to both shifts and hours, even to the point of re-considering the standard 12-hour shift.
  • Reinvent flexibility. Flexible work arrangements extend beyond altered schedules and shift changes. For clinicians, it can mean the security of continued employment before and after a travel contract.5 The loyalty gained from varied flexibility will help reduce burnout, supporting retention efforts.
  • Create and change the culture. Create learning and development opportunities with mentoring programs between senior and junior clinicians that can help close or avoid the critical knowledge and experience gap created by hiring new staff. As patient care becomes more complex, additional focus on strengthening the pipeline may be your strategy to help close this gap5.
  • Introduce proactive communication. Improve the frequency and method of communication with staff, so they know they are seen and heard. With open, candid discussions about career goals and future plans, you can acknowledge their workplace values and gain insight into what you can do to retain them.
  • Find travelers who fit. Identify where you have staffing gaps or potential gaps at all levels of the organization and find a strategic partner to help fill them. This can help you prevent a short-term crisis and better plan for future needs. Finding quality travelers with the right clinical background as well as fit with your community can help prevent churn or create the opportunity to hire them as permanent staff.

Quality clinicians are in great demand and short supply. The reality of that labor market may remain for quite some time. Strategically planning to retain existing staff and augment units with travelers can help bridge the gap.

1 Source:

2 Source: American Association of Colleges of Nursing, April, 2021

3 Source: NCSBN National Nursing Workforce Study, 2020

4 Source: NSI Nursing Solutions. “Healthcare Retention & RN Staffing Report.” 2021

5 Source: Advisory Board Daily Briefing. “Why So Many Nurses Are Leaving Amid Delta—and How You can Keep Them.” 2021

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