By Heidi Raines

Nurse retention is a critical issue for healthcare organizations. High turnover rates can lead to increased costs, decreased quality of care, and reduced morale among remaining staff.

Registered nurse (RN) turnover rates reached nearly 30% in 2021, with the cost of an RN turnover reaching up to $58,300, according to a 2022 report from NSI Nursing Solutions. The cause? Many point to COVID-19 as the tipping point for many nurses, though staffing issues and nurse turnover pre-date the pandemic. (story continues below)

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Nurse retention and patient safety are closely linked

High turnover rates among nurses can lead to decreased quality of care and increased risks for patients. On the other hand, when nurses are retained, patient safety outcomes are often improved. This is why nurse recruitment and retention are top of mind for practically every healthcare organization and healthcare leader in 2023.

One of the main ways in which nurse retention affects patient safety is through continuity of care. When nurses are retained, they can establish relationships with patients and develop a deeper understanding of their unique needs. This leads to improved communication, more accurate assessments, and better care planning. Additionally, when nurses have been with an organization for a longer time, they are more likely to have a good understanding of the organization’s policies and procedures, which can lead to improved adherence to standards of care and guidelines.

Another way in which nurse retention affects patient safety is through staffing levels. High turnover rates can lead to shortages in nursing staff, which can lead to nurses being overworked and fatigued, increasing the risk of errors and accidents. This was the case in the recent nursing strikes in New York. Additionally, when staffing levels are low, nurses may not have the time to provide the level of care that patients need, which can lead to delays in treatment and poorer outcomes.

How to stop the exodus

While many nurses once anticipated a lifelong career in the field, the effects of the pandemic, compounded with decades of systemic procedural problems, have forced many to leave the profession they once loved. About one in five healthcare workers have left medicine since the pandemic began, and 90% of nurses are considering leaving the profession in the near future.

Resulting staffing shortages have since led to unmanageable work schedules and workloads for those care providers who remain in healthcare, leading to unprecedented rates of burnout. By addressing nurse retention and creating a positive work environment, healthcare organizations can improve the quality of care, keep staffing costs in check, and ultimately improve patient safety. To address high turnover among nurses, healthcare organizations should focus on strategies that retain their nurses. Here are 10 strategies to improve nurse retention:

1. Emphasize professional development: Nurses want to feel valued and respected by their employer. One way to achieve this is by providing opportunities for professional development, including tuition reimbursement and continuing education courses.

2. Ensure adequate training: It’s important that each department within a healthcare organization provide adequate equipment and training of safety protocols so that employees understand their responsibilities. And just as importantly, organizations should implement new procedures and workflows to ensure that adequate processes are in place for prioritizing safety and avoiding employee burnout.

3. Promote work-life balance: Nurses often work long and irregular hours, which can lead to healthcare worker burnout and fatigue. Healthcare organizations should consider flexible scheduling options and promote work-life balance among staff. This can include offering telecommuting options, providing paid time off, and promoting self-care and stress management.

4. Offer competitive compensation and benefits: Nurses are in high demand, and healthcare organizations that offer competitive salaries and benefits are more likely to retain their staff. Organizations should ensure that their compensation packages are competitive with other healthcare organizations. This can include offering sign-on bonuses, tuition reimbursement, and retirement benefits.

5. Create a safe work environment: Providing nurses with a platform to share their observations is one way to maintain a safe environment. By implementing an incident reporting platform, for example, organizations give voice to nurses by allowing them to (anonymously or not) share their observations around unsafe conditions and events. This information then becomes part of a larger data set so leaders can look at trends across the organization.

6. Encourage employee engagement: When nurses feel engaged in their work and feel that their opinions are valued, they are more likely to perform better – and stay with their organization. An Advisory Board engagement study showed that engaged employees had a turnover rate of 9.8%. Even those workers who reported being “content” (or, satisfied in their roles but not necessarily engaged) had rates of 13.4%. Healthcare organizations should encourage employee engagement by creating opportunities for nurses to voice their concerns, participate in decision-making, and take on leadership roles.

7. Provide supportive supervision: Healthcare organizations should provide supportive supervision by assigning nurses to managers who are knowledgeable about the nursing profession and can provide guidance, support, and mentorship.

8. Foster a “just culture”: A just culture in nursing refers to a model of shared accountability that encourages transparency and open communication about potential safety issues so teams can better understand organizational gaps and root causes of harmful events. Establishing a just culture based on trust and taking proactive action to prevent harm enables nurses to feel heard, valued, and that they’re making a positive difference in patient care.

About Heidi Raines

Heidi Raines is the author of Shared Voices: A Framework for Patient and Employee Safety in Healthcare. She also is the founder and CEO of Performance Health Partners (, a software company providing patient safety, employee health and quality improvement solutions to healthcare organizations. In addition, Raines is the Board President of the American College of Healthcare Executives’ Women Healthcare Executive Network and holds Preceptor Faculty positions at Tulane University’s Master of Health Administration (MHA) and University of New Orleans’s Bachelor of Healthcare Administration program. Raines has received awards for innovation and executive leadership, including City Business’ Innovator of the Year and Woman of the Year awards.