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The Causes of High Nurse Turnover in Hospitals and Its Effect on the Healthcare System


The United States is experiencing a nursing shortage that is many years in the making. Hospitals are short-staffed, and the communities that they serve are suffering as a result. Some hospitals report that they are one bad car accident away from complete overload.

This is a problem with deadly consequences. In this article, we examine what is causing the nursing shortage, and what can be done to help fix it.

The Situation

Last fall, a charge nurse working in Washington phoned 911. The situation? Not an unruly patient. Not even a specific emergency. Just a general state of desperation. The hospital was full. The emergency room didn’t have enough people on staff to take care of the patients already admitted, let alone the 45 others waiting to be processed in.

The dispatcher listened carefully and eventually sent over an ambulance with qualified EMTs to help with patient care and processing.

Dramatic though the situation may sound, it’s far from being an isolated incident. Nurses all over the country responded to the incident in droves, reporting similar situations in their own places of work. Long patient wait times. Floors staffed with only five or fewer nurses. Ambulances back up six hours or more.

It’s a disastrous situation for nurses, but it is also dangerous for the communities that they serve.

While many feel that this issue began with Covid, it actually predates the pandemic. For years, experts have been raising the red flag. Nurses were quickly aging out of the profession. Not nearly enough people were coming up to replace them.

But why? Why is it so hard to get and keep nurses? Below, we explore some of the many reasons that the nursing profession is experiencing such radical turnover numbers.

The Hours

Hospitals don’t keep normal business hours. Sick people need attention around the clock, which means nights, weekends, and holidays are always on the table for a working nurse. Unfortunately, there is nothing to be done to solve this particular hardship of the job.

However, the worse nursing shortages get, the harder this predicament becomes. A well-staffed hospital can make sure that its nurses rotate evenly on weekend and holiday shifts. That means that any one nurse might only work a single Saturday each month. This doesn’t fix the issue entirely, but it can do a lot to boost morale.

When hospitals are short-staffed, nurses find that they have little to no say in how they are scheduled. This can lead to higher turnover rates, which in turn makes schedules even harder to arrange fairly.

Nursing hours are also complicated by their overall length. Hospital shifts tend to be twelve hours long. This is done because it makes scheduling easier from an administrative perspective. Instead of scheduling three shifts every day, administrators can just do two.

Fine for them. Not so good for the nurse, or for the patients that they serve. Studies show that the average person can only put forth about four hours of sustained concentration throughout the day. That doesn’t literally mean that the other eight hours are for naught. It does mean that the nurse’s performance will most likely go downhill well before their shift is over.

Hospitals can make things a little bit easier on their staff by shifting to an eight-hour schedule.

Emotionally Draining Work

Nurses routinely see things that the average person never even needs to think about. Not only are they experiencing all forms of human suffering, but they also routinely deal with patients who don’t recover at all.

Eventually, many nurses experience what is called “compassion fatigue.” Essentially, the experience of feeling emotionally burnt out at work. They see so much suffering and pain that it becomes difficult to empathize with it. This is a troubling experience that can lead to diminished professional performance, and eventually, the desire to seek different work.


Turnover begets more turnover. As with any business, hospitals tend to lose employees in groups. There are several reasons for this. For one thing, workers often feel inspired to leave at the same time their friends do. Professional friendships consistently poll as being more important than compensation for people who are seeking new jobs.

Turnover also puts a lot more pressure on everyone else. Hospitals can’t afford to be short-staffed. When they must, they will overschedule an employee to make sure that the needs of the floor are being covered.

Work enough weekends and holidays, and eventually, a person will want to start looking for a less demanding job.


It’s important to point out that nursing positions typically make slightly more than the national average. There are caveats. For example, nurses working at non-profit hospitals may make significantly less than others in the profession.

Overall, however, with a median salary of $67 thousand a year, it wouldn’t be fair to say that they are underpaid. It is fair to say that they aren’t maximizing their earning potential.

Many bedside nurses find that they can make more money by changing lanes. It’s not at all uncommon for RNs to find that they can make a better living in the cosmetic medical field, administering botox or hair removal procedures. The work isn’t as impactful, but it is significantly easier.

A Solution?

Unfortunately, there is no single solution that can take care of the nursing shortage. Robust scholarship and outreach opportunities may help bring in nurses of the future. It will, however, take a large cultural shift to keep them in the profession long enough to make a difference.

Nursing, like so many other professions, is being taken to task. Workers want to know that their mental and emotional health is being taken into consideration when they show up for work. If hospitals can do this, it may be an enormous step forward when it comes to boosting retention.


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