What Is Nurse Retention?
Nurse retention refers to an organization’s ability to keep qualified nurses employed over time — reducing the rate at which nurses voluntarily leave for other positions, careers, or organizations. It is a critical priority for healthcare workforce stability because improving nurse retention directly affects patient safety, care quality, and operating costs.
Unlike simply reducing turnover, improving nurse retention is an active, ongoing strategy. It requires healthcare organizations to understand why nurses stay — not just why they leave — and to build the leadership culture, career pathways, and workplace conditions that make staying the obvious choice.
The Real Cost of Nurse Turnover
The average cost of turnover for one bedside nurse ranges from $38,000 to $61,100, according to NSI data — with the most recent 2025 NSI report placing the figure at the high end of that range at $61,000 per nurse. Per hospital, that adds up to a loss of between $4.4 million and $7 million annually. Each 1% change in nurse turnover is worth $337,500 to a hospital — in either direction.
As the healthcare system in the U.S. struggles with a shortage of nurses and clinical support occupations, administrators are burdened with the impact on patient safety, public health, and the financial costs of employee turnover. The annual number of nurses leaving the workforce nearly doubled from 40,000 in 2010 to almost 80,000 in 2020 — a trend that shows the ongoing need for proven nurse retention strategies.
Direct Costs vs. Indirect Costs
Nurse turnover carries both direct and indirect financial costs. Direct costs include recruitment advertising, agency/travel nurse coverage, overtime for remaining staff, and new hire onboarding and orientation — expenses that are easy to quantify but often underestimated.
Indirect costs are harder to see but equally damaging. They include lost institutional knowledge, reduced team morale, lower patient satisfaction scores, productivity gaps during the transition period, and the time nurse managers spend managing turnover instead of leading their teams. Together, these costs make nurse retention one of the highest-ROI investments a healthcare organization can make.
Why Nurses Leave — And What the Data Actually Shows
Eighteen percent of new nurses will change jobs — or even professions — within the first year after graduation. An additional one-third leave their organizations within two years. These numbers represent more than a staffing problem. They signal a leadership and culture gap that organizations must address proactively.
A key insight from Catalyst Learning’s research: nurses don’t leave organizations, they leave supervisors. Turnover studies consistently show that staff loyalty is tied most closely to their relationship with their first-level supervisor — not to the organization at large. All levels of leadership, including the charge nurse, play a key role in retention.
First-Year Nurse Turnover Risk Factors
First-year nurses face a specific set of pressures that make them especially vulnerable. Common risk factors include role ambiguity, a lack of structured mentorship, unclear performance expectations, and limited exposure to experienced leaders who invest in their growth. Some organizations unknowingly contribute to first-year turnover by undervaluing new nurses, offering little role clarity, or failing to show that their contributions matter.
What Nurses Say They Actually Need
Survey data from Catalyst Learning’s “How Can I Be The Boss No Nurse Wants to Leave” workshop, led by Dr. Rose Sherman, reveals a clear generational shift in what nurses want from their leaders. Younger nurses are more likely to aim for career purpose over a large paycheck, and they look for frequent feedback rather than annual reviews. They want a coach, not just a boss. Nurses who feel valued, appreciated, and respected — and who have access to leaders who communicate and guide them — are significantly more likely to stay and remain engaged.
The First 90 Days: Why Onboarding Is a Retention Strategy
The data is clear: the highest-risk period for nurse turnover is the first year. That makes the first 90 days the most important window for building retention. Onboarding is not just orientation — it is a nurse’s first sustained experience of the organization’s culture, leadership, and investment in their success.
What High-Risk First 90 Days Looks Like Without Structure
Without a structured onboarding framework, new nurses experience role confusion, inconsistent mentorship, and a sense of being thrown into the deep end. They complete tasks without understanding how their work contributes to the team or the mission. When early stressors go unaddressed by leadership, disengagement sets in quickly — and disengagement is often the step right before resignation. Many organizations don’t realize they’re contributing to their own first-year turnover.
Onboarding Practices That Improve First-Year Retention
High-retention organizations invest in structured onboarding that provides role clarity from day one, connects new nurses to experienced mentors early, and builds competency gradually through deliberate practice. Communicating expectations across multiple channels — not just once in a packet — gives new nurses the confidence to perform and the context to care.For entry-level healthcare staff, programs like teamwork training for frontline healthcare staff from CLiMB help new employees build the professional relationship and collaboration skills that support early retention — giving them the tools to integrate into a team effectively from the start.
Nurse Retention Strategies That Work
In order to get a clear vision for what might motivate nurses to stay in their jobs, it is important to Build a Culture of Recognition
CNOs and nurse leaders have a direct role in shaping recognition culture. According to Catalyst Learning’s CNO engagement guidance, celebrating nurse certifications, acknowledging caring behaviors, and organizing meaningful recognition events all signal that professional growth is noticed and valued. Recognition doesn’t require a budget — it requires intentionality. Even on-the-spot verbal recognition, a shout-out in a team meeting, or an offer to attend an off-site training can demonstrate to a nurse that their leader is genuinely invested in them.
Conduct Stay Interviews
Stay interviews are one of the most underutilized and effective retention tactics available to nurse leaders. Dr. Rose Sherman’s “Become the Boss No One Wants to Leave” workshop recommends conducting at least two stay interviews per nurse each year — the first within 90 days of hire. Ask questions like: “What do you look forward to each day?” “What obstacles are you encountering?” and “How can I make your job better?” After each interview, use a stoplight method to assess turnover risk: green for likely to stay 1+ years, yellow for 6–12 months, red for high immediate risk. Stay interviews also support internal mobility, reducing recruitment costs and keeping high-potential nurses in the organization.
Offer Clear Career Pathways
Millennial and Gen Z nurses are more likely to see their jobs as a step on a career ladder than as lifetime employment. Organizations that support nurses’ career goals and show a clear path forward retain more of them. Think more like a coach than a boss — show young nurses how their current role connects to their long-term trajectory. The GROW® Coaching Model is one practical tool nurse leaders can use to structure career development conversations around goals, reality, options, and next steps.
Develop Coaching Skills in Your Leaders
Leadership behavior is the most controllable retention variable an organization has. Nurses leave managers, not organizations — which means improving manager coaching skills directly improves retention. Leaders who communicate transparently during difficult periods, ask nurses for input on staffing challenges, and acknowledge they don’t have all the answers build the trust that makes nurses want to stay. Structured leadership development programs equip nurse leaders with the communication, conflict management, and coaching skills that make this kind of leadership possible at scale.
Addressing Nurse Burnout Before It Becomes Turnover
Nurse burnout and nurse turnover are closely linked — but they are not the same thing. Burnout is the precursor. It builds over time, often invisibly, and by the time a nurse submits a resignation, the organization has already lost the battle. The best nurse retention strategies address burnout before it escalates.
It’s estimated that 25–50% of hospital nurses experience some type of burnout even during “normal” times. During periods of high demand or short staffing, that number rises. Nurse leaders who recognize early warning signs and intervene proactively can prevent a disengaged nurse from becoming a departing one.
Signs a Nurse Is at Burnout-Driven Turnover Risk
Nurse managers and charge nurses are often the first to notice the signals. Watch for: increased absenteeism or frequent shift changes, withdrawal from team interactions, reduced quality or thoroughness in documentation, cynicism or visible disengagement during huddles, or a nurse who stops asking questions and developing skills. Any of these can indicate a nurse who is quietly moving toward the exit.
How Leaders Can Intervene Before a Nurse Resigns
Early intervention starts with creating a culture where nurses feel safe raising concerns without fear of judgment — what researchers call psychological safety. Leaders should actively check in with nurses showing warning signs, offer workload adjustments where possible, and connect nurses to resiliency resources such as peer support programs or employee assistance programs (EAPs). At the manager level, avoiding micromanagement and providing constructive performance feedback signals trust and respect — conditions that support nurse resilience over time. As Catalyst Learning’s Nurse Managers article notes, managers who offer role clarity, recognition, and growth opportunities for younger nurses are more effective at preventing the kind of quiet disengagement that leads to turnover.
The Role of Nurse Managers in Retention
Nurse Managers and Assistant Nurse Managers (ANMs) are among the most important retention levers in a healthcare organization. Their daily behaviors — how they communicate under pressure, how they recognize staff, and how they create team culture — have a direct impact on whether nurses stay or go.
Catalyst Learning’s research into Nurse Manager effectiveness found that managers who provide role clarity when nurses first start, offer recognition to make their team feel valued, and create growth opportunities for high-performing young nurses are significantly better at retaining their staff. Transparent communication during staffing challenges — acknowledging the problem, sharing what’s being tried, and asking for input — builds the trust that holds teams together during difficult periods.
How CNOs Can Support Their Nurse Managers
CNOs play a critical upstream role in manager-level retention. Key guidance from Catalyst Learning’s CNO engagement content:
• Make sure Nurse Directors have relationships with Nurse Managers built on mutual respect and accountability.
• Provide constructive performance feedback that helps managers grow — without micromanaging, which signals a lack of trust.
• Conduct workload check-ins to ensure managers aren’t overwhelmed to the point of burnout themselves.
• Be visible. Use bi-weekly open office times, surveys that give nurses a quiet moment to reflect, and celebrate certifications and professional milestones.
When CNOs actively support their nurse managers, they strengthen the entire retention chain from the executive suite to the unit floor.
How Charge Nurses Impact Nurse Retention
Organizational loyalty is cemented through relationships with supervisors and managers — but don’t overlook the importance of the charge nurse role in nurse loyalty and retention. Turnover studies show that staff leave their first-level supervisor more often than they leave an employer. The charge nurse is often that first-level supervisor.
Charge nurses play a role in onboarding, coaching, patient experience and safety, and nurse retention. They are often the first to recognize when a colleague is struggling, and the first positioned to do something about it. Their visibility on the unit during every shift gives them an influence no manager working off-unit can replicate.Developing charge nurses to be effective unit leaders — by teaching critical thinking, delegation, conflict management, and effective communication — pays direct dividends in retention. Programs like the charge nurse leadership training program from Catalyst Learning give charge nurses the skills to serve as both clinical leaders and retention officers on their units.
Improving Nurse Retention for Millennial and Gen Z Nurses
Millennial and Gen Z nurses now make up the largest and fastest-growing share of the nursing workforce. Their retention needs differ from prior generations in important ways. Understanding those differences is essential to building retention strategies that actually work for the workforce you have today.
What Younger Nurses Need to Stay
Catalyst Learning’s 2018 Millennial Nurse Retention content, drawing from Dr. Rose Sherman’s research and NSI survey data, identifies a consistent set of needs for this generation:
• Purpose over paycheck. Younger nurses want to understand how their work contributes to the larger mission — at the team level and the health system level.
• Coaching over authority. They want managers who act as coaches and mentors, not bosses. Accessibility and guidance matter more than hierarchy.
• Frequent feedback. Annual reviews are not enough. Younger nurses want regular, real-time feedback on how they’re performing and where they can grow.
• Career development visibility. They want to see a path forward. Organizations that show nurses how to advance — and don’t give the perception of holding them back — retain far more of them.
• Psychological safety and recognition. Younger nurses who feel safe speaking up and who are recognized for good work are more engaged and far less likely to leave.
The key shift: adapt your leadership approach to what is meaningful for this generation. Retention strategies that worked for Baby Boomer nurses will not retain Millennial or Gen Z nurses at the same rates. Flexibility, coaching, and clear career pathways are the foundation.
What’s the ROI of Investing in Nurse Retention?
The business case for investing in nurse retention is straightforward: the cost of doing nothing is far higher than the cost of structured prevention. With one nurse departure costing an organization up to $61,000, even a modest improvement in retention rate delivers significant financial return.
As Catalyst Learning’s foundation article notes: compared to the roughly $50,000 loss from the resignation of just one nurse, an investment in learning resources is certain to be a cost-effective venture. The calculus is simple — but many organizations still underinvest in the leadership development and cultural programs that drive retention, while absorbing the far larger costs of turnover year after year.
Leadership Development as a Retention Investment
The most effective nurse retention strategies are leadership strategies. Programs that develop charge nurses and nurse managers into coaching-oriented leaders address the #1 driver of turnover: the supervisor relationship. Catalyst Learning’s charge nurse leadership training program prepares first-level supervisory nurses with the communication, engagement, and leadership skills that retain staff at the unit level. The NCharge Recognition Program provides an added layer of structure for organizations building formal recognition into their nurse retention strategy. For frontline staff, teamwork training for frontline healthcare staff through CLiMB builds the collaboration and professional skills that support early retention and long-term engagement.
How to Measure Retention Progress Over Time
Nurse retention improvement requires measurement to be sustainable. Track your nurse turnover rate by unit, tenure cohort (first-year, 1–2 years, 2+ years), and manager — patterns at the unit level often reveal leadership issues before they become organization-wide problems. Supplement turnover data with engagement surveys, stay interview tracking, and exit interview themes to build a full picture of what’s driving retention and what isn’t. Organizations that measure consistently are better positioned to allocate resources where they will have the most impact.
[1] 2020 AACN Nursing Shortage Fact Sheet
[2] [2] 2022 NSI National Health Care Retention & RN Staffing Report
[3] 2022 NSI National Health Care Retention & RN Staffing Report
[4] People Element – The Hidden Cost of Nursing Turnover 2020