Ilana Borkenstein

Why Nurse Turnover Isn’t Just a Staffing Problem, It’s a Leadership Opportunity

Drawing on the 2025 NSI National Health Care Retention and RN Staffing Report and current insights from nurse leaders, M7 Health CEO and RN Ilana Borkenstein explains why nurse turnover is not just a staffing issue, it is a leadership opportunity hospitals cannot ignore.

There is a moment many of us in nursing eventually face.

You look around a unit and realize how many talented colleagues have left. Not because they disliked the work or lacked skill, but because the system around them became too chaotic, unpredictable, or unsustainable to stay.

That is the real story of nurse turnover. Not a story of a workforce that has fallen out of love with patient care, but a story of structures that make it difficult for nurses to thrive inside the profession they chose.

Turnover shows up as vacancies and rising costs in a spreadsheet, but on the ground it shows up as exhausted teams, constant onboarding of new staff, and nurses questioning whether the job still aligns with the life they want to have.

This piece brings together three threads: what the latest data tells us, how turnover is experienced day to day, and what leaders can do differently if they want to build environments where nurses stay.

What the Numbers Say, and What They Miss

The 2025 NSI National Health Care Retention and RN Staffing Report makes the situation plain:

The average RN turnover rate is 16.4 percent
It costs about 61,110 dollars to replace one staff RN
It takes roughly 83 days to fill a single RN role
Nearly one in four new hires leave within their first year

Specialty areas like telemetry, step down, behavioral health, and ED continue to see even higher rates.

These numbers matter because they quantify what leaders already feel: recruitment costs rising, overtime expanding, and workloads intensifying.

But the numbers do not capture the lived experience. They do not show the impact of last minute schedule changes, short staffing, or the erosion of trust between nurses and leadership. They do not show what it feels like for a nurse manager to be responsible for dozens of direct reports with almost no time to support them.

To understand retention, you have to understand the reality behind the metrics.

What Turnover Feels Like on the Ground

Across health systems, nurses describe a similar pattern. When turnover rises, stability disappears. Schedules come out late. Teams become a mix of permanent staff and short-term replacements. The energy of a unit shifts from collaboration to survival.

Some units manage to stay grounded because of strong local leadership. Others experience the opposite: inequitable schedules, inconsistent communication, unclear expectations, and constant scrambling to cover holes. Fairness becomes highly dependent on individual effort rather than supported by system design.

Many nurses who leave do not leave the profession. They leave environments that make it too hard to do the work well. They leave due to unpredictability, lack of input, poor staffing visibility, or feeling unseen by leadership. These are solvable problems, but only if leaders acknowledge them as systemic, not personal.

Nurse managers feel this strain acutely. A recent McKinsey analysis highlighted spans of control that would be unthinkable in most industries. Some managers oversee over 200 people. The average is about 30, still far beyond Fortune 500 norms. Many report working up to 90 hours a week.

They are expected to be culture builders, coaches, schedulers, budget owners, and operational troubleshooters, often without the tools or time required to do any of these roles well.

Turnover is not simply a staffing issue. It is a leadership capacity issue.

Why Nurses Actually Leave

Across surveys, exit interviews, and workforce studies, the same themes appear:

Little control or input on scheduling
Chronic or unsafe staffing levels
Limited communication or clarity from leadership
Few opportunities for growth or mentorship
A work environment that feels generic rather than personal

In a large survey of 2,500 nurses, roughly 40 percent said they might not choose nursing again if they could go back. That does not mean the clinical work is the problem. It points to everything surrounding the work: the structure, the culture, the predictability, the support.

At the same time, 82 percent of nursing students report feeling optimistic about entering the profession. The next generation wants to contribute. They want a career with meaning. It is on health systems to ensure they do not lose that optimism in the first few years.

Generational differences get a lot of attention, especially regarding Gen Z. But what younger nurses are asking for, flexibility, feedback, progression, and support, is what nurses across all generations want. The difference is simply how quickly they will act when those needs are not met.

This is not a new problem. It is the accumulation of years of unmet needs across the workforce.

Where Nurse Managers Fit Into the Story

There is a popular saying that people do not leave jobs, they leave managers. Manager relationships do matter. But placing the responsibility entirely on nurse managers ignores the structural obstacles they face.

Consider the reality:

Many managers oversee far more direct reports than any comparable leadership role in other industries
Their staff vary widely in experience, needs, and career goals
They are often learning administrative systems on the job
They are bogged down in tasks that could be automated
They lack structured time for leadership development

The same McKinsey survey found that 98 percent of nurse managers said that adopting technology to make staffing tasks easier would improve their job satisfaction. Nearly unanimous agreement in a sample of over 1,500 leaders should be a wake-up call.

Nurse managers want to lead. They want to mentor. They want time to understand what each staff member needs to feel supported. But much of their bandwidth is consumed by manual scheduling, last minute staffing decisions, payroll alignment, and troubleshooting tools that were never built for nursing workflows.

If we want nurses to stay, we must support the people responsible for keeping their work environment healthy.

That means:

Giving nurse managers modern tools to remove low value administrative tasks
Providing evidence based leadership development, especially early in their careers
Creating systems that make it easy to understand individual staff needs and motivations
Giving managers the capacity to actually lead, not just react

This is the leadership opportunity hiding inside the turnover problem.

What Hospitals Need to Do Differently

Health systems often respond to turnover with more recruiting. More sign-on bonuses. More travelers. More external spend. But the most powerful opportunities are inside the organization, not outside it.

A shift from reactive recruiting to proactive retention looks like:

Scheduling models that give nurses input and predictability
Real time visibility into staffing, workload, and volume changes
Infrastructure that keeps nurse managers focused on people, not spreadsheets
Tools that surface insights about what motivates or drains each nurse
Structured mentorship and career exploration pathways from day one
Culture work focused on rebuilding trust, not launching perks

Nurses do not want symbolic gestures. They want less friction. They want clarity. They want to feel known. They want leaders who understand their experience and can respond to it.

Investing in retention means redesigning the job in ways that make it sustainable, supportive, and personal.

A Call to Action for Healthcare Leaders

If you are a health system leader, here are the questions worth asking:

Do our nurse managers have the tools and capacity to actually lead?
Are we making it easy for managers to understand what each staff member needs to stay engaged?
Are we investing more in executive development than in the leaders who manage our most critical workforce?
Can our organization tell a nurse, with confidence, that their work experience matters at an individual level?

The NSI report shows the cost of doing nothing: 16.4 percent turnover, 61,110 dollars per RN replacement, and nearly three months to fill a vacancy.

The alternative is an environment where nurses stay because the system works for them, not against them. Where managers have time to lead. Where trust is rebuilt. Where new graduates see a future worth committing to.

Turnover is not just a staffing problem. It is a leadership opportunity. The question is whether we choose to act on it.

FAQ

Is turnover mostly about pay?

Compensation matters, but the most common reasons nurses cite for leaving are related to scheduling, staffing, leadership support, and growth. Pay may open a door, but environment determines whether someone stays.

What is the fastest lever hospitals can pull to improve retention?

Support nurse managers. Remove low value administrative work, especially around staffing and scheduling, and reinvest that time into leadership.

Are Gen Z nurses really the source of the turnover problem?

No. They are voicing the same needs nurses have had for decades. They are simply more willing to act when those needs are unmet. Retention strategies should serve the entire workforce.