Nurse Retention: Is it Worth It?

Bonnie L. Atencio; Jayne Cohen; Bobbye Gorenberg


Nurs Econ. 2003;21(6) 

In This Article


The costs of the nursing shortage are high. The most obvious cost is in actual dollars. The rate of nurse turnover in 2000 was 21.3% (The HSM Group, 2002), with turnover costs up to two times a nurse's salary. The national average salary of a medical-surgical nurse is $46,832. Therefore the cost of replacing just one nurse would be $92,442. To replace a specialty area nurse, the cost can increase to $145,000. Replacement costs include human resources expenses for advertising and interviewing, increased use of traveling nurses, overtime, temporary replacement costs for per diem nurses, lost productivity, and terminal payouts (Colosi, 2002). If a hospital with 100 nurses experienced turnover at the rate of the national average of 21.3%, expenditures could amount to as much as $1,969,015 yearly, for the turnover of medical-surgical nurses alone (The HSM Group, 2002).

Another cost of the shortage is negative patient outcomes. Needleman, Buerhaus, Mattke, Stewart and Zelevinsky (2002) reported that more RN hours were associated with shorter lengths of stay, lower rates of urinary tract infections, pneumonia, upper gastrointestinal bleeding, shock or cardiac arrest, and failure to rescue (when a negative outcome, such as death, would have been avoided if a nurse had been available to accurately assess the patient's condition and intervene). Aiken, Clarke, Sloane, Sochalski, and Silber (2002) determined that each additional patient, over a patient-nurse ratio of 4:1, was associated with a 7% increase in the chance of failure to rescue, as well as a 7% increase in the likelihood of the patient dying within 30 days of admission. Furthermore, they reported that a 6:1 ratio increased the chance of death by 2.3 per 1,000, and an 8:1 ratio increased the chance of death by an additional 8.7 per 1,000. Each patient over a 4:1 ratio increased the odds of nurse burnout by 23% and job dissatisfaction by 15%. Job dissatisfaction is a major cause of nurse turnover, and turnover increases the nursing shortage. Multiple studies have shown that job dissatisfaction is a predictor of nurses' intent to leave their jobs. Intent to leave is the greatest predictor of whether or not nurses actually do leave (Boyle et al., 1999; Bruffey, 1997; Davidson et al., 1997; Ingersoll, Olsan, Drew-Cates, DeVinney, & Davies, 2002).

The purpose of this study was to determine the perceptions of staff nurses regarding autonomy, task orientation, and work pressure in the acute care hospital work environment.


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