Nurse Turnover: The Revolving Door in Nursing

Laura A. Stokowski, RN, MS


December 16, 2014


The title of this article poses two questions, but only one is answered. The investigators were able to provide good data for turnover rates among new RNs, but they were unable to locate a consistent definition of turnover.

The job and career patterns of newly licensed RNs are of high interest to healthcare organizations. Although the anticipated nursing shortage hasn't materialized yet in most regions, the retirement of a huge cohort of baby boomer nurses is still impending, and early-career nurses will be needed to fill the void.

For now, newly licensed nurses who aren't able to land those sought-after hospital jobs will continue to take whatever jobs they can find to acquire the experience needed to be hired by the hospital. Nurse residency programs were designed to narrow the expertise gap of new grads and assist them in the transition to their first nursing position, with the hope of reducing turnover.[2] A recent systematic review[3] concluded that nurse residency programs can, indeed, reduce turnover rates within the first year of employment among newly licensed nurses. Not only do they reduce early turnover, but nurse residencies have shown to be cost effective compared with traditional orientation of new grads.[4] More nurse residency programs might further limit turnover, but nurse residency programs are expensive, especially if the organization can expect to lose one third of these nurses within 2 years.

The revolving door of early-career nurses does little to encourage hospitals to expand their investment in new grads. For this to change, healthcare employers need to understand not just how many nurses are likely to quit within a year or two and seek jobs elsewhere but why.

Another analysis[5] from the RN Work Project provides some answers, but employers will have to judge whether they are helpful. When nurses who had left their first jobs were asked whether there was anything their employers could have done to keep them, 42% said that nothing would have induced them to remain in their first position. Other factors, cited by less than 10% of respondents, were an increase in pay, a change in shift or hours, and improvements in management. However, other findings from RN Work Project studies illuminate modifiable job factors that can influence the intentions of new nurses to leave their positions, such as verbal abuse from nurses[6] or physicians[7] and characteristics of the physical work environment.[8]

In a comparison of new grads from 2004-2005 with those from 2010-2011, Kovner and colleagues[5] found that nurses in the later cohort were less likely to work in hospitals, although the reason for this was unexplained. Was this because nurses are finding it even harder to get hospital jobs, or does it herald a shift away from the acute care hospital to primary and ambulatory care? They also documented some positive trends among new grads in the later cohort that might bode well for turnover. Although the cohorts did not differ in their intent to stay in their first jobs or to leave them, nurses in the later cohort perceived their work environments more positively than those in the earlier cohort, especially in terms of better relations between nurses and physicians and fewer organizational constraints. Nurses in the later cohort were more committed to their organizations and were more likely to be enrolled in a formal educational program. Nurses in the later cohort also perceived that they had fewer job options, another factor that, if true, could positively influence turnover rates.

The RN Work Project is a unique study that is providing a wealth of up-to-date information about nurses and nursing as a career. Because each generation of nurses can have different career goals and aspirations, healthcare organizations and others who hope to slow that revolving door need to keep current with these findings. A list of publications to date from the project, including many of those discussed in this article, is available here.


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