Understand how we got here — and how to move forward.


March 9, 2022

Staff turnover: 4 key takeaways from Advisory Board's survey of 224 hospitals

Daily Briefing

Every health care organization is feeling the strain from high rates of staff turnover.

We collected a fresh set of turnover benchmarks from 224 hospitals to quantify the level of departures hospitals are experiencing. The numbers below won’t surprise any leaders managing turnover day-in and day-out. But the benchmarks can help you understand whether your organization is on par with the rest of the country—or losing more staff than most.

Our key findings are detailed and charted below.

The nursing shortage, discussed: A conversation with Advisory Board's top nursing experts

Four takeaways from our 2021 hospital staff turnover and vacancy survey

  1. Turnover of full-time and part-time staff is the highest we’ve recorded in 16 years of benchmarking. Median turnover (excluding PRN, per diem, and casual staff) rose to 18.8% in 2021, up from 15.5% in 2020. That’s an unusually high jump of more than three percentage points in a single year. The average year-over-year change across the last 15 years was one percentage point in either direction.

  2. Turnover of bedside RNs is double the historic low we saw in 2010. Median bedside RN turnover of full-time and part-time staff (excluding PRN, per diem, and casual staff) rose to 18.0% in 2021, up from 14.8% in 2020. That’s double the lowest rate we recorded across the last 16 years: 8.7% in 2010.

  3. The overall vacancy rate for all staff and for bedside RNs reached new peaks. The median overall vacancy rate (measured as the percentage of open budgeted FTE positions) was 10.1% in 2021, up from 5.3% in 2020 and a historic high (the previous peak was 6.3% in 2007). The median bedside RN vacancy rate is 11.7%, up from 5.8% in 2020 and another historic high (the previous peak was 7.5% in 2007 and again in 2015).

  4. Spending on agency labor and traveling labor is twice the rate of 2020. The median organization spent 5.6% of their total payroll expense on agency and traveling labor in 2021. This is double the 2020 rate of 2.8%, which was the highest we’d seen since first reporting the metric in 2014.

To download our ready-to-present slide deck with national benchmarks on hospital turnover, vacancy, and premium labor rates, you can access the full results here.

How to stabilize your workforce

These numbers validate what is all too obvious to any health care leader: staffing remains the number one crisis facing hospitals and health systems. There is no one solution to this different-in-kind shortage. Achieving workforce stabilization will require C-suite attention and investment in a wide variety of tactics, including but not limited to the following:

  • Competitive pay and willingness to use retention bonuses alongside recruitment bonuses;
  • Significant, sustained investment in employee well-being;
  • Proactive strategies to stem the rise in violence against staff;
  • Team-based staffing models that account for long-term nursing supply challenges;
  • Stay interviews with current staff asking what’s keeping them at your organization—and reinforcing those factors;
  • Enhanced options for flexible work arrangements;
  • A seamless application process that makes it easy for candidates to express interest in roles;
  • Reconsideration of baseline requirements for roles, particularly entry-level positions; and,
  • An alumni return campaign to encourage former staff to re-join the organization

For additional staffing resources, you can review our hard truths on the current and future state of the nursing workforce along with the three no-regrets moves to respond to rapidly shifting employee expectations.

Disclaimer: the number of responses were varied for each metric


6 Advisory Board resources for recruitment, retention, and the workforce landscape

Workers are feeling overwhelmed by the demands of Covid-19 and are increasingly concerned about pay and staffing shortages. With resignations and even labor strikes on the rise, what can you do to recruit, support, and retain your workforce? We've uncovered the most important insights and turned them into actionable items for you. Whether you are trying to recruit a nursing workforce amid a shortage or simply trying to keep your existing staff, we have curated multiple pieces of expert guidance.



Workforce landscape:

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