Higher RN turnover is directly linked to increased patient falls and costs

Coauthored by Angela Pascale, Research Analyst, Press Ganey.

Nurse turnover is a major challenge at hospitals across the country, negatively impacting patient care, staff burnout and morale, and financial performance. Recent Press Ganey data reveals just how prevalent this issue is: Nearly one in five registered nurses (RNs) left their role between 2022 and 2023. It also shows a clear connection between engagement and RN turnover: Facilities that score at the top in engagement outperform those at the bottom by 5.6 percentage points. Looking at the financial implications, lower turnover rates translate to $313,000 in cost savings for every 100 RNs. 

Research using data from the National Database of Nursing Quality Indicators (NDNQI) brings another concern to light: Higher RN turnover rates are associated with an increase in patient falls and higher costs.  

Thankfully, organizations can implement several strategies to address these challenges, leading to improved patient safety and outcomes as well as reduced costs.

The connection between RN turnover, patient falls, and costs

Press Ganey analyzed 2023 annual turnover rates for employed full-time equivalent (FTE) RNs and advanced practice registered nurses (APRNs) alongside patient fall rates per 1,000 patient days. Our analysis focused on 844 medical-surgical and step-down units with turnover data stratified by hospital bed size: 100 to 200 beds, 200 to 400 beds, and 400 to 500 beds. Within each group, we identified the units in the top and bottom quartile based on RN turnover rates.

Lower RN turnover rates are associated with fewer falls and lower cost. Smaller hospitals (100–200 beds) save $105,000 per year, while larger hospitals (400–500 beds) save $616,000.

So, what did we learn? Units with the lowest annual turnover rates demonstrated lower fall rates across all bed sizes:

• 100–200 beds: 0.55 fewer falls*
• 200–400 beds: 0.50 fewer falls*
• 400–500 beds: 0.68 fewer falls*

_{*Per 1,000 patient days for units with lower turnover}

We then compared units with high and low RN turnover rates to see how turnover, falls, and associated costs were linked. Hospitals with lower turnover rates had fewer falls on average, and, as a result, hospitals with 100–200 beds saved approximately $105,000, and those with 400–500 saved about $616,000 annually.

Lower nurse turnover directly translates to improved patient safety, fewer patient falls, and, ultimately, cost savings for the healthcare organization. But how do organizations reduce turnover and, in turn, drive retention?

RN feedback is essential to improvement. What do your RNs want? What’s their experience like at your organization? And how might these experiences and needs differ across demographics and populations? 

4 ways to understand the RN experience

1. Continuously listen, starting on day #1. Elevating RN engagement and retention requires an authentic listening strategy—a strategy that lets you regularly gather, analyze, visualize, and, most importantly, act on employee feedback. Checking in, via employee and leader rounding, pulse surveys, and other feedback mechanisms, is crucial for monitoring progress and adjusting strategies—not just on an annual basis, but regularly throughout the year.
2. Segment your data. The healthcare workforce is diverse and complex. A one-size-fits-all approach won’t drive sustainable, meaningful change. Segmenting RN data by tenure, shift, age, race/ethnicity, gender identify, and other factors is key to identifying disparities in experience across your organization. 
3. Leverage advanced analytics to pinpoint areas of focus. A proactive employee retention approach is far more effective than playing catch-up. Flight risk analytics can help organizations pinpoint areas and populations at risk of turnover, so they can implement targeted retention strategies before someone hands in their notice. 
4. Move from insight to action, fast. Regularly listening is only one piece of the puzzle. Organizations need to be quick to act. While surveys and data can be helpful tools in diagnosing issues and identifying hot spots of flight risks, acting swiftly and intentionally is critical to drive retention and improved nurse experiences. Digital tools help organizations crowdsource and create focus groups to accelerate idea gathering—and action.

But improving the nurse experience—and, as such, reducing RN turnover and improving PX and outcomes—takes a village. We are all in this together. To discuss your organization’s unique challenges, reach out to one of our nursing experts. We can’t wait to hear from you.