Operationalizing the RETAIN Framework: Calculating the cost of nurse turnover in practice

This Part II study operationalizes the RETAIN Framework to close a two-decade gap in primary evidence on nurse turnover costs and provide contemporary benchmarks for health systems.

We used event-level, bottom-up costing to link expenditures to discrete turnover events and assign costs to individual nurses. Analyses covered 1,501 medical-surgical nurses (23% of the nursing workforce) across seven hospitals in an academic medical center.

In 2023, 360 turnover events yielded a 24% turnover rate. Mean time to fill vacancies was 21.7 weeks; 75.5% of backfill hours were covered by contract labor. Per-nurse turnover cost with contract replacement was $85,498, totaling $27.9 million.

Nurse turnover costs are substantial, measurable, and driven by operational decisions. The RETAIN dashboard translated drivers into actionable evidence that informed a $150 million salary investment, adding $9,000 annually to nurses' pay.

RETAIN links event-level costs to organizational outcomes, establishing turnover reduction as a financial imperative and strategic opportunity.