RN turnover is climbing again, just as hospitals are deciding what 2027 staffing will cost.
The national staff RN turnover rate fell from 27.1% in 2021 to 16.4% in 2024, declining each year along the way. But in 2025, that all changed. RN turnover in 2025 rose to 17.6%, according to NSI’s latest staffing report, which looked at 527 acute-care hospitals in 40 states and covered over 262,000 registered nurses.
More nurses are now reaching the end of their careers, reports NSI. Retirement is now the third most common reason RNs voluntarily leave their jobs, behind personal issues and relocation. For example, some nurses move, go back to school, or change jobs to advance their careers. For others, the schedule no longer works, the commute is too much, the pay is too low, or their teams are too understaffed. Nearly 40% intend to either leave or retire by 2029.
The burden of rising RN turnover—and how to address it
Every departure can create another position hospitals have to fill. Meanwhile, the pool of available nurses is expected to stay tight. HRSA projects a national shortage of about 109,000 full-time RNs in 2038. The Bureau of Labor Statistics expects roughly 180,800 RN openings each year over the next decade.
Hospitals setting their 2027 labor budgets should plan for both retention and replacement.
1. Identify the pain points
Upping nurse retention starts with knowing where people are leaving.
The 17.6% national turnover rate is a useful benchmark, but can hide big differences by specialty. Turnover ranged from 22.5% in behavioral health and 20.7% in emergency services to 13.4% in pediatrics, with telemetry, step-down, and med/surg also above the national average.
There is also a difference in how turnover is counted. NSI’s 17.6% figure includes all staff RN employment classifications. Hospitals that count only full- and part-time RNs reported an average turnover rate of 14.6%. Hospitals should make sure they are comparing their own turnover against the right number.
A hospital may, for example, have an overall turnover rate close to the national average while one department is struggling much more than the rest.
2. Track the real cost of turnover
NSI estimates that losing one staff RN costs an average of $60,090.
The average hospital lost $5.19 million to RN turnover in 2025. A one-percentage-point change in RN turnover works out to roughly $295,000 in annual cost or savings for the average hospital.
Only 46.1% of hospitals surveyed track the cost of RN turnover. That means over half of hospitals may be spending money on retention without regularly calculating the expense they are trying to reduce.
Looking ahead to 2027, a hospital staffing budget must include calculating current turnover costs and setting a measurable goal to lower them. That gives leaders something concrete to compare against the money going into retention programs.
According to Prolink’s retention guide for nurse leaders, focus retention spending on career growth, flexible scheduling, compensation, staffing levels, and nurse leadership. Then track measures like engagement, overtime, and no-shows to see what is working.
3. Sharpen recruiting strategies with a workforce partner
The national RN vacancy rate is 8.6%, according to NSI. One-third of hospitals reported vacancy rates of 10% or higher. The average hospital had 43 unfilled RN FTEs. Hiring an experienced RN took an average of 78 days.
Hospitals also expect to need more nurses. For 2026, 71.8% said they anticipate increasing their RN workforce. Only 26.7% expect to increase their recruitment budgets.
Hospitals may need more recruiting capacity, stronger internal staffing pools, per diem coverage, overtime, or outside staff while positions remain open. The right workforce partner can help tie together those scattered data points, market factors, and strategies to put together a recruiting plan that works for your health system.
Prolink’s tailored approach to our client relationships means that we understand your needs and goals before we get to work—in other words, we don’t do one-size-fits-all. Read how we delivered process improvements and advanced recruiting strategies that saved one health system $1.3 million.
4. Identify key metrics and contingent labor strategy
Over one in four hospitals, said NSI, had no measurable turnover-reduction goal for 2026. Hospitals had aimed to lower turnover in 2025, but hospital turnover still rose slightly.
A 2027 hospital retention budget should say what it is expected to accomplish. Nearly three in four hospitals already have a formal retention strategy. Four in five focus on newly hired nurses. That focus makes sense: that’s because 22.7% of newly hired RNs left within a year, accounting for 29% of RN separations. Losing those nurses means paying to recruit, hire, onboard, and train replacements all over again.
When a unit runs short, NSI says hospitals commonly turn to per diem staff, overtime, internal staffing pools, higher pay, and travel or agency nurses. But every option has a price. NSI estimates annual staff RN pay, including benefits, at $123,676, compared with $189,758 for a travel RN. That is a $66,081 difference per full-time employee.
At the same time, for 2026, 70.7% of hospitals said that they planned to reduce travel and agency use. Reducing agency use can indeed lower labor costs. Hospitals still need coverage when someone resigns, goes on leave, or census rises unexpectedly.
To reduce agency spending, decide which shifts can be covered through permanent staff, per diem nurses, or internal float pools. And where outside staffing will still be needed. Agency coverage may still make sense for census spikes, leaves, and specialties that are especially difficult to fill. Additionally, internal travel programs can give health systems another option for filling gaps while reducing what they spend on outside agency labor.
For 2027, hospitals need to know what will replace agency coverage and what that alternative will cost.
5 questions to address in your 2027 staffing budget
If you’re currently working on your 2027 budget, here are five questions to ask yourself to help ensure you’re addressing the full picture when it comes to RN retention and turnover.
- What does RN turnover cost us today?
- What turnover rate are we trying to reach?
- What are we funding to keep the nurses already here?
- How will we cover a vacancy during the average 78-day hiring period?
- If travel and agency use falls, what will replace that capacity?
Not sure where to start? Identify your key metrics first
Identify where turnover is highest, calculate what it costs, and set a measurable goal for reducing it. Then decide what you are willing to spend on retention and how you will cover vacancies while replacements are being hired. By the time the 2027 budget is final, every hospital should know who it is trying hardest to keep, what an open RN role costs, and what will happen when a shift still needs coverage.
RN turnover is expensive long before a hospital hires a replacement. As hospitals plan for 2027, our workforce experts can help them decide where permanent hires, internal teams, and flexible staffing make the most sense. Learn more about Prolink’s healthcare staffing solutions, or click below to contact us today.
