First-Year Nurses Are Leaving Hospitals Fastest

After the staffing crisis of the pandemic years, hospital nursing has partly stabilized. Hospitals are hiring more registered nurses than they lose. But turnover is creeping back up, vacancies remain stubborn and the newest nurses are leaving at high rates. The latest data shows why retention, especially in the first year, has become the most important lever for hospital HR teams.

What the 2026 NSI report found

The 2026 NSI National Health Care Retention and RN Staffing Report found that staff RN turnover rose to 17.6 percent in 2025, up 1.2 percentage points from the prior year. The RN vacancy rate was 8.6 percent, and 33.1 percent of hospitals reported vacancy rates of 10 percent or higher.

The average hospital had about 43 RN full-time positions unfilled. Recruiting an experienced RN took about 78 days. The report estimated that losing one bedside RN costs about $60,090, once recruiting, onboarding, overtime and temporary staffing are included.

There is also good news. Hospitals hired about 377,650 RNs in 2025 against about 324,090 departures, a net gain. Supply is growing. The challenge is keeping nurses once they arrive.

The first-year problem

Nearly a third of RN turnover came from nurses with less than one year of tenure, according to NSI. Press Ganey reported early-career nurse turnover of about 22 percent and estimated that the average hospital lost $5.19 million to nurse turnover in 2025.

New nurses face a steep transition. Many move from school into high-acuity units with heavy patient loads, rotating shifts and limited mentoring. When the reality of the job differs sharply from expectations, some leave nursing or move to outpatient settings with more predictable hours.

That pattern makes onboarding and residency programs especially important. Our guide to the first 90 days covers general practices, and many hospitals now run year-long nurse residency programs with structured mentoring, classroom time and peer support.

Demand keeps growing

Health care continues to lead job growth. The sector added 42,000 jobs in October, according to the Bureau of Labor Statistics, as we noted in our industry jobs breakdown. The BLS projects about 189,100 openings for registered nurses each year on average from 2024 to 2034, many to replace workers who retire or leave the occupation.

An aging population adds pressure across the care continuum, including senior living, where turnover is also high, as we reported in our senior living workforce report.

What hospitals are doing

Scheduling flexibility has become a major retention tool. Self-scheduling, shorter shift options, weekend-only roles and internal float pools give nurses more control over their time. Some systems offer part-time and per diem options that keep experienced nurses from leaving entirely.

Internal agencies and float pools reduce reliance on expensive outside travel nurses while giving staff higher pay for flexibility. Several large systems have built their own internal staffing programs since the pandemic.

Career paths matter too. Clinical ladders reward experienced bedside nurses without requiring them to move into management. Tuition support for advanced degrees and specialty certifications helps retain ambitious nurses. Apprenticeship and earn-while-you-learn programs for nursing assistants and technicians create pipelines into nursing, as described in our apprenticeship guide.

Manager support is a recurring theme. Charge nurses and unit managers often supervise large teams with little time for coaching. Gallup research on manager span of control, covered in our report on manager coaching, applies directly to nursing units.

For hospital HR leaders, the data points to a few priorities. Track turnover by tenure, unit and manager to find where first-year nurses are leaving. Hold stay conversations at 30, 60 and 90 days and again at six months. Pair new graduates with trained preceptors who have protected time to teach.

Calculate the full cost of turnover and share it with leadership. At roughly $60,000 per departure, reducing first-year turnover by even a few points can fund a strong residency program several times over.

Hiring speed matters as well. With experienced RN recruitment taking about 78 days, hospitals that shorten the process gain an edge. Our guide to time to hire covers practical steps.

The broader lesson for health care employers is that the supply of nurses is improving. The organizations that win will be those that keep the nurses they hire.