This analysis synthesizes 6 sources published the week ending Oct 21, 2026. Editorial analysis by the PhysEmp Editorial Team.
U.S. hospitals hired 377,650 registered nurses in 2025 and lost 324,090, according to NSI Nursing Solutions figures that Business Model Analyst unpacked this week from a Wall Street Journal report. The net result was 2.9% workforce growth, down from 5.6% the year before. A hospital can set a hiring record and barely grow, and that arithmetic is the quiet center of the Healthcare Workforce & Labor Market story this week.
The headline number was bedside RN turnover of nearly 18%, which Becker’s Hospital Review put against roughly 11% about fifteen years ago. NSI’s exact figure for 2025 is 17.6%, up 1.2 points. The coverage this week converged on one framing: the country does not lack nurses, it fails to keep them. The framing is accurate and also incomplete.
Hiring volume hides the churn
A turnover rate is a share of the workforce, but a hospital experiences it as a permanent recruiting operation. Replacing 17.6% of staff each year means a large fraction of every unit is always new. Press Ganey’s chief nursing officer, Jeff Doucette, told the Journal there is no shortage of nurses in the country, only a shortage of nurses willing to work under current conditions. Oregon’s nurses association makes the same argument: the state has more licensed nurses than at any point in its history, and WENG Radio reports hospitals still struggle to fill shifts.
Where the coverage thins out is the connection to capacity. A UCLA-led study in JAMA Network Open, cited in the Business Model Analyst piece, found hospital occupancy averaged about 64% from 2009 to 2019 and reached 75% in the year after the pandemic emergency ended, with hospitalizations roughly flat and staffed beds down 16%. Researchers attributed much of that to workforce shortages. Turnover is usually reported as an HR cost. It also removes staffed beds, which raises occupancy, which lengthens emergency department waits, which makes the next nurse more likely to leave. The loop is a labor-market mechanism, and most retention coverage treats its pieces separately.
A hospital that hires 377,650 nurses to net 53,000 is running a treadmill, not a pipeline. The relevant measure of recruiting success is not offers accepted but how many hires are still there in eighteen months.
The price of a departure
NSI puts the average cost of replacing one staff RN at $60,090, and the average hospital’s annual loss from turnover at about $5.19 million. Each percentage point of turnover is worth roughly $295,000 a year to the average hospital, per the Becker’s summary. Emory Healthcare’s own analysis, as described by Business Model Analyst, puts a departure nearer $78,000. At that figure, the article calculates, Emory’s $150 million in raises, mostly for nurses, pays for itself by avoiding about 1,900 exits. Emory’s contract nurse count fell from 1,370 in March 2023 to fewer than 300, and its CEO said turnover dropped below 2019 levels.
Rome Health, a safety-net hospital in upstate New York, shows the same logic at much smaller scale. Turnover there fell from 50% in 2019 to 28% last year, with a roughly $5 million, five-year foundation grant paying for a nurse residency, one-on-one coaching and virtual nursing support. Business Model Analyst estimates the grant covers its cost if it prevents about 13 departures a year. One caveat from the same article is worth keeping: post-pandemic turnover eased as pay rose, so the 2025 uptick could be noise rather than a new trend.
Who leaves, and where they go
The exits are not evenly spread. A Forbes Business Council piece by Jersey College’s chancellor cites NSI data showing 22.7% of newly hired RNs leave within a year, and that this group accounts for 29% of all RN separations. Oregon’s nurses association puts first-year attrition among new graduates at 30%. The two figures measure different groups, so they should not be stacked, but both say the early months are where retention is won or lost. Press Ganey’s turnover figures run by generation, as Forbes and Becker’s both note: Gen Z RNs turn over fastest, at 22% to 24% depending on the report, against 13% to 14% for Gen X.
Unit type matters as much as age. NSI’s five-year cumulative turnover runs 117.8% on telemetry, 115.4% on step-down and 113.6% in the emergency department, meaning those units have effectively replaced their entire nursing staff more than once. Emergency Nurses Association president Dustin Bass described ERs with 133 care spaces staffed by nurses with two to three years of experience. Violence compounds it: Press Ganey found 2.4% of nursing staff were physically attacked in 2025, up 26% since 2017.
Leavers also have somewhere to go. Nurse practitioners earn a median $132,300, about 36% more than RNs, and BLS projects NP jobs to grow 41% from 2025 to 2035, according to Business Model Analyst. A HonorHealth nurse who left to offer cosmetic treatments as an NP prompted the system’s chief nurse executive to say she could not compete with that. For hospital executives, the implication is that experienced bedside nurses have a credentialed exit with a higher median wage inside the same labor pool. For physicians weighing a move, the practical signal is unit stability: a department running on staff with two or three years of experience is a different place to practice than one with a settled core, whatever the posted salary says.
Ratios, retention and who pays
Pennsylvania is testing whether policy can force the question. A Penn Leonard Davis Institute research update reports an average of 5.9 patients per nurse on the state’s medical-surgical units, with some hospitals reporting up to nine. House Bill 106, which would set a 1:4 ratio, passed the House and stalled in the Senate, and its sponsor intends to reintroduce it. A Penn-led observational study of 132 hospitals estimated that moving from 1:6 to 1:4 would save over $305 million a year statewide through avoided turnover and shorter stays. The Hospital and Healthsystem Association of Pennsylvania counters that federal Medicaid cuts will reduce payments to state hospitals by $4.5 billion over ten years.
That collision is the real constraint. The savings from retention accrue over years and show up in avoided costs, while the staffing expense is immediate and the revenue squeeze is already here. In rural New York, state nursing association staffer Margaret Franks told Radio Catskill the problem is a failure to retain nurses after a pandemic-era wave of departures and hiring freezes, and a worker at an Optum-owned practice described corporate layoffs shrinking the workforce around her. Systems under margin pressure may cut the very staffing that keeps their people.
The figure to watch is NSI’s next retention report. If turnover holds near 17.6% while the net add rate stays near 2.9%, hospitals will keep paying for recruiting that does not compound, and the systems that tie raises, residencies and ratios to retention will gain an edge in recruiting over those that keep buying replacements.
Sources
Bedside nurse turnover reaches 18% – Becker’s Hospital Review
ER Waits Are Stuck High. Hospitals Ran Out of Slack, Not Nurses – Business Model Analyst
Oregon’s Nursing Crisis Isn’t a Shortage — It’s a Retention Problem – WENG Radio
Pennsylvania Nurses Are Overloaded, Putting Patients at Risk – Penn LDI
The Nursing Shortage Runs Deeper Than Supply And Demand – Forbes
As Rural NY’s Health Workforce Shrinks, Workers Point to Unsafe Staffing – Radio Catskill