NSI Nursing Solutions has been running this survey since 2010, and the 2026 edition pulls data from 527 hospitals across 40 states — 965,886 healthcare workers, 262,405 registered nurses. It is the most comprehensive view of acute-care hospital workforce dynamics available. The findings: turnover up, vacancy stubbornly high, the cost of losing a single RN now over $60,000.
The 17.6% RN turnover figure is up 1.2 percentage points from 2024. To translate that into actual humans: in 2025, 324,090 acute-care RNs left their jobs. Hospitals replaced them by hiring 377,650 RNs — a net addition of roughly 53,500, but only a 2.9% net add rate. That is down sharply from the 5.6% net add rate the previous year. The hiring pipeline is slowing while the exit door stays open.
The Vacancy Number That Should Worry Every Hospital Board
The national RN vacancy rate is 8.6% — functionally unchanged from 2024 but masking real distribution problems. The "average hospital" carries 43 unfilled RN FTE positions. That is a manageable number. But the average is doing a lot of work. One in three hospitals (33.1%) reports a vacancy rate of 10% or higher. That is the crisis tier.
At a 10% vacancy rate, every shift starts short. Every charge nurse is running float-pool math before report. Every ICU is asking the surge tracker if PACU can hold one more post-op. Travel agencies fill the gap, but at rates that consume the operating margin the CFO needs for capital projects. The NSI report estimates 158,600 RN positions sit vacant across surveyed hospitals nationally. That number translates almost directly into deferred care, longer ED hold times, and the staffing dysfunction that drives the next cycle of nurse exits.
$60,090 Per RN Loss — And Hospitals Are Still Skimping on Retention
The 2026 report puts the average cost of losing a single bedside RN at $60,090. That number includes recruitment, orientation, productivity loss during onboarding, travel-fill costs while the position is vacant, and the cascade effect on remaining staff. For the typical hospital running normal turnover at normal vacancy, that adds up to $4.2–$6.2 million in annual losses. For a 10%-vacancy hospital, the number is dramatically worse.
What the report does not say in those words but the data implies: a $60,090 loss-per-RN equation means a hospital can spend up to that amount on retention measures — raises, ratios, better PTO, real schedule control — and still come out financially ahead. Most hospitals do not. The dominant pattern remains underinvest in retention, overspend on travel and agency, and then quote “market conditions” when asked why the unit cannot be staffed.
The Top Five Reasons RNs Resign — Read Them Carefully
NSI asked surveyed hospitals to rank the top reasons RNs voluntarily resigned in 2025. The order:
- Personal issues
- Relocation
- Retirement
- Career advancement
- Scheduling conflict
Two things stand out. First, “burnout” is not on the list as a stated reason. Hospitals classify burnout-driven departures as “personal” or “career advancement” on the exit survey because the language nurses use in the actual conversation does not map cleanly to the survey checkbox. Second, “scheduling conflict” at #5 is the most actionable category on this list. Schedule control is the cheapest retention lever available to any nurse executive, and it is consistently the lever hospitals refuse to pull because it means giving up unit-level operational flexibility.
What This Means for You
If you are a staff RN, the macro numbers are working in your favor. Net-net, hospitals need more RNs than they can hire. That gives you leverage. Use it. If your hospital is below market on pay, the NSI data is the most-cited industry benchmark for retention conversations — bring it to the table.
If you are a charge nurse or unit manager looking at a vacancy posting, understand that the recruitment side of this is your problem. NSI also tracks how long RN positions stay vacant before being filled; specialty units routinely sit vacant for 60–90+ days. Plan staffing accordingly. The travel agency is your operating partner whether you want it to be or not.
If you are an HR director or CNO reading this, the question to answer this quarter is whether your hospital can fund retention to a level that beats the cost of replacement. The math is now in print. Use our staff vs. agency calculator to model what a 1% reduction in turnover saves your unit annually. The number is bigger than most executives expect.
The Larger Pattern
Cross-reference the NSI data with the Press Ganey engagement work and the recent Nurses.org survey showing 23% of nurses now plan to leave the profession entirely. Those three data sets are converging on the same conclusion: the post-COVID retention story is not improving. The recruiting market is tightening. The cost per exit is rising. The number of hospitals running at crisis-tier vacancy is one in three and not decreasing. This is the operating environment for the next decade.
If you work in healthcare leadership and you are still calling this a “recovery period” or “return to baseline,” the NSI numbers are evidence that there is no baseline to return to. The pre-pandemic acute-care nursing workforce is gone. The current one is structurally different. Plan accordingly.