Staff RN turnover climbed to 17.6% nationally in 2025 — a 1.2 percentage-point increase from the prior year — according to the 2026 NSI National Health Care Retention & RN Staffing Report. The increase reverses two consecutive years of improvement and signals that the structural retention problems in US nursing did not resolve with the post-pandemic staffing rebalancing. The report drew on data from 527 hospitals across 40 states, covering 965,886 healthcare workers including 262,405 registered nurses.
The financial impact is concrete: the average cost of replacing one staff RN reached $60,090 in 2025, and for a typical hospital, total RN turnover losses now run approximately $5.19 million per year. Each percentage-point change in RN turnover costs or saves the average hospital $295,000 annually — meaning the 1.2-point uptick added roughly $360,000 to the average hospital's turnover bill in 2025 alone.
Where Turnover Is Worst by Specialty
Behavioral health nursing leads all specialties in turnover at 22.5% — a figure that is not surprising to anyone who has worked inpatient psychiatry. The combination of workplace violence risk, therapeutic intensity, and often inadequate staffing ratios makes behavioral health one of the most challenging retention environments in nursing. The NSI data confirms what bedside psych nurses already know: the attrition problem in behavioral health is measurably worse than the already-elevated acute care average.
| Specialty | Turnover Rate (2025) | vs. National Avg |
|---|---|---|
| Behavioral Health | 22.5% | +4.9 pts |
| Emergency | 20.7% | +3.1 pts |
| Telemetry | 19.5% | +1.9 pts |
| Step Down | 19.0% | +1.4 pts |
| National RN Average | 17.6% | — |
Emergency nursing at 20.7% is the other notable figure. ER nurses deal with the full force of what healthcare systemically fails to address — the psychiatric boarding crisis, unhoused patients with complex comorbidities, violence, and near-constant high acuity — and the turnover data reflects it. Telemetry and step-down at 19.0–19.5% suggest the mid-acuity units that require high vigilance without the ICU's staffing ratios or compensation are a significant retention gap.
Vacancy Rates: One Piece of Good News
The RN vacancy rate improved, dropping to 8.6% nationally, down from 9.6% the prior year. The average hospital carried 43 unfilled RN FTE positions in 2025, and 33.1% of hospitals reported a vacancy rate of 10% or higher. The vacancy rate improvement — even as turnover rose — suggests hospitals are getting somewhat faster at recruiting replacements, even if they're not retaining nurses at better rates.
The average time to recruit an experienced RN ranged from 56 to 102 days, with the RN Recruitment Difficulty Index sitting at 78 days — five days faster than the prior year. That improvement is meaningful: an open position that takes 78 days to fill versus 83 days means 5 additional shifts covered by overtime or agency staff, at significant cost.
What the 1.2-Point Reversal Actually Means
The NSI data covers 2025, a year that saw several converging pressures on nursing retention: the post-pandemic staffing rebalancing had largely played out, travel nurse pay compression had reduced the financial premium for agency work (reducing the pull factor), but the underlying workload and burnout conditions that drove the original pandemic-era exodus had not resolved. The 2026 State of Nursing Survey separately found that job satisfaction dropped 8 percentage points in 2026, and the likelihood of leaving the bedside rose among nurses still in practice.
The combination of rising turnover and declining job satisfaction suggests the 2025 uptick is not a one-year correction but a trend that will continue into 2026 data unless hospital management makes substantive changes to workload distribution, staffing ratios, or compensation. A 1.2-point annual increase that compounds over three years would bring national RN turnover above 20% — a figure last seen at the height of the pandemic workforce crisis.
The $60,090 cost per departing RN figure is the number hospital administrators actually respond to. If you're making the case for better staffing, safer ratios, or retention bonuses — and you're being told there's no budget — that number is your argument. A unit that loses 4 nurses per year is spending $240,000 on turnover alone. What would adequate staffing ratios cost? Often less. Get your CNO to run the math.
What Facilities Are Doing About It
NSI identifies several retention interventions that have shown measurable impact in their participating hospitals:
- Structured stay interviews: Proactive conversations with nurses who are currently employed, focused on what would cause them to leave and what would make them stay — conducted well before the point of resignation
- Nurse residency programs: Facilities with formal first-year residency programs for new graduates report meaningfully lower first-year attrition, which contributes significantly to long-term retention since nurses who survive year one are much more likely to stay three or more years
- Flexible scheduling models: Self-scheduling and hybrid shift options are consistently cited by nurses as retention factors; facilities that offer these report lower turnover than those with fixed schedule assignments
- Competitive total compensation: The NSI data is clear that pay increases alone don't close the gap — but facilities that fall below market on compensation face a double penalty of worse retention and harder recruiting
The 17.6% national figure covers enormous variation. The NSI sample ranges from 5.6% to 40.0% RN turnover, reflecting the enormous gap between facilities with strong retention cultures and those where turnover has become self-reinforcing: high turnover → higher workload per remaining nurse → more turnover. Reversing the trend in a high-turnover facility almost always requires changes to the conditions that drive nurses out, not just better recruiting of replacements.