Assessment of Acute Care Hospital Nurse Turnover Rates and Factors Affecting Turnover

Abstract

Background
The global nursing shortage is exacerbated by high nurse turnover, which negatively impacts healthcare institutions by worsening nurse-to-patient ratios, increasing burnout, and contributing to higher operational costs. Previous research has primarily focused on nurse retention intentions rather than actual turnover rates, with limited studies addressing a broad range of hospital settings and nurse characteristics. Understanding the turnover rates and factors influencing nurse attrition is crucial for healthcare management and improving patient care.
Methods
This retrospective cohort study utilized hospital records from acute care hospitals across the country. A total of 96,158 nurses were included in the study, Survival analysis, including Kaplan-Meier estimation and Cox proportional hazards regression, was used to estimate turnover rates and identify factors influencing nurse resignation. Variables analyzed included gender, career duration, hospital region, hospital type, ownership, and staffing levels.
Results
The overall turnover rate was 49.7%, with male nurses (64.5%) showing higher turnover than female nurses (49.3%). Nurses with less than one year of experience had the highest turnover rates (66.2%), followed by those with 1 to <3 years (61.5%). Turnover rates were highest in smaller hospitals, rural settings, and private hospitals. Cox regression analysis identified several significant factors influencing turnover, including career duration (HR = 2.11 for <1 year), hospital size, ownership type (HR = 1.30 for private hospitals), and staffing levels (HR = 1.57 for low staffing).
Conclusion
Nurse turnover is influenced by multiple factors, including experience, hospital characteristics, and staffing levels. Strategies to reduce turnover should focus on improving working conditions in smaller hospitals, increasing staffing levels, and providing support for early-career nurses. These findings are essential for healthcare management to retain nurses and ensure the delivery of high-quality patient care.