Nurse turnover: understanding the causes and taking effective action
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Key takeaways:
- Almost one in two hospital nurses (46%) no longer works in a hospital or has changed profession ten years after their first job, according to the DREES.
- 30% of newly qualified nurses leave the profession within five years of graduating, according to the French National Union of Nursing Professionals (SNPI).
- Nurse turnover reaches 52.5% in nursing homes (EHPAD) and up to 30% in the for-profit private sector, compared with 5.5% in public hospitals.
- The cost of replacing a nurse is estimated at between 30% and 150% of their annual salary, depending on how technical the position is and how long it stays vacant.
- Participatory management and a recognition policy significantly reduce turnover, whereas directive management makes it worse.
What is nurse turnover and why is it so high?
Nurse turnover refers to the rate at which nursing staff are replaced within a facility or sector, whether through moves to another employer, a career change or leaving the profession altogether.
Definition and turnover rates in the nursing profession
The turnover rate is usually calculated by dividing the number of departures over a given period by the average headcount over the same period. In nursing, this rate varies widely depending on the sector, the facility’s status and the region, which can make raw comparisons between facilities misleading if the context is not taken into account.
Nurse turnover should not be confused with positive, voluntary career mobility, which allows some professionals to broaden their experience. It is its excessive frequency, often unwanted and linked to poor working conditions, that poses a structural problem for healthcare facilities.
Key figures on nurse turnover in France and Belgium
In France, nurse turnover varies widely by sector: it stands at around 30% in the for-profit private sector, compared with just 5.5% in public hospitals, according to an analysis of annual social data returns. In the medico-social sector, the gap is even wider: turnover reaches 52.5% for nurses and 48.3% for care assistants in nursing homes (EHPAD), according to a DREES study.
Almost one in two hospital nurses has left the hospital or changed profession after ten years in the job.
— DREES, Études et Résultats No. 1277, August 2023
Over a ten-year period, the DREES found that 21% of hospital nurses had left salaried employment, 11% had moved to other employers and 10% had switched to working exclusively as self-employed nurses. In Belgium, the situation is also worrying: even before the health crisis, 36% of nurses were already at high risk of burnout and 32% intended to change jobs.
The main causes of turnover among nurses
Nurse turnover results from a combination of organisational and individual factors, which often add up over the course of a career.
Difficult working conditions and excessive workload
Chronic understaffing and a faster pace of work are among the leading reasons for leaving. In some contexts, such as coordinating poorly organised outpatient pathways, up to 80 to 90% of working time can be taken up by repetitive, low-value tasks, creating a sense of loss of meaning.
This excessive workload, combined with atypical hours (nights, weekends, on-call duty), gradually wears down nurses’ physical and psychological resources, to the point where the job becomes untenable for some professionals.
Lack of recognition and appreciation of the profession
A lack of recognition, whether from management, the institution or society at large, is a major factor in disengagement. This lack of appreciation particularly affects caring professions, which have historically received little recognition for both their relational and technical dimensions.
Burnout and psychosocial risks
Occupational exhaustion, or burnout, is closely linked to turnover: a nurse suffering from exhaustion is much more likely to consider changing jobs or profession. Psychosocial risks, when they are not anticipated by an active prevention policy, translate directly into departures, sometimes sudden ones, because the professional concerned sees no alternative.
Limited career prospects and insufficient training
A lack of career prospects within the same facility pushes some nurses towards other organisations or a career change. Limited access to continuing education, or a lack of support in building a career plan, reinforces this sense of stagnation, especially among professionals who have been in post for several years.
The consequences of nurse turnover for healthcare facilities
High turnover is not just a one-off HR problem: it has a lasting impact on how the whole facility operates.
Impact on quality of care and patient safety
Overly frequent staff changes directly affect the quality of care, in particular through the loss of familiarity with a department’s specific protocols and the adjustment time each new recruit needs. In facilities caring for vulnerable people, such as medicalised care homes, residents experience team instability as a particularly unsettling loss of familiar points of reference.
Financial costs of recruitment and training
The cost of replacing an employee in the care sector is estimated at between 30% and 150% of their gross annual salary, depending on how technical the position is and how long it remains vacant. This cost includes recruitment fees, the period during which the post is unfilled, the use of temporary staff to ensure continuity of service, and the time needed to train and onboard the new recruit, during which productivity remains lower.
Once this cycle has started, it is very costly to stop. The facility acquires a reputation for high turnover in the local job market, making recruitment even harder and more expensive.
Work overload for remaining teams and a deteriorating workplace climate
Every unplanned departure immediately shifts the workload onto the teams on duty, at a time when finding a replacement often takes several weeks or even months. This overload in turn fuels burnout among the remaining colleagues, creating a cycle that sustains turnover rather than reducing it.
How to reduce nurse turnover: effective levers and solutions
Reducing nurse turnover over the long term requires combined action on work organisation, recognition and support for career paths.
Improving working conditions and reducing workload
Adjusting nurse-to-patient ratios, limiting the systematic use of overtime and investing in suitable equipment remain the most structural levers for reducing day-to-day strain. Automating repetitive administrative tasks, when done well, can also give nurses back time for care and restore meaning to their work.
Strengthening recognition and valuing the profession
Explicit, regular recognition of the work done, combined with transparent communication from management about the actions taken in response to teams’ feedback, helps to restore trust and limit the feeling of being invisible to the institution.
Developing career paths and continuing education
Offering clear career prospects, whether towards a specialisation, a healthcare manager position or chosen internal mobility, reduces the feeling of professional stagnation. Continuing education that is accessible and valued by the facility also allows nurses to renew their interest in the job without having to change employer.
Measure and prevent psychosocial risks
Regular assessment of psychosocial risks, included in the mandatory occupational risk assessment document, makes it possible to act upstream rather than in reaction to departures that have already happened. Participatory management, which involves teams in organisational decisions, noticeably reduces turnover compared with directive management that imposes decisions without consultation, a factor identified as aggravating in several field studies.
Encouraging work-life balance
Predictable schedules, fewer last-minute changes to working hours and taking personal constraints into account (parenthood, caring for relatives) are increasingly decisive retention factors for new generations of nurses, who now compare the actual quality of working life in facilities before choosing or staying in a job.
Frequently asked questions about nurse turnover
What is the average nurse turnover rate in 2026?
The nurse turnover rate varies widely by sector: it stands at around 30% in the for-profit private sector compared with 5.5% in public hospitals, and rises to 52.5% in nursing homes (EHPAD). In terms of career paths, 46% of hospital nurses no longer work in a hospital or have changed profession ten years after their first job, according to the DREES.
Why do nurses leave hospital nursing?
Nurses mainly leave hospital nursing because of excessive workload, lack of recognition, burnout and career prospects they see as insufficient. A sense of loss of meaning, particularly when administrative tasks take precedence over direct patient care, also plays an important role in this decision.
How can nurses be retained in nursing homes (EHPAD)?
Retaining nurses in nursing homes requires better working conditions, a pay policy that is competitive with hospitals in the same area, stronger employee benefits (meal vouchers, insurance, transport) and recognition from frontline managers. Team stability is all the more important because turnover in nursing homes directly affects the quality of care for residents who often stay for the long term.
Which tools can be used to measure caregivers’ well-being?
Caregivers’ well-being can be measured using several complementary tools: regular anonymous engagement questionnaires, cross-referenced tracking of absenteeism and turnover indicators, one-to-one meetings with frontline managers, and continuous listening systems that detect weak signals before they turn into departures. This data-driven management, combined with managerial action on the ground, makes it possible to measure the real impact of the quality-of-working-life policies in place.
