A study of staffing and the correlation to turnover
Turnover can be both expensive and exhausting for an organization. By focusing on key staffing metrics, significant improvements can be made in reducing turnover rates
Extensive research exists on nursing retention, yet there is a lack of specific information regarding the impact of staffing metrics on clinician turnover.
Clinician retention aims to reduce turnover and maintain staff within an organization. However, decisions about turnover and retention are frequently made without a comprehensive understanding of the underlying causes.
It is widely recognized that staffing levels and scheduling rank among the top five factors contributing to turnover.
The following metrics and related turnover were analyzed: In an effort to shine a light on some of the most important staffing and scheduling factors tied to staff retention, we looked at a number of key metrics from 186 facilities across 28 health systems from July 20, 2014 – September 7, 2024. Only licensed skills in the peer groups of Critical Care, Intermediate Care, Medical Surgical, and Behavioral Health were considered.
The following metrics and related turnover were analyzed:
Seniority
5.1 yrs
<= 3 yrs
78.2%
Leakage
4.2%
> 10.0%
43.8%
Core staff floating
8.4%
> 55.5%
41.6%
Overtime
3.2%
> 15.5%
40.0%
UTO
7.5%
> 11.4%
30.4%
IWT
3.1%
> 11.4%
29.0%
Cancellation
2.4%
> 5.2%
28.5%
Extra time
12.4%
> 8.9%
8.8%
Although the metrics examined in this report may appear varied, they collectively share underlying causes and a related set of strategies for addressing the issues at hand. Enhancing performance in each area necessitates a series of interconnected strategic and operational approaches. The overarching strategy is to ensure the appropriate size and alignment of both core and contingency staffing resources, based on anticipated needs.
Employees who have worked 1.1 years or less at an organization are 87.9% more likely to leave the organization versus employees who have worked more than 1.1 years with the organization.
Our research has found that nursing units with a mix of senior, mid-career, and new grads provide an ideal environment for mentorship and continual staff development. Units with this blend experience lower instances of turnover than those skewed with less experienced or more experienced staff. Effective onboarding strategies and education initiatives, such as
pairing inexperienced staff with a mentor, are crucial in guiding them through their early years.
Incorporating leadership touchpoints through onboarding at 30, 60, 90, and 180 days of a nurse’s tenure allows them to express concerns, frustrations, and areas of confusion. This demonstrates leaders’ investment in each nurse, integrating career goals and individual development plans to help them achieve their objectives. Additionally, providing newer staff with
exposure to different areas of nursing helps them identify their niche and career focus.
This has proven successful through an extended onboarding period where staff spend 8 to 12 weeks within specific departments over 6 to 12 months, emerging well-rounded and feeling valued by the organization. It is highly recommended that organizations deploy an “exit interview” workflow step with employees leaving, these conversations can help uncover root issues and identify trends for leadership to focus on, which could include poor onboarding, the wrong role, overwhelming workload, culture issues, generational differences, or travel opportunities.
By fostering a supportive environment with diverse experience levels and comprehensive onboarding, organizations can significantly enhance staff satisfaction and professional growth, ultimately reducing turnover and building a committed workforce.
Employees who were floated out of their core units for more than 55.5% of their productive hours were 41.6% more likely to leave the organization than employees who were floated out 55.5% or less than their total productive hours.
Employees whose cancellations hours represented greater than 5.2% of their productive hours were 28.5% more likely to leave the organization than employees whose cancellation hours represented 5.2% or less of their productive hours.
The issue of fluctuating core staff and cancellations stems from the same underlying cause yet leads to vastly different outcomes. To mitigate instances of overstaffing or understaffing, a workforce assessment can be conducted which provides guidelines on the appropriate number of core staff for each unit (and subsequent need for flexible resources) based on its projected demand. Scheduling staff in alignment with this demand will enhance operational efficiency. Achieving this requires a robust forecasting methodology that accurately
predicts needs and volumes at the time core staff schedules are created.
Another strategy to reduce employee dissatisfaction related to floating is a cultural mindset shift of hiring into “sister units,” where an employee will be core to a group of units instead of a single unit. This mindset takes time to adopt and will be a major change for tenured employees. However, organizations can still maintain a primary leader and unit role, with the expectation that you can and will be floated within the sister units regularly. This strategy can be expanded to include “sister unit” leaders in feedback and coaching discussions.
Employees whose extra time represented greater than 8.9% of their total productive hours were 8.8% more likely to leave the organization than employees whose extra time represented less than or equal to 8.9% of their total productive hours.
Employees whose overtime represented greater than 15.5% of their total productive hours were 40.0% more likely to leave the organization than employees whose overtime represented less than or equal to 15.5% of their total productive hours.
To reduce excessive overtime, organizations can optimize their core staff levels and establish appropriately sized and layered contingency resources. This strategic staffing approach allows organizations to cost-effectively adjust to varying patient demand while minimizing the reliance on overtime.
Research indicates that excessive overtime is defined as usage at or above 3.1% of total hours—lower than the average observed in the hospitals studied. This highlights the detrimental effects of consistently exceeding one’s full-time equivalent (FTE) limits. It’s important to remember that the 3.1% threshold for overtime should be considered over a sustained period.
While some overtime is unavoidable, it should only be utilized in extreme situations when all other contingency options have been fully exhausted.
Employees whose extra time represented greater than 8.9% of their total productive hours were 8.8% more likely to leave the organization than employees whose extra time represented less than or equal to 8.9% of their total productive hours.
Employees whose overtime represented greater than 15.5% of their total productive hours were 40.0% more employees whose leakage represented greater than 10.0% of their total productive hours were 43.8% more likely to leave the organization than employees whose leakage represented less than or equal to 10.0% of their total productive hours.
Given that various legitimate and unavoidable circumstances necessitate IWT, most organizations typically maintain a reasonable tolerance for such instances. This is particularly relevant when it comes to ensuring safe patient care or completing essential operational processes during shift changes. IWT objectives often focus on identifying and eliminating preventable or repetitive situations to enhance efficiency.
We suggest arranging the leadership response according to the category under which these circumstances fall:
Addressing turnover within healthcare organizations requires a multifaceted approach that focuses on key staffing metrics. Our study highlights the significant impact of factors such as cancellations, core staff floating, extra time, overtime, and both expected and unexpected time off on clinician retention. By understanding and strategically managing these metrics,
organizations can create a more stable and supportive work environment.
The data underscores the importance of maintaining an optimal mix of senior, mid-career, and new staff, as well as implementing effective onboarding and mentorship programs. Additionally, accurate workforce assessments and robust forecasting methodologies are crucial in aligning staffing levels with patient demand, thereby reducing instances of overstaffing and understaffing.
Ultimately, the goal is to foster an environment where clinicians feel valued and supported, leading to improved retention rates and better patient care. By adopting these strategies, healthcare organizations can not only reduce turnover but also empower their staff, creating a more optimistic and sustainable future for the healthcare workforce.
Discover how AI-powered scheduling helps your organization fill shifts faster, balance workloads, and improve satisfaction across every department.
