The national hospital turnover rate reached 18.5% in 2025, with frontline support roles experiencing even higher rates of employee churn. With research showing that disengagement, reduced feedback, and declining trust often emerge months before resignation, turnover can be a predictable outcome of conditions in the work environment.
Despite this, many healthcare organizations are struggling to determine what’s causing turnover even while they’re investing (sometimes unsuccessfully) in retention efforts. Understanding the true drivers of turnover in healthcare can help organizations change the outcome.
Key Takeaways
- Employee retention in the healthcare field is shaped by the entire employee experience, from the expectations set during recruitment to first-year support, leadership, workload, and scheduling.
- Broad, reactive retention efforts can miss the specific challenges affecting different roles, shifts, departments, and career stages.
- Continuous feedback and workforce analytics give leaders earlier visibility into retention risks so they can take more focused action before employees leave.
What Drives Healthcare Employee Turnover?
Press Ganey's 2026 data shows that the root causes can come down to several structural, generational, and sometimes shift-specific factors:
- Weak first-year support. When early-tenure employees feel unprepared or unsupported, they leave early, with 22.7% of newly hired registered nurses (RNs) leaving within their first year.
- Leadership experience. More than a third of healthcare employees (35%) and providers (37%) report low confidence in senior leadership. Confidence in leadership remains a strong driver of employee engagement, and when it erodes, retention follows.
- Shift and schedule differences. Nurses working nights and weekends report significantly lower perceptions of safety culture, teamwork, and organizational support compared to daytime counterparts, and RNs with negative perceptions of teamwork and resources are 1.53x more likely to leave.
- Workload and recovery. Sustained workload pressure without adequate recovery time compounds burnout and accelerates exit decisions.
- Unmet expectations. When the job does not match what was described during recruitment, early attrition rises. This may happen when call schedules, patient volumes, or team dynamics differ from what was communicated during the hiring process.
Why Retention Efforts May Not Produce Lasting Results
Many retention programs are well-intentioned, but may be too broad or too late to help you prevent turnover. For example:
- One-time bonuses or across-the-board incentives apply the same solution to every role, regardless of where risk is concentrated.
- Annual engagement surveys provide useful trend data, but results often take months to reach frontline leaders and can delay necessary action.
- Exit interviews capture why someone left, but by that point the organization has already absorbed the cost and the team has already felt the impact.
How Can Employers Identify Root Causes Earlier?
When leaders can see where risk is developing, they can act before a resignation reaches HR.
The organizations making the most progress use continuous listening at the role, shift, and department level to surface warning signals early. This should involve implementing:
- First-year checkpoints that track the new hire experience in real time
- Stay interviews that capture what’s working before someone decides to leave
- Sentiment trends broken out by unit and shift
- Workforce analytics that connect engagement data to turnover patterns
What Does a Proactive Retention Strategy Look Like?
A proactive strategy connects each stage of the employee experience so that gaps in one area do not quietly undermine the next:
- Set realistic expectations during recruitment so new hires arrive prepared for the actual role, schedule, and workload they will encounter.
- Structure the first-year experience with scheduled check-ins, assigned mentorship, and clear competency milestones.
- Equip managers to act on early signs of disengagement through leadership development and access to workforce data, because frontline managers are often closest to retention risk and least prepared to address it.
- Collect feedback continuously through touchpoint surveys, stay interviews, and department-level sentiment tracking so leaders can act in weeks instead of quarters.
- Target interventions by role, shift, and tenure, because night-shift nurses, early-career CNAs, and experienced providers leaving for schedule flexibility all require different responses.
Where Does RetentionWise™ Fit?
As part of its healthcare talent acquisition and retention work, Churchstreeter and Crosse developed RetentionWise to help healthcare organizations move from turnover response to workforce foresight. The framework follows three stages:
- Listen through touchpoint surveys, manager check-ins, and exit interviews
- Analyze through workforce trend data, turnover-risk indicators, and role and shift pattern analysis
- Act through data-backed talent strategy, leadership development, and targeted intervention
This gives leaders early visibility into where retention risk is building so they can respond with specific, targeted retention strategies to reduce turnover.
Move From Turnover Response to Workforce Foresight
Retention challenges rarely have a single cause. RetentionWise helps healthcare leaders identify where risk is building, understand what is driving it, and take focused action before employees leave.