Building Workforce Stability: Nursing Retention Strategies for Acute-Care Hospitals

The U.S. health care system is confronting a growing workforce instability crisis, especially within acute-care hospitals. According to the 2025 American Hospital Association's Costs of Caring report, hospital labor costs soared to $890 billion in 2024, making up nearly 60% of all hospital expenses, and contract staffing alone consumed more than $51 billion in 2023. Meanwhile, a 2024 HealthExec analysis noted that almost half of U.S. hospitals now operate at negative margins as staffing shortages squeeze budgets and strain operations.

Compounding these financial pressures, retention challenges also are intensifying. The 2024 National Nursing Workforce Survey data revealed that more than 138,000 nurses have already left the workforce since 2022 and by 2029 nearly 40% of registered nurses (RNs) and 41% of licensed practical nurses/licensed vocational nurses said they intended to leave the profession in the next five years-a potential loss of 1.6 million nurses nationwide.

In this environment, effective nursing retention is no longer optional. It's mission-critical.

What Is a Nursing Retention Strategy?

A nursing retention strategy is a proactive, structured plan to reduce turnover by improving nurse engagement, satisfaction, and professional growth. In acute-care settings, this means cultivating environments where nurses feel supported, valued, and empowered to grow in their roles over time.

The goal is to turn nursing from a transient, burnout-prone job into a sustainable, purpose-driven career choice.

Why Nurse Retention Matters in Acute Care

Burnout and Turnover

A 2024 peer-reviewed study in The Journal of Healthcare Leadership found that agency nurse use in U.S. hospitals increased 133% between 2019 and 2022, driving a 260% increase in total agency labor costs and a 178% rise in its share of hospital labor expenses. Reliance on agency labor, where hourly pay rates can exceed staff pay by 50% or more, correlates strongly with financial strain and higher staff turnover.

Another analysis, in JAMA Network Open, found that in 2023, 41% of nurses worked understaffed shifts, 43% experienced workplace violence, and 32% intended to leave within a year, primarily due to high workloads and limited support.

High turnover undermines team cohesion, extends onboarding timelines, and increases reliance on agency labor, ultimately disrupting care continuity.

Financial Strain

The Nursing Solutions Inc. National Health Care Retention & RN Staffing Report estimates that replacing a single RN cost anywhere between $49,500 to $72,700, including recruiting, training, and lost productivity. The Center for American Progress similarly finds turnover costs average 20% of annual salary across industries. Additionally, each nursing vacancy can cost a facility between $5,000 and $9,000 per month.

Hospitals that reduce turnover by even 1% saved an average of $289,000 annually, making retention a powerful lever to reduce financial strain.

Proven Nursing Retention Strategies for Acute-Care Hospitals

1. Strengthen Onboarding and Mentorship.

A 2023 MDPI systematic review affirmed that onboarding, mentoring, and social support are among the most effective retention interventions in hospital settings.

What to do:

• Extend onboarding across 90 days with phased learning goals.
• Pair each new nurse with a mentor for at least six months.
• Provide regular check-in feedback and shadowing.
• Use surveys to identify weaknesses in onboarding.

2. Create Leadership Development and Career Pathways.

Investing in internal advancement opportunities not only improves engagement but also reduces stagnation and shows that your facility values internal talent. However, recent findings from the 2025 Harris Poll Survey reveal that this remains a major area for improvement across healthcare organizations. Less than one-third of health care employees feel very valued or very loyal to their current employer, and only one in five feel their employer is truly invested in their long-term career success.

What to do:

• Offer clinical ladder programs, cross-training, and certification pathways.
• Promote internal candidates to leadership roles.
• Use "stay interviews" to identify staff goals.
• Showcase promotions and internal success stories.

3. Cultivate a Supportive Culture.

Culture is one of the most important-and most overlooked-factors in retention. A 2025 BMC Nursing study linked transformational leadership and work-life balance to improving nurse retention. Nurses who feel heard, respected, and psychologically safe are more likely to stay.

What to do:

• Provide resilience training, peer support, and wellness resources.
• Conduct routine check-ins to detect burnout.
• Train managers in compassionate leadership.
• Host open forums for authentic dialogue.

4. Recognize and Reward Contributions.

When nurses feel seen and appreciated, they're more likely to stay. Recognition, whether public or private, fuels motivation and reinforces purpose. It also builds stronger workplace relationships and reminds staff that their contributions matter.

What to do:

• Celebrate achievements through awards or highlights.
• Host recognition events (e.g. "Nurses Week," service awards).
• Offer education stipends, shift bonuses, or wellness grants.
• Personalize thanks via handwritten notes or public shout-outs.

5. Ensure Competitive Pay and Transparent Benefits.

Salary still matters. Fair, competitive pay communicates respect and reinforces the value of a nurse's work. Financial incentives tied to performance, longevity, or hard-to-fill shifts can also reduce turnover and prevent nurses from seeking higher pay elsewhere.

What to do:

• Benchmark pay against competitors regularly.
• Offer shift differentials, retention bonuses, or flexible pay options.
• Share total compensation packages openly.
• Provide financial wellness resources.

6. Involve Nurses in Decisions.

When nurses shape policies and workflows, they feel ownership. Shared governance reduces frustration and supports retention.

What to do:

• Create nurse-led councils for scheduling, safety, and policy.
• Implement nurse suggestions and publicize outcomes.
• Integrate front-line staff into leadership planning.

7. Offer Scheduling Flexibility.

Rigid schedules drive exits. According to a recent study from the University of Pennsylvania School of Nursing's Center for Health Outcomes and Policy Research, poor work-life balance is among the top reasons why nurses are leaving health care employment. Consider leveraging workforce platforms like Booker powered by SnapCare to forecast demand, reduce schedule volatility, and improve staff satisfaction.

What to do:

• Use predictive scheduling tools to match supply/demand.
• Support shift-swapping and self-scheduling.
• Pilot flexible block scheduling models.
• Monitor schedule satisfaction data each quarter.

8. Support Ongoing Education and Upskilling.

Recent findings from the 2025 Harris Poll Survey underscore how crucial continuing education is for retention. More than eight in 10 employees believe employers should be investing in their education, and 63% of health care employees say they'd be more likely to stay with their employer if tuition support were provided. Among younger staff, the numbers are even higher, with 61% of Gen Z employees citing education benefits as a key reason they remain with their current employer.

What to do:

• Subsidize continuing education units and specialty certifications.
• Host internal workshops and leadership training.
• Provide time off or paid attendance for workshops and symposiums.

Final Thoughts

Failing to address nurse retention risks accelerating labor cost growth. Hospital reliance on agency staffing has already surged, and rising wages continue to erode margins amid slim reimbursement models.

For acute-care hospitals balancing margins and mission, nurse retention must be a strategic priority. Strategies such as structured onboarding, inclusive leadership, and flexible scheduling not only reduce turnover costs but improve patient outcomes, staff engagement, and organizational resilience.

Implementing even a few of these steps can have a major impact: lower vacancy costs, increased staff satisfaction, and more consistent, high-quality patient care.