Staff RN turnover remains a costly and persistent challenge for healthcare organizations, even as hospitals continue investing in workforce initiatives, retention programs, and new care models.
According to NSI Nursing Solutions’ 2025 Retention & RN Staffing Report, staff RN turnover stands at 16.4%, while the average cost to replace a bedside RN has climbed to $61,110. At the same time, Press Ganey’s Nurse Experience 2025 report found that 17% of nurses left their roles last year, including 24% of Gen Z nurses in 2024.
The findings suggest that nurse retention depends less on launching new initiatives and more on whether nurses feel included in decisions that affect their practice.
As nurse leaders search for solutions, Bethany Robertson, clinical executive at Wolters Kluwer Health, says the answer may not be another retention initiative. Instead, nurse retention may depend on how leaders communicate, involve nurses in decision-making, and build trust through shared governance and meaningful engagement during change.
Why Communication Matters More Than Ever
Healthcare organizations communicate constantly, but that does not always mean the communication is effective.
“In a complex clinical environment, communication itself is often the challenge,” Robertson said. “It’s happening in every direction, up and down the organization, across teams, and between individuals. Without a clear structure, it quickly becomes inconsistent or gets lost altogether.”
Rather than encouraging more communication, Robertson says organizations need consistent systems that embed it into everyday clinical work. Pre-shift huddles and post-shift debriefs can help align teams around patient needs, organizational priorities, and emerging concerns while creating space for nurses to ask questions and raise issues in real time.
The same principle applies to nurse-to-nurse communication. Frameworks such as SBAR (Situation, Background, Assessment, Recommendation) create consistency and clarity, but only when organizations adopt and reinforce them across the workforce.
Just as important, leaders must close the loop.
“Leaders need to come back with what they heard, what’s changing, and what isn’t, along with the reasoning behind those decisions,” Robertson said. “Even when the answer is ‘not right now,’ context builds trust.”
Why Good Ideas Often Fail
Many workforce initiatives fail not because they are bad ideas, but because nurses are brought into the process too late to shape the outcome.
“A lot of workforce and workflow changes don’t fail because the idea is wrong, but rather because the implementation falls short,” Robertson said.
She points to a common pattern in healthcare organizations: decisions are made in isolation and rolled out quickly, with insufficient attention to long-term sustainability.
Instead, Robertson advocates for a structured change management approach that clearly explains why changes are occurring, what success looks like, and how those changes will affect nurses’ day-to-day work.
Success metrics also matter. In Wolters Kluwer’s FutureCare Nursing research, chief nursing officers identified patient outcomes and nurse competency, each cited by 87%, as key indicators of successful change. Robertson says those measures resonate because they directly connect to nurses’ practice and patient care.
Moving Beyond Feedback Surveys
Healthcare leaders frequently talk about nurse engagement, but Robertson believes true empowerment requires more than collecting feedback. For her, empowerment starts earlier, when nurses are included in the work itself.
“Authentic nurse empowerment is far more complex than a feedback survey or a one-time listening session,” she said.
Too often, nurses are asked for input after major decisions have already been made. By that point, opportunities to influence care delivery, workflows, and operational priorities are limited.
According to Robertson, organizations achieve stronger results when nurses participate during the design phase of initiatives rather than after implementation plans have already been finalized.
Shared governance models can play an important role when supported by clear responsibilities, protected time, and organizational resources.
“The impact should also be measurably reflected in improvements in patient outcomes, stronger nurse engagement, and an increase in nurse-led initiatives that directly improve practice,” Robertson said.
What Nurses Need From Leaders During Major Change
Whether organizations are implementing new technologies, adjusting staffing models, or redesigning workflows, Robertson says nurses need leaders who remain engaged long after launch day.
“Nurses need leaders who stay close to the work well beyond go-live,” she said.
According to Robertson, nurses need ongoing visibility into progress, outcomes, and adjustments made along the way. Leaders who remain engaged after implementation signal that change is a shared responsibility rather than a burden placed solely on frontline staff.
She also emphasized the importance of psychological safety.
“Continuous improvement depends on that kind of environment, with consistent feedback loops tied to clear metrics,” Robertson said.
When nurses feel safe speaking up about concerns, organizations are more likely to identify problems before they affect patient care or staff well-being.
Sometimes Slowing Down Helps Organizations Move Faster
One of Robertson’s most notable observations challenges the pressure many healthcare organizations feel to move quickly.
“Sometimes you have to slow down in order to move fast,” she said.
Robertson argues that involving nurses earlier often accelerates implementation rather than slowing it down. Frontline nurses can identify workflow challenges before rollout, reducing the need for costly fixes and workarounds later.
“Not involving nurses early enough is often what creates delays later,” Robertson said.
The Gen Z Retention Challenge
The latest turnover data suggests healthcare organizations may need to pay closer attention to the needs of early-career nurses.
With nearly one-quarter of Gen Z nurses leaving their roles in 2024, Robertson says healthcare organizations must pay closer attention to the needs of early-career clinicians.
New nurses often look for clear expectations, timely coaching, and reliable support systems as they develop confidence and competence.
“They’re also watching closely for the behaviors that define unit culture, especially whether speaking up leads to action,” Robertson said.
When nurses see no follow-through after raising concerns, disengagement can take root, affecting individual nurses, team culture, and morale.
One Change Leaders Can Make Today
If nurse leaders want to improve trust immediately, Robertson recommends creating more visible and actionable communication between leaders and frontline staff.
“We need to make communication more visible and more useful in the moment,” she said.
Her advice is simple: conduct regular rounding, ask nurses what is getting in their way, remove barriers when possible, and communicate what changed because nurses spoke up.
“Nurses don’t need or want speeches; they want proof that leadership is paying attention and acting.”
Building Nurse Retention Through Trust
As hospitals continue grappling with turnover, burnout, and workforce shortages, Robertson believes lasting solutions depend on more than recruitment efforts or new programs. They also depend on trust and nurse involvement.
For Robertson, the foundation of successful change is trust. Nurses are more likely to support and sustain new initiatives when leaders communicate clearly, act on feedback, and remain accountable for results.
“Doing what you say you will do builds trust and respect, and that’s what ultimately determines whether people will support and sustain change.”
That, she argues, may be one of the most important retention strategies available to nurse leaders today.
