Navigating the Nursing Crisis: A Sustainable Approach for Health Systems

For years, health systems have attempted to recruit their way out of the nursing crisis. However, the latest data from NSI and JAMA Network Open reveals a different story: the real issue is not merely supply, but sustainability.

The NSI Numbers: Turnover Is Still Bleeding Margin

NSI’s 2025 National Health Care Retention & RN Staffing Report makes the financial consequences painfully clear:

• National RN turnover remains elevated at 16.4%, even after dropping from a pandemic peak of 27.1%.

• The average acute care hospital has effectively replaced its entire RN workforce once in the last five years (103.1% cumulative RN turnover).

• RN vacancy is still 9.6%, and more than 40% of hospitals report vacancy rates above 10%, driving chronic overtime, crisis pay, and reliance on travelers.

• The average cost of turnover for a staff RN is $61,110, with the typical hospital losing $3.9–$5.7 million per year from RN turnover alone.

• Every 1 percentage point change in RN turnover now costs or saves roughly $289,000 per year, and replacing 20 travel RNs with employed staff can save about $1.58 million annually.

  
  

On paper, this appears to be a staffing problem. In practice, it is a burnout and work design problem that manifests as turnover, vacancies, and labor expense.

What JAMA Found: Nurses Would Come Back – But Not to “Business as Usual”

A new JAMA Network Open study of more than 4,000 nurses who left hospital jobs between 2019 and 2024 posed a simple question: What would it take for you to return? The answers align almost perfectly with the pressure points hidden in the NSI data:

• A significant share would consider returning to hospital employment if three organizational factors improved:

- Adequate and safer staffing levels

- More flexible scheduling

- Better pay and benefits

Many of these nurses are not “done with nursing.” They are done with unsustainable conditions. This distinction matters for strategy. If leadership treats this purely as a pipeline issue—more schools, more recruitment, more sign-on bonuses—they will miss the much larger opportunity: reattracting experienced talent that already knows the work, the patients, and the culture.

Where NSI and JAMA Converge: The Levers Are the Same

When read side by side, NSI and JAMA describe two sides of the same problem:

• NSI shows where the system is breaking:

- Elevated RN turnover and vacancy

- High churn in high-acuity settings (ED, stepdown, behavioral health, critical care, med-surg, telemetry, burn)

- Heavy dependence on overtime and travelers as a structural crutch

• JAMA shows what nurses need to see fixed before they trust the bedside again:

- Staffing ratios that do not guarantee moral distress

- Schedules that allow for a life outside the hospital

- Compensation that reflects risk, responsibility, and flexibility

The common thread is clear: burnout is not a soft, abstract concept—it is operational, measurable, and reversible.

What This Means for Health System Strategy

For health systems, this combined evidence should reshape the workforce agenda:

1. Redesign work before scaling recruitment. If first-year nurses leave due to workload, scheduling, and support, adding more bodies only accelerates the churn. NSI’s finding that over one-fifth of newly hired RNs leave within a year is a warning, not a footnote.

   
   

2. Treat turnover and vacancy as “burnout KPIs.” Elevated RN vacancy (9.6% on average, with many organizations above 10%) and high reliance on travelers are not just cost issues—they are real-time indicators that the frontline environment is unsustainable.

   
   

3. Invest in re-attraction, not just attraction. The JAMA study shows that a meaningful segment of former hospital nurses can be recruited again if organizations address core conditions. This represents a fundamentally different strategy than chasing an ever-shrinking pool of new graduates.

   
   

4. Align financial incentives with retention outcomes. When each RN departure costs approximately $61K and each 1% change in turnover swings nearly $300K in either direction, retention is not merely “HR’s initiative”—it is a central margin lever.

   
   

How WonWay Health Thinks About This

At WonWay Health, we view workforce strategy as a system design problem, not merely a hiring problem. The NSI and JAMA data reinforce a simple truth: You do not resolve a burnout-driven crisis by recruiting harder. You resolve it by making the bedside a place nurses can sustainably choose again.

If your organization is grappling with persistent RN vacancy, high travel spending, and stalled retention initiatives, this may be the moment to step back and redesign the work itself—staffing, scheduling, and compensation—around what both the numbers and nurses are clearly indicating.

The Path Forward: Building a Sustainable Workforce

Understanding the Root Causes of Burnout

To effectively address the nursing crisis, we must first understand the root causes of burnout. Factors such as excessive workloads, lack of support, and inadequate staffing levels contribute significantly to nurse dissatisfaction. By identifying these issues, health systems can implement targeted strategies to alleviate stress and improve job satisfaction.

Implementing Effective Solutions

Health systems should prioritize solutions that directly address the identified causes of burnout. This includes:

• Enhancing staffing levels to ensure nurses are not overwhelmed.

• Offering flexible scheduling options that allow for a better work-life balance.

• Providing competitive pay and benefits that reflect the demands of the role.

  
  

Creating a Supportive Work Environment

A supportive work environment is crucial for nurse retention. This can be achieved through:

• Regular check-ins with staff to gauge their well-being.

• Access to mental health resources for nurses experiencing stress.

• Encouraging open communication between management and staff.

  
  

Fostering a Culture of Recognition

Recognizing the hard work and dedication of nurses can significantly boost morale. Health systems should implement programs that celebrate achievements and acknowledge the contributions of nursing staff.

Investing in Professional Development

Offering opportunities for professional growth can enhance job satisfaction. Health systems should invest in:

• Continuing education programs that allow nurses to expand their skills.

• Leadership training for those interested in advancing their careers.

  
  

Leveraging Technology for Efficiency

Technology can play a pivotal role in reducing burnout. By streamlining administrative tasks and improving communication, health systems can free up nurses to focus on patient care. This can lead to increased job satisfaction and reduced turnover.

Conclusion: A Call to Action

The nursing crisis is a complex issue that requires a multifaceted approach. By understanding the root causes of burnout and implementing effective solutions, health systems can create a sustainable workforce. At WonWay Health, we are committed to helping organizations navigate these challenges and achieve significant revenue growth. Together, we can establish a healthcare environment where nurses thrive and patients receive the best care possible.

By addressing these critical issues, we can transform the nursing profession and ensure that healthcare systems are equipped to meet the demands of the future.