Why Is Nursing Still So Hard to Staff?

The nursing shortage isn’t news. Its persistence is the real story. What’s new is a clearer understanding of what that cycle costs.

A February 2026 study in Nursing Outlook from Emory University’s Nell Hodgson Woodruff School of Nursing quantified the cost, line by line. Across 1,501 med-surg nurses at seven Emory hospitals, turnover hit 24%, with vacancies taking 21.7 weeks to fill and contract labor covering 75.5% of backfill hours.

When contract labor replaced a departing RN, the cost was $85,498 per nurse, totaling $27.9 million annually across the system. Hiring isn’t where the system breaks down; hospitals can still recruit thoughtful, empathetic people who want to care for others at their worst moments. Keeping them is where it breaks down.

The 2026 NSI National Health Care Retention Report found hospital RN turnover at 17.6%, with nearly a third of newly hired RNs leaving within their first year. The pipeline leaks fastest where it matters most.

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Part of the issue starts in school. Programs train students to pass the NCLEX and obtain credentials, then send them to the bedside unprepared for the realities of practice. A recent Nurse.org survey of more than 470 nurses on social media found that 24% of respondents agreed that traditional nursing schools are designed for NCLEX prep while “real nursing is learned on the job.”

“The translation from classroom to floor has always required time. But many nurses say they weren’t told that upfront, and the shock of that gap is part of what makes the first year so hard,” according to the article.

Classroom-to-bedside gaps are further compounded by additional factors such as toxic workplace behavior, patient violence, and unsustainability of the job, ultimately leading to burnout. A 2022 McKinsey & Company report found that 32% of nurses planned to leave direct patient care because of insufficient staffing levels, lack of support at work, and the emotional toll of the job.

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The answer for hospital leadership isn’t to recruit harder. It’s to grow from within.

The Emory research made such a compelling case that the health system acted, investing $150 million systemwide, returning roughly $9,000 per nurse to paychecks, cutting contract nurse use from 1,370 to fewer than 300, and restoring turnover to pre-pandemic levels.

Most hospitals won’t write a $150 million check, but every hospital already has turnover money sitting in the budget. Reallocate it.

The NSI report puts the average turnover cost for a bedside RN at $60,090, which costs the average hospital $4.2 million to $6.2 million a year. How could that money be better allocated?

Invest in the nursing assistant already in your building who can’t see a financial path to nursing school. Every nurse I know, including me, worked two jobs and picked up extra shifts to pay for their degree. Instead of burning that money on churn, put it toward advancing the people already in your hallways.

Corporate partnerships are another path. A company funding 10 nursing degrees costs roughly $1.5 million, a considerable investment in its community and a pipeline it helps build.

Another way to keep nurses engaged and motivated is by encouraging them to get active or connect with their alumni chapters.

Reducing nurse attrition is a key priority for alumni relations offices as they continually focus on initiatives that support both career longevity and professional well-being.

Some of those initiatives could include pairing new and transitioning nurses with experienced alumni to reduce burnout, foster confidence, and create supportive peer relationships. Offering workshops and targeted programming can help nurses grow into advanced leadership and specialty practice roles to support career progression and long-term satisfaction.

Another method to stem nurse attrition is to highlight alumni accomplishments and impact stories, a tactic that could help reinforce pride in the profession and build a stronger emotional connection to nursing as a long-term career path.

The shortage isn’t going away. Real levers remain: build and promote internal talent, partner with employers to fund the pipeline, and protect the first two years so churn stops becoming the system’s default. The cycle won’t stop on its own. It’s time to break the wheel.

Disclosure: The author is an executive at Nightingale Education Group, a nursing education company that partners with employers on workforce education programs. Nurse.org received no compensation for this article.

🤔 If your hospital reinvested its turnover costs in the people already working there, what would you want that money spent on first? Share your thoughts in the comments below.