What the data says
The above chart illustrates the relative impact of various factors in a machine learning model predicting frontline health system employee turnover in 2024, relative to the prior year; more details are at the end of the article.
The most influential category includes employee tenure in their current organization and number of years of work experience prior to hire. The next most influential category is change in team member role or behavior, followed by demographic elements, burnout events, and managers’ span of control. Example metrics in each category are listed below.
While the ranking of factors contributing to burnout did not shift year over year, the chart also shows that the relative influence of changes in employee behavior, role, and work patterns decreased in 2024 relative to 2023 while the influence of burnout-related factors increased – making this category now tied with demographic factors.
What it means
The decreased risk over the last year is related to change in role, behavior, and work patterns
There has been a dedicated effort to improve onboarding, leadership engagement, and role clarity, leading to noticeable progress in reducing their impact on turnover risk. However, healthcare organizations need to continue investing in these areas given that this category remains the second largest contributor to risk, despite it declining.
The increased risk over the last year is related to burnout
Frontline team member burnout is being fueled by changing workplace stressors, including workplace violence, verbal abuse from visitors, and staffing shortages. These challenges are causing emotional trauma and exhaustion, making it increasingly difficult for nurses to sustain their engagement and resilience.
The workplace environment has deteriorated, with more reports of patient aggression and safety concerns. Healthcare facilities, once considered safe havens where violence was left at the door, have now become settings where the frontline are encountering growing threats to their safety, creating anxiety and emotional exhaustion that accelerates burnout. At the same time, many nurses are working longer hours, skipping breaks, and dealing with chronic understaffing, which leaves them physically and emotionally drained.
Chronic staff shortages continue to be one of the biggest drivers of burnout, forcing nurses to handle increased patient workload and take on additional responsibilities. As a result, nurses, who entered the profession to care for others, are extending their shifts, skipping wellness breaks, and struggling to provide the safe, compassionate care patients deserve.
What the implications are for healthcare leaders
Commit to a balance of approaches to reducing burnout
Addressing the spike in burnout as a leading driver of frontline team member turnover requires a comprehensive, multifaceted approach. Nurses are facing increasing demands, staffing shortages, and workplace challenges, all of which contribute to exhaustion and disengagement.
As one nurse executive consultant, Katherine Howell, BSN, MBA, RN, shares, “The solutions are not simple but need to include: care model redesigns, the removal of non-value added work for the clinical staff and managers, and ensuring senior leaders understand what really is happening at the bedside.”
A balanced strategy may also include proactive recruitment efforts, mental health support, resiliency initiatives, and workplace violence measures to create a stable and secure environment where nurses feel valued and supported. By prioritizing these efforts, patients will ultimately benefit, receiving the quality care they deserve from a well-staffed and focused nursing workforce.
These initiatives all take time and commitment but without decisive action, the consequences will extend beyond nurse retention, placing additional strain on healthcare teams, impacting patient outcomes, and ultimately affecting the entire healthcare system.
A key step in addressing burnout is bolstering support for managers, so they are better positioned to connect with and support their teams, particularly with key events and trends that contribute to burnout. For more on practical steps to take to support managers, see the recent AONL-Laudio Insights report, Trends and Innovations in Nurse Manager Retention, from fall 2024.
Details of the turnover prediction model
The model is built on xgboost; it includes 6 different models that are trained on different department types within a health system. It is trained in 487,451 employee months covering CY 2024.