May 16, 2024 The upcoming RN retirement wave is in revenue-generating specialties

While the “Great Resignation” retirements are behind us, in Ambulatory Surgery Centers (ASCs), Operating Rooms (ORs), and related surgical areas, more retirements are about to happen. This has major implications for health systems’ priorities in recruiting and training.



What the data says
The greatest percentage of RNs over the age of 55 are in ambulatory, Operating Rooms (ORs), and Pre-Op/Anesthesia/Post Acute Care Units (PACUs). In these three surgical areas, 20-30% of RNs are in this age group, which will comprise the next wave of retirements in the coming years. These areas also have the fewest number of young RNs; in other words, those who will soon need the most early-tenure RNs are the least experienced in recruiting and supporting them.

Ambulatory includes a number of different location types, detailed further in the chart below:Ambulatory Surgery Centers (ASCs), clinics (e.g., pediatric and cardiovascular physician offices), and urgent care centers, among others. ASCs have the highest percentage of RNs over the age of 55 at close to 50%.

ASCs generally have shorter, weekday-based, predictable working hours, unlike inpatient surgical areas. As the upcoming retirement wave requires new RNs in both inpatient surgical areas and ASCs, the natural attraction of ASCs will make it even harder to adequately staff the inpatient surgical areas.

The specialty with the next highest percentage of older RNs is Telehealth/patient sitters, where RNs gravitate when they want to stay in nursing but are looking for less strenuous work.  


What it means
Upcoming retirements will be anchored in revenue-generating surgical areas, which have not proven attractive to younger RNs nor able to support the needs of a large early-tenure workforce.

  1. The next major wave of health system retirements is anchored in surgical specialties, which generate most of the revenue for hospitals and health systems.
    • ASCs, ORs, and PACUs are most of the major revenue-generating areas within health systems. This is the group with the highest share of older RNs and where the next major wave of retirements are most likely to occur.
    • Emergency Departments (EDs) are also revenue-generating, though their major wave of retirements already occurred during the “Great Resignation.”

  2. Younger RNs are currently attracted to non-surgical specialities; it is not clear that surgical specialties will be as attractive.
    • Over the last few years, as the first “Great Resignation” wave hit, many of the retirements were in ICUs, Step Down Units, and EDs because they cared for most of the acute COVID patients, which accelerated burnout and turnover. In contrast, surgery units shut down during Covid resulting in a lot of lost hours and work by members of those surgical teams; therefore, surgical RNs may have delayed retirement.
    • To fill the gap created by retirements, younger RNs have moved into these specialties earlier in their careers than typically in the past. Younger RNs are attracted to these specialties in particular because they accelerate the building of a critical care skill set. Women’s Health and Pediatrics have also been attractive specialties for younger RNs in recent years.
    • It is not clear that the surgical specialties will be as attractive to the younger RNs they need to replace retirees, unless investments are made in recruiting, onboarding, and ongoing mentoring and development.

  3. The pipeline to recruit and the platforms to train, coach, and support young surgical RNs does not exist at the scale that will soon be needed.
    • The lack of young RNs in the surgical specialties today implies that health systems have not marketed them to early tenure RNs sufficiently or built a sustainable RN recruiting pipeline.

What the implications are for healthcare leaders 
Surgical specialties need to accelerate efforts to build new leadership opportunities for their mid-career team members, create new communications to attract recruits, and create platforms to onboard and support an upcoming wave of younger RNs.

  1. Surgical specialties need to start preparing for the loss of their most experienced team members; a key step is creating opportunities for mid-career team members to proactively take on new leadership roles.
    • With 20-30% of RNs in the specialties very experienced, the teams and their managers naturally rely on them for both informal guidance and formal leadership roles. The next generation of experienced leaders – the cohort of RNs in their 30s and 40s today – may have had fewer opportunities to lead given the large role the more senior team members have played.
    • Advancing these mid-career RNs into leadership roles (e.g., as charge nurses, preceptors, committee members, and managers, owning internal processes, and leading education events) now will allow them time to learn these new roles before they are more urgently needed to fill them. This may require asking some more senior team members to step back prematurely.
          • Surgical specialties are among the fastest growing areas in the hospital where managers are adding additional departments and increasing their spans of control and responsibility, reinforcing the need for mid-career RNs to take on new formal leadership roles within their teams.

  2. Surgical specialties should consider ways to communicate the unique value and sustainability of a surgical career (both within their organization and to nursing school partners).
    • With only 10-15% of surgical specialty RNs in their 20s today, these departments need to build new messaging to recruit new RNs, especially early-tenure ones. For example, collecting and sharing messages from current surgical RNs about their role and how the specialty has helped them grow and stay challenged over a career.
    • Creating channels to share communications inside the health system, as well as with external nursing program partners, could help to create a new pipeline of prospects.
    • A new emphasis is needed on creating and communicating a sustainable work-life balance in surgical services.
          • As one surgical services director recently shared, “We’ve definitely recognized the need to focus on recruitment and retention in surgical services…There is a renewed emphasis on work-life balance and as leaders we need to look for staffing options that will cover the department effectively, but also give staff the work-life balance they desire.”
    • Leaders should consider new committees that focus on supporting new graduate recognition and preceptor recognition. Preceptor programs that support team members outside of their home department provide the additional value of creating a relationship that they can confide in.  

  3. Surgical specialties need to start investing and building platforms to train, coach, and support young surgical RNs at scale.
    • Training and residency programs are costly but there is a need to build and invest in these areas. There is a clear ROI to maintaining surgery as a fully staffed and thriving department as revenue leaders for health systems in the future.
    • Many health systems are dealing with significant financial challenges including escalating labor and supply costs as well as lower reimbursements. Given that ambulatory and surgical specialty areas are among the largest revenue generators, waiting to address these trends could bring additional financial risk in the near future.
    • In particular, executives may want to prioritize building formal partnership with Float Pool, Residency, and Med Surg leaders to create an internal pipeline of OR RNs to meet the upcoming demand. This is quantified in the chart below which shows where recently hired OR RNs, who have transferred into the OR, have come from.


Written by Tim Darling

President of Laudio Insights

Tim Darling is a Co-Founder of Laudio and President of Laudio Insights. With over 20 years of experience in healthcare technology, Tim has a passion for using data and analytics to serve the challenges facing healthcare organizations. Prior to Laudio, Tim was on the leadership team of a healthcare education analytics company and also spent seven years as a consultant at McKinsey & Company. Tim has an MBA from Carnegie Mellon and BS degrees in Mathematics and Computer Science from the University of Maryland, College Park.

Subscribe to Laudio Insights