Why Your Nursing Home's Turnover Rate Is Higher Than You Think (And What to Do About It)

The nursing home industry has a staffing problem, and almost everyone in the industry knows it. What fewer operators fully appreciate is the true scope of the problem and the compounding damage it causes when left unaddressed.

According to data from the Bureau of Labor Statistics and CMS staffing reports, the average annual turnover rate for nursing home staff hovers between 50% and 75%, with some facilities experiencing rates well above 100%. CNA turnover is particularly acute, with many facilities replacing their entire aide workforce every 12 to 18 months.

But here is what the headline number does not tell you: most facilities undercount their turnover. They exclude agency staff from the calculation. They do not account for internal transfers that mask dissatisfaction. They count only voluntary separations and ignore the involuntary terminations that often stem from the same root causes. When you calculate true all-in turnover -- every position that had to be refilled, regardless of the reason -- the numbers are almost always worse than what leadership reports.

This article examines why turnover is so persistent, what it truly costs, and the strategies that evidence shows actually work to reduce it.

The True Cost of Turnover

Most administrators can estimate what they spend on agency staffing. Fewer have calculated the full cost of turnover, which extends far beyond the direct expense of filling open positions.

Direct Costs

• Recruitment expenses. Job postings, recruiter fees, background checks, drug screenings, and onboarding paperwork. For a single CNA position, these costs typically range from $2,500 to $5,000. For licensed nurses, the figure can exceed $10,000.
• Agency and overtime spend. When positions sit vacant, shifts still need to be covered. Agency CNAs cost two to three times what a facility's own staff costs per hour. Overtime for existing staff, while less expensive than agency, contributes to burnout and further turnover.
• Training and orientation. New hires require orientation to your facility, training on your systems and protocols, and a ramp-up period before they reach full productivity. This investment is lost every time a new hire leaves within their first 90 days -- which happens with alarming frequency.

Indirect Costs

• Quality of care degradation. Research consistently shows a direct correlation between staffing continuity and resident outcomes. Facilities with high turnover have higher rates of falls, pressure injuries, infections, and hospitalizations. Residents form relationships with consistent caregivers, and disruption of those relationships has measurable effects on mental health and engagement.
• Remaining staff burnout. When colleagues leave, the workload does not leave with them. Remaining staff absorb additional assignments, work more overtime, and experience the emotional toll of constantly training new coworkers who may leave within weeks. This creates a vicious cycle where turnover causes burnout, which causes more turnover.
• Survey and regulatory risk. CMS evaluates staffing levels and consistency during surveys. High turnover can lead to deficiencies related to staffing adequacy (F725, F726), quality of care (F684), and resident rights. Poor staffing also increases the likelihood of incidents that trigger complaint surveys.
• Reputation damage. In an industry where word-of-mouth matters enormously, facilities known for high turnover struggle to attract both residents and employees. Online reviews from former staff can deter potential applicants, and family members increasingly research staffing stability before choosing a facility.

Putting a Number on It

A conservative estimate of the fully loaded cost of replacing a single CNA is $4,000 to $6,000. For a 100-bed facility with a 60% CNA turnover rate and 40 CNA positions, that translates to approximately 24 CNA replacements per year -- a cost of $96,000 to $144,000 annually on CNA turnover alone. Add in LPN and RN turnover, and the total cost can easily exceed $250,000 to $500,000 per year.

For many facilities, turnover is their single largest controllable expense. Yet it rarely receives the strategic attention it deserves.

Why Staff Really Leave

Exit interviews, when conducted at all, often produce sanitized answers. "Found a better opportunity" or "personal reasons" are common responses that tell you almost nothing useful. Understanding the real drivers of turnover requires looking beyond surface-level explanations.

It Is Not Just About Pay

Compensation matters, certainly. But multiple studies -- including research published in the Journal of the American Medical Directors Association and the Gerontologist -- have found that pay is rarely the primary driver of turnover in long-term care. Staff leave facilities that pay well. Staff stay at facilities that pay modestly. The difference is almost always something else.

The Real Reasons

1. Feeling undervalued and disrespected. This is consistently the number one driver of turnover in frontline healthcare roles. CNAs and nurses who feel that their contributions are not recognized, that their input is not welcome, and that they are treated as replaceable will eventually prove the point by leaving. This is a leadership and culture problem, not a compensation problem.

2. Unmanageable workloads. When staffing ratios are chronically inadequate, staff cannot provide the level of care they entered the profession to deliver. The moral distress of knowing that residents need more than you can give is a powerful driver of burnout and departure. This is compounded when management's response to short staffing is to demand more from fewer people rather than addressing the root cause.

3. Scheduling inflexibility and unpredictability. Healthcare workers, particularly CNAs, often have complex personal lives that require scheduling flexibility. Facilities that mandate overtime, change schedules with little notice, or refuse to accommodate reasonable scheduling requests drive away competent employees who can find more accommodating employers.

4. Inadequate training and support. New hires who are thrown into patient care without adequate orientation and mentoring feel set up to fail. When mistakes happen -- as they inevitably do with insufficient training -- punitive responses rather than coaching further erode retention.

5. Toxic workplace dynamics. Bullying, cliques, favoritism, and poor conflict resolution are rampant in some facilities. When management fails to address interpersonal toxicity, good employees leave rather than tolerate the environment. Often, it is the best employees who leave first because they have the most options.

6. Lack of advancement opportunities. Ambitious, high-performing staff want to grow. Facilities that offer no career ladder, no tuition assistance, and no path from CNA to licensed nurse (or from staff nurse to leadership) will lose their most driven employees to organizations that do.

7. Poor management. People do not leave jobs; they leave managers. Supervisors who micromanage, communicate poorly, play favorites, or fail to advocate for their teams directly drive turnover. Investing in frontline supervisor training is one of the highest-return retention strategies available.

Proven Retention Strategies

Reducing turnover requires a multi-faceted approach. There is no single intervention that solves the problem. The facilities that achieve meaningfully better retention rates -- and they do exist -- typically implement several strategies simultaneously.

1. Fix the Onboarding Experience

The first 90 days of employment are the most critical period for retention. National data shows that a disproportionate share of turnover occurs within the first three months, often because the onboarding experience fails to set new hires up for success.

What effective onboarding looks like:

• A structured orientation program that spans at least two weeks, not two days.
• Assignment of a dedicated preceptor or buddy who is compensated for the mentoring role.
• Graduated workload increases rather than immediate full assignment.
• Regular check-ins with a supervisor during the first 90 days -- at minimum on days 7, 30, 60, and 90.
• A formal mechanism for new hires to provide feedback about their onboarding experience.

2. Redesign Scheduling

Scheduling is one of the most actionable levers for retention. Modern scheduling approaches can dramatically improve staff satisfaction without increasing labor costs.

Strategies that work:

• Self-scheduling within guardrails. Allow staff to select their preferred shifts within parameters that ensure adequate coverage. Technology platforms exist that make this manageable even for large facilities.
• Consistent scheduling patterns. Rotating schedules that change every week are a retention killer. Staff need predictability so they can manage childcare, education, and personal commitments.
• Shift differential optimization. Ensure your shift differentials are competitive and genuinely incentivize hard-to-fill shifts rather than simply adding a token premium.
• Eliminate mandatory overtime where possible. Mandatory overtime is one of the fastest ways to burn out and lose good staff. If your facility relies on mandatory overtime regularly, you have a staffing level problem, not a scheduling problem.

3. Build a Recognition Culture

Recognition does not require a large budget. It requires intentionality and consistency.

Effective recognition approaches:

• Immediate, specific praise. "I saw how you handled Mrs. Johnson's anxiety this morning -- you were patient and kind, and she calmed down because of you" is infinitely more powerful than a generic "good job" or a quarterly pizza party.
• Peer recognition programs. Allow staff to recognize each other. This builds community and ensures that contributions visible only to peers are acknowledged.
• Milestone celebrations. Acknowledge tenure milestones publicly. When a CNA reaches their one-year anniversary, make it an event -- because in this industry, one year is an achievement worth celebrating.
• Career development investment. Tuition reimbursement, CNA-to-LPN bridge program support, or leadership training opportunities signal that the facility invests in its people's futures.

4. Invest in Frontline Supervisors

Your charge nurses, shift supervisors, and unit managers are the single most influential factor in frontline staff retention. Yet these roles often receive the least leadership development.

Priority investments:

• Leadership training for new supervisors. Clinical competence does not equal management competence. Supervisors need training in communication, conflict resolution, delegation, and performance management.
• Coaching and accountability. Hold supervisors accountable for their team's retention metrics, and provide them with the coaching and resources to improve.
• Reasonable spans of control. Supervisors who are responsible for too many staff members cannot provide the individual attention that drives retention. Evaluate whether your supervisory structure supports meaningful engagement.

5. Address Compensation Strategically

While pay alone does not solve turnover, below-market compensation will undermine every other retention effort. Approach compensation as one component of a comprehensive retention strategy.

Beyond base pay:

• Sign-on bonuses with retention strings. Structure bonuses to pay out over time (e.g., one-third at hire, one-third at 6 months, one-third at 12 months) to incentivize staying.
• Retention bonuses for tenured staff. Do not reserve bonuses only for new hires. Staff who have been loyal for years should be rewarded, or they will notice and resent the disparity.
• Benefits that matter to your workforce. Health insurance is baseline. Consider what your specific workforce values: childcare assistance, transportation stipends, flexible scheduling, or tuition reimbursement may have outsized impact relative to their cost.
• Competitive market analysis. Conduct wage surveys at least annually. Know what competitors in your market are paying and ensure you are at or above the median for your area.

6. Measure What Matters

You cannot improve what you do not measure. Build a turnover dashboard that tracks:

• Overall turnover rate by position and department. Identify where the problem is most acute.
• First-year turnover rate. This isolates onboarding and early experience issues.
• Turnover cost per position. Quantify the financial impact to justify retention investments.
• Exit interview themes. Code and categorize exit interview responses to identify patterns.
• Employee engagement scores. Regular pulse surveys (quarterly, not annually) detect dissatisfaction before it becomes resignation.
• Agency spend trends. Track monthly agency spend as a proxy for staffing stability.

7. Create Career Pathways

The most retention-focused facilities create visible career ladders that give staff a reason to stay and grow:

• CNA advancement levels. Create CNA I, II, and III tiers with increasing responsibilities, competencies, and pay.
• CNA-to-nurse bridge programs. Partner with local nursing schools to offer tuition assistance or clinical placement opportunities for CNAs pursuing their LPN or RN license.
• Leadership pipelines. Identify high-potential staff early and provide mentoring, cross-training, and leadership development opportunities.

The ROI of Retention

Investing in retention is not a charitable act -- it is a business decision with measurable returns. A facility that reduces its CNA turnover rate from 65% to 40% can expect to save $50,000 to $100,000 annually in direct replacement costs alone. Factor in reduced agency spend, improved quality metrics, better survey outcomes, and enhanced reputation, and the return on investment is substantial.

Moreover, stable staffing creates a positive feedback loop. Better care leads to better outcomes, which leads to better survey results, which leads to a better reputation, which leads to easier recruitment, which leads to more stable staffing. Breaking the cycle of turnover starts with deliberate, sustained action.

Take Action on Your Turnover Challenge

If your facility is struggling with turnover and you are not sure where to start, you are not alone. Most SNF operators know they have a problem but lack the bandwidth or expertise to implement a comprehensive retention strategy while managing daily operations.

That is where we come in. Our staffing solutions services help skilled nursing facilities diagnose the root causes of their turnover, build retention programs tailored to their workforce, and implement the systems and training needed to create lasting improvement. We do not offer generic advice -- we work inside your facility to build solutions that fit your specific challenges and culture.

Schedule a consultation to discuss your facility's staffing challenges and learn how we can help you build a more stable, engaged workforce.