Advancing the calculation of nurse turnover costs: A methodological approach using the RETAIN Framework

Abstract

Background

Nurse turnover has reached a crossroads, driving up labor costs and threatening organizational stability. Persistent vacancies and reliance on contract labor continue to strain healthcare systems. This paper introduces the RETAIN Framework, a structured methodology designed to quantify the costs of nurse turnover and guide evidence-based workforce investments.

Methods

The RETAIN Framework employs a four-phase methodology. First, the nurse turnover continuum was process-mapped to identify every turnover touch point and associated costs. Second, a cost accounting structure was developed to categorize both direct and indirect costs. Third, staffing back-fill strategies were analyzed to assess and evaluate financial trade-offs. Finally, all variables were integrated into a dynamic modeling dashboard that enables scenario testing using modifiable inputs. This approach supports workforce advocacy through data-driven financial analysis.

Conclusion

The RETAIN Framework provides a robust methodology for quantifying the cost of nurse turnover. In part two, the framework will be applied to a multihospital population to identify granular cost data and identify actionable outcomes.