We Measure the Cost of Nurse Turnover. What About the Cost of Losing a Nurse?

Healthcare leaders have become increasingly sophisticated in calculating the cost of nurse turnover. We have formulas to estimate vacancy costs, recruitment expenses, orientation costs, contract labor expenditures, and productivity losses.

Yet, we continue to overlook a larger question: What is the societal cost of losing a nurse from the profession?

When a nurse leaves one employer and joins another, the loss is largely organizational. One organization experiences a loss while another experiences a gain. The nurse remains available to patients, colleagues, and the profession.

However, when a nurse leaves the profession due to burnout, disability, trauma, career change, or death/suicide, the loss extends far beyond a single institution. Society loses years of educational investment, clinical expertise, mentorship capacity, workforce productivity, tax contributions, and future patient care. Despite ongoing concerns about workforce shortages, nursing has lacked an accepted method for estimating those broader societal costs.

Recent work by Omid Razmpour, RN, and colleagues advanced the science of nurse turnover economics through development of the RETAIN Framework, a rigorous methodology for identifying and quantifying turnover costs. The framework provided a foundation for understanding and measuring organizational losses associated with nurse turnover. Those contributions represent an important step forward.

However, we posit an essential distinction: turnover and professional loss are not the same.

This distinction matters because public investment decisions are often guided by economic evidence. Policymakers routinely evaluate workforce development programs, educational initiatives, public health interventions, and prevention efforts through economic analyses. Yet, without credible estimates of the societal costs associated with losing nurses from the profession, proposals for nurse well-being programs, workforce retention initiatives, suicide prevention efforts, and demonstration projects may struggle to compete for limited state, federal, and local funding.

Without measurement, important losses remain invisible.

Organizational concerns focus on staffing shortages, recruitment challenges, and agency labor expenditures. But the societal consequences and costs of losing a nurse are much different. Investments supporting a nurse’s development were made by individuals, families, employers, educational institutions, and taxpayers. Knowledge accumulated through years of practice is difficult to replace. Mentorship relationships disappear. Future contributions to patient care are forfeited.

These are not merely organizational costs. They are societal costs.

In our recent paper in Nursing Outlook, we sought to expand the empirical RETAIN Framework beyond organizational turnover to examine the broader and theoretical implications of nurse loss from the profession. Using publicly available information, we conducted a theoretical analysis applying the framework to an illustrative case following the death of Minnesota nurse Alex Pretti, RN.

The purpose was not to assign a dollar value to a human life, nor to generate a universal estimate applicable to all nurses. Rather, the case served as an example demonstrating how broader societal costs of nurse loss might be identified, organized, and measured.

Applying our proposed method to that illustrative case of a nurse’s unanticipated death, we produced a conservative estimated societal impact exceeding $3.67 million.

Of course, there are a lot of variables at play. If we had applied the model to a nurse with burnout, there would have been no costs related to death but there would have been other costs related to a decline in productivity prior to leaving the organization, which may include sick days, backfill hours, and even leaves of absence. In the case of a nurse who dies by suicide, society incurs similar costs to a nurse who leaves the profession due to burnout plus the costs associated with death.

Importantly, estimates using our model are highly context dependent and reflect the specific characteristics of that case. Different specialties, educational backgrounds, geographic regions, career stages, employers, and labor market conditions would produce substantially different results. The precise number is therefore less important than the larger implication.

If the societal consequences of losing even a single nurse can reach the magnitude of $3.67 million, then the economic burden of all nurses who leave the profession is far greater than current workforce discussions acknowledge.

So, what about the future? The next step is not to debate a single estimate. The next step is to improve the methodology.

Future research should empirically validate and refine these models, identify additional variables, test them across specialties and geographic regions, and develop dynamic tools capable of reflecting local workforce conditions. Just as turnover cost calculators evolved through years of refinement, societal loss estimation will require continued methodological development.

Better measurement alone will not solve workforce shortages, burnout, or clinician suicide. But it can help policymakers, healthcare leaders, and funding agencies understand the magnitude of what is at stake. If society can estimate the costs of losing nurses from the profession, it becomes easier to evaluate investments in nurse well-being, retention, suicide prevention, and workforce sustainability using the same economic frameworks that guide other major public policy decisions.

For decades, healthcare organizations have measured the cost of nurses leaving jobs. We suggest it is time to begin measuring the cost of nurses leaving the profession.

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