Building the Business Case for Investing in the Nursing Workforce: The Economics of Financial Strain, Turnover, and Retention Investment Restricted; Files & ToC
Razmpour, Omid Richard (Spring 2026)
Abstract
Hospitals in the United States continue to face financial and operational strain, driven in part by persistent challenges in nurse recruitment and retention. The COVID-19 pandemic intensified workforce instability, increased reliance on premium labor, and accelerated hospital labor costs. Despite the nursing workforce’s central role in care delivery and hospital operations, evidence linking pressures experienced by nurses to measurable financial consequences for health systems remains limited. Nurse financial hardship remains understudied as a workforce issue, and widely cited estimates of nurse turnover cost still rely on methods developed more than two decades ago. This dissertation addresses these gaps through three papers examining nurse financial strain, nurse well-being, and the cost of nurse turnover.
The first paper examined the association between financial hardship and nurse well-being among nurses across a large academic health system. Using data from a cross-sectional survey and validated measures from the Professional Quality of Life instrument, the study examined how financial hardship, specifically difficulty paying bills, was associated with burnout, secondary traumatic stress, and compassion satisfaction. Financial hardship was significantly associated with higher burnout and secondary traumatic stress, suggesting that economic strain may serve as an upstream driver of diminished nurse well-being and workforce instability.
The second paper developed the RETAIN Framework (Retention Evaluation and Turnover Analysis for the Investment in Nursing), a structured methodology for calculating the cost of nurse turnover. The framework integrates process mapping, cost accounting, and workforce modeling to capture expenditures across the turnover continuum, including separation, recruitment, onboarding, training, productivity loss, and vacancy coverage.
The third paper applied the RETAIN Framework in a multi-hospital academic health system to assess current turnover costs and identify key financial drivers. Turnover costs totaled $85,498 when vacancies were covered through contract labor. Contract labor accounted for 75.5% of backfill coverage and contributed to an estimated $27.9 million in annual turnover costs.
Together, these papers link individual nurse financial strain, workforce instability, and hospital cost with greater precision than prior research. They provide a contemporary foundation for measuring the financial consequences of turnover and informing more effective retention investment.
Table of Contents
This table of contents is under embargo until 27 May 2032
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File download under embargo until 27 May 2032 | 2026-04-16 11:28:14 -0400 | File download under embargo until 27 May 2032 |
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