In today’s turbulent health care landscape, turnover among clinical professionals isn’t just a workforce challenge, it’s a threat to care delivery, financial performance, and health system sustainability. It’s true that the financial costs of turnover are significant. Replacing just one registered nurse can cost upwards of $73,500 on average, according to Lotis Blue, which increases with the level of specialization and licensure. But the real costs lie in the impact on patients and overstretched teams that threaten health system stability.

New research conducted by Lotis Blue has finally quantified the real reasons why clinicians leave their jobs, some of which challenge historical assumptions about turnover. With the right insights, health systems have an opportunity to address the labor crisis from a place of deep knowledge, using a data-driven approach to understand why clinicians are walking away–and what leaders can do to keep them.

Beyond the Exit Interview

Traditional tools like engagement and exit surveys have failed to deliver meaningful insights—riddled with bias and disconnected from the real-time decisions employees are making today. Drawing on independent polling of more than 1,000 clinical health care professionals across over 400 organizations, this research uses a proprietary methodology that bypasses the flaws of convenience sampling, the study dives deep into 33 key elements of the employee value proposition (EVP), moving beyond surface-level satisfaction metrics to uncover the real psychological drivers behind workforce turnover.

Vital Signs: The Real Drivers of Turnover

This study found that every element of the EVP—from compensation to career growth to workplace culture—plays a role in whether someone chooses to stay in a job or walk away. Using a machine learning algorithm, Lotis Blue can predict an employee’s likelihood of quitting with 90% accuracy, based solely on how they rate the importance of the EVP components. While all factors matter, some carry more weight than others. Five key elements stood out as the strongest predictors of turnover:

1. Emotional Stress: This is the most powerful predictor of both quitting and considering leaving one’s job. When left unresolved, it erodes engagement and productivity on the job and accelerates departure.
2. Excessive Workload: High levels of turnover and staffing shortages for key roles often result in overstretching remaining staff, further contributing to physical and mental exhaustion and burnout.
3. Disliking Senior Leadership: While liking one’s immediate supervisor drives retention, disliking senior leadership is one of the most influential drivers of turnover, reinforcing perceptions that senior leadership may seem removed from the realities of the frontline.
4. Lack of Career Development: Limited visibility into development and growth opportunities can make it difficult for clinical professionals to see a future for themselves with a health system, especially for those who are new to the organization or earlier in their career.
5. Poor or No Education Benefits: In an industry that prizes upskilling, many health workers cited a lack of support for continuing education as a key driver of their decision to quit. Limited time off further impedes health workers’ ability to utilize any offered education benefits.

Retention Isn’t One-Size-Fits-All

The research also underscores a crucial insight: the reasons employees leave can vary widely by select workforce characteristics, meaning one-size-fits-all solutions to retention are destined to fall short. To truly optimize for impact, health systems must tailor their EVPs to three key considerations:

1. Role Matters: Nurses prioritize physical well-being and peer relationships, while other clinical roles—like radiology or pharmacy techs—place more importance on safety, advancement, and inclusion.
2. Priorities Shift with Tenure: For new hires (under one year), scheduling flexibility and shift preferences are top drivers. But once employees hit the one-year mark, they prioritize job stability more, and emotional stress becomes increasingly important to employees tenured 7 years or more.
3. Work Setting Shapes Experience: Those in high-acuity areas like emergency departments or behavioral health units report attribute higher importance to emotional stress and workload intensity compared to outpatient or ambulatory settings.

From Diagnosis to Treatment: What Health Systems Can Do Now

Tackling the root causes of employee turnover will require health system leaders to simultaneously play both offense and defense—addressing the factors driving clinicians to leave while strengthening the reasons they choose to stay. The effectiveness with which a health system delivers its EVP through the employee experience is also crucial to retention and often varies widely from organization to organization. While specific retention strategies will vary across organizations, three foundational principles consistently support a high-impact EVP:

1. When patient care is central to all strategies, it helps clinicians rediscover joy and meaning in their work
2. Start with the basics: competitive compensation and benefits should be considered before attempting to optimize other retention levers
3. Health and safety must be non-negotiable priorities; when these needs go unmet, it’s very difficult for other aspects of the employee value proposition to compensate

Addressing health care turnover requires more than good intentions—it demands a clear, data-driven strategy. Equipped with data in hand, health care leaders can finally quantify the true costs of turnover on the organization, identify the specific root causes, and make more strategic investments in how they deliver value. The opportunity is clear, and the data is in—addressing turnover is possible and creates a strong foundation for delivering meaningful careers and exceptional patient care.

By Alyssa Green, Ph.D. and Erica Grant

Originally published in Healthcare Business Today, May 7, 2025