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(717) 560-3986Recruitment. Retention. Results.2021 NSI National Health CareRetention & RN Staffing ReportPublished by: NSI Nursing Solutions, Inc.www.nsinursingsolutions.com.

PrefaceWe are proud to present the annual NSI National Health Care Retention and RN Staffing Report.In January 2021, NSI Nursing Solutions, Inc. invited over 3,000 hospitals across the country toparticipate in the nation’s most comprehensive survey on healthcare turnover, retentioninitiatives, vacancy rates, recruitment metrics and staffing strategies.The healthcare labor market continues to be bullish with demand for nurses and alliedprofessionals outpacing supply. Although the industry has been resilient throughout thepandemic and surge, COVID has definitely amplified and stressed the labor market and shortage.Registered Nursing continues to be one of the top growth occupations and is projected to grow7% through 2029. While supply varies geographically; on a national level, a major crisis isevident and deteriorating. The questions remaining are: how do we protect our human capitalinvestment and how do we staff while controlling labor costs?NSI Nursing Solutions provides industry insight to help you benchmark performance, identifybest practices, and understand emerging trends. We sincerely extend our appreciation to all 226participating facilities for making this report possible. Your feedback and suggestions wereencouraging and valuable. As promised, all information is provided in the aggregate to maintainthe confidential and sensitive nature of the data provided.Should you have any questions or recommendations on expanding the scope or depth of thissurvey, please feel free to contact me at [email protected] I request yourparticipation in future studies conducted by NSI Nursing Solutions, Inc.Brian Colosi, BA, MBA, SPHRNSI Nursing Solutions, Inc.PresidentMarch 2021About NSI Nursing Solutions, Inc.NSI Nursing Solutions, Inc. is a national high-volume nurse recruitment and retention firm.Since 2000, we have successfully recruited U.S. experienced RNs (averaging 14 years) asyour employees, who fit your culture, and do so in an average time-to-fill of 30 days. At NSI,we provide an industry leading one (1) year guarantee and the best part is that our services arerisk-free since you must hire the nurses before we are paid.We have helped many clients and can help you! I encourage you to call Michael Colosi, EVP,Business Development, at (717) 575-7817 or [email protected] to learn howNSI can satisfy your staffing needs.i NSI Nursing Solutions, Inc

Table of ContentsExecutive Summary1Methodology2Survey Findings – Hospital Turnover3Survey Findings – RN Vacancy5Survey Findings – Hospital Staff RN Turnover6Survey Findings – Hospital RN Turnover by Specialty8Survey Findings – Advanced Practice and Allied Health Turnover9Survey Findings – Hospital Turnover by Tenure10Survey Findings – RN Recruitment Difficulty Index11Survey Findings - Workforce Projections12Conclusion13NSI Quick Reference GuideaOverview of Survey Participantsbii NSI Nursing Solutions, Inc

Executive SummaryHealthcare has consistently been a leading contributor to job market growth. Last year, COVIDhas not only amplified the mismatch between the supply and demand of labor, but, it has alsostressed the industry and providers. Through perseverance, resilience and staying focused on amission of healing, your communities are thankful.For 2021, the healthcare jobs market will continue to trend up with 37.4% of hospitals surveyedanticipating an increase in their labor force. This is down 16% from the previous study and canbe a reflection of the uncertainty and downturn caused by COVID. During the past year, hospitalturnover increased by 1.7% and currently stands at 19.5%. Although, hospitals did not meet their2020 goal to reduce turnover, they have doubled down by setting a higher goal. The currenthospital goal is to reduce turnover by 4.7%.From a nursing perspective, the labor market continues to tighten with 39.8% of hospitalsprojecting to increase their RN staff. This is down 19.2% from last year. In 2020, the turnoverrate for staff RNs increased by 2.8% and currently stands at 18.7%. Registered Nurses workingin burn care, surgical services and women’s health recorded the lowest turnover rate, while nursesworking in step down, behavior health and emergency services experienced the highest.The cost of turnover can have a profound impact on diminishing hospital margins and needs to bemanaged. According to the survey, the average cost of turnover for a bedside RN is 40,038 andranges from 28,400 to 51,700 resulting in the average hospital losing between 3.6m – 6.5m/yr. Each percent change in RN turnover will cost/save the average hospital an additional 270,800/yr.Hospitals are experiencing a higher RN vacancy rate. Currently, this stands at 9.9%, up anotherpoint from last year. Less than a quarter (23.9%) of hospitals reported a RN vacancy rate of “lessthan 5%”. However, over a third (35.8%) reported a vacancy rate exceeding 10%. The RNRecruitment Difficulty Index remains elevated at 89 days on average, regardless of specialty. Inessence, it takes 3 months to recruit an experienced RN.Feeling the financial stress, hospitals expressed an interest to decrease reliance on supplementalstaffing, particularly given the higher rates being charged due to COVID. The greatest potentialto offset margin compression is in the top budget line item (labor expense). For every 20 travelRNs eliminated, a hospital can save, on average, 3,084,000. Contact Michael Colosi at (717)575-7817 to learn how NSI can improve your bottom line.HOSPITAL & STAFF RN TURNOVER25%20%15%16.2%18.2% 16.8%19.1%17.2%14.6%17.8%19.5%18.7%15.9%All Employees10%All Staff RNs5%0%CY16CY17CY18CY191 NSI Nursing Solutions, IncCY20

MethodologyIn January, invitations were sent to hospitals across the nation to participate in the “NSI NationalHealth Care Retention & RN Staffing Survey”. To maintain consistency and integrity, allfacilities were asked to report data from January through December 2020, and for systems toreport each hospital separately. I am pleased to announce that 226 facilities from 37 states,responded. In total, this survey covers 501,764 healthcare workers, and 144,300 RegisteredNurses. This is an increase of 18.3% and 33.6%, respectively.All findings are reported in the aggregate, with no individual hospital identifying informationprovided. Since organizations track and report turnover differently, it is important to establish aconsistent methodology. To this end, raw data was collected on all employee terminations,whether voluntary or involuntary. Temporary, agency and travel staff were specifically excluded.Also, this survey does not measure transfers or “internal terminations.”According to the findings, hospitals continue to be split on which employment classifications toinclude when calculating turnover. A majority (60.9%) include all employment classifications,such as full time, part time, per diem, prn, casual, occasional, etc. when reporting turnover. Theremaining hospitals only include full time and part time employment classifications. Given thissplit, respondents provided data on all employees and for full/part time staff only. Forcomparative purposes, we will adjust for this distinction and report for both methodologies.Hospitals who only include FULL and PART-TIME classifications and exclude all otheremployment classifications in their metrics are directed to utilize the “Full/Part Time”statistics for comparative purposes.2 NSI Nursing Solutions, Inc

Hospital TurnoverHospital turnover remains elevated and executives need to be concerned since this is a leadingindicator of future financial pressure, and patient & employee satisfaction. Last year, hospitalturnover increased by 1.7% and currently stands at 19.5%. Since 2016, the average hospitalturned over 90.8% of its workforce. The following graph illustrates annual changes since 2016.The national hospital turnover rate is 19.5%, with the median and mode recorded at 18.8% and17.5%, respectively. Hospitals that only measure “FULL/PART TIME” separations reported anaverage turnover rate of 16.7%, with a median of 15.5%, and a mode of 15.1%. Presently,hospital turnover ranges from 3.0% to 43.1%.HOSPITAL TURNOVER RATE25%20%15%18.2%16.2% 14.8%19.1%16.3%19.5%17.5%17.8%16.1%16.7%All Employees10%FT/PT Only5%0%CY16CY17CY18CY19CY20The following table records the average hospital turnover rates by region and bed size. Again,hospitals who only include full and part-time employment classifications in their metrics aredirected to the column on the right. The number in parenthesis reflects the year-over-yearchange.Hospitals with more than 500 beds and located in the West and North-East experienced turnoverbelow the national average and tend to have a greater retention level. Conversely, the profile of ahospital with the highest turnover is a facility with 200-349 beds and located in the South-Eastand North-Central regions.The 2019-20 percent change in hospital turnover, by region, ranges from -1.6% to 4.8%. TheNorth-East experienced the greatest decrease in turnover from the prior year. Hospitals in theNorth-Central and South-East recorded a dramatic increase in turnover. All other regions postedmodest changes.Upon review of turnover by bed size, all groups reported an increase. Hospitals with more than500 beds outperformed all other facilities and is the only group below the national average.Hospitals between 200-349 beds saw the highest increase and experienced the greatest level ofturnover.3 NSI Nursing Solutions, Inc

HOSPITALTURNOVERFULL/PART TIMETURNOVER15.7% (-0.5%)13.3% (-1.6%)23.7% ( 4.8%)21.2% ( 4.7%)24.6% ( 4.7%)21.1% ( 2.8%)19.0% ( 1.3%)16.3% (-0.1%)15.8% ( 0.9%)13.1% (-0.1%) 200 Beds19.9% ( 1.1%)17.1% ( 0.6%)200-349 Beds23.0% ( 3.9%)19.8% ( 2.3%)350-500 Beds20.0% ( 2.1%)16.9% ( 0.6%) 500 Beds18.4% ( 1.1%)15.9% ( 0.2%)19.5% ( 1.7%)16.7% ( 0.6%)REGIONNorth East – (CT, DC, DE, MA, MD, ME, NH, NJ, NY,PA, RI & VT)North Central – (IA, IL, IN, KS, MI, MN, MO, MT, ND,NE, OH, SD, WI & WY)South East – (AL, FL, GA, KY, MS, NC, SC, TN, VA &WV)South Central – (AR, CO, LA, NM, OK, & TX)West – (AK, AZ, CA, HI, ID, NV, OR, UT & WA)BED SIZENATIONAL AVERAGEVoluntary terminations accounted for 93.9% of all hospital separations. To further understandturnover, respondents were asked to identify the top five (5) reasons why employees resigned.Participants were asked to select from a list of 20 common reasons. Career advancement andrelocation were at the top of the list. Retirement was the third most common reason, moving uptwo spots from 2019. Since conducting this survey, this is the first time that retirement was in thetop three. Whether this is due to the aging of the healthcare workforce or COVID was not a topicof the survey. Finishing the list of top ten reasons include: personal reasons (caring for achild/parent, marriage, disability, etc.), unknown, education, workload/staffing ratios, workingconditions, scheduling and salary.An overwhelming majority (94.8%) of hospitals view retention as a “key strategic imperative”and to a lesser degree, is evident in operational practice/planning. Almost all hospitals haveretention initiatives (80.7%) however, only half (51.4%) have tied these to a measurable goal.Establishing a measurable goal needs to be a core component of any retention strategy.In 2020, hospitals set a goal to reduce turnover by 3.7%. In actuality, turnover increased 1.7%during this same period. For 2021, hospitals set an even more aggressive goal to lower turnoverby 4.8%. Almost half (48.6%) have not established a measurable goal.4 NSI Nursing Solutions, Inc

RN Vacancy RateThe RN vacancy rate continues to be of concern and currently stands at 9.9%, almost a full pointhigher than 2020. An elevated rate directly impacts quality outcomes, the patient experience andleads to excess labor costs such as overtime and travel/agency usage. In 2019, less than a quarter(23.7%) of hospitals reported a vacancy rate greater than 10%. Today, over a third (35.8%) are inthis group. This downward shift, along with the elevated RN Recruitment Difficulty Index, (seepage 11) is a clear indication that the RN labor shortage will continue to challenge hospitals.Of significant concern is that sixty-two percent (62%) of all hospitals have a RN vacancy ratehigher than 7.5%. Given the economy and impact of COVID, RNs are no longer delayingretirement, and many have gone back to travel nursing, particularly given the lucrative contracts.During the pandemic, travel nurse packages reached 10,000/week. As the demand for RNsincrease and as Baby Boomers reach retirement, expect the vacancy rate to further deteriorate.When the labor market tightens, hospitals bridge the gap by authorizing overtime and criticalstaffing pay, by increasing travel staff usage, and by flexing their internal staffing pool. All ofwhich are costly strategies, especially when travel rates range to 200/hr. The greatest potentialto offset margin compression is in the top budget line item (labor expense). When patient volumeis flat; when Medicare/Medicaid is squeezed; when commercial insurance rates decrease or arebundled; when health care legislation is uncertain.recapturing lost productivity, controllingcontract labor and excess overtime can help offset this compression.At NSI Nursing Solutions, Inc. we encourage our clients to minimize excess labor utilization andfocus on a strategy that embraces full staffing and builds retention while enhancing ROI. [email protected] to learn how NSI can improve your bottom line.201718.2%31.8%27.3%9.1%13.6%RN VACANCY RATELess than 5%5.0% to 7.49%7.5% to 9.9%10.0% to 12.49%Greater than %13.8%26.6%22.9%12.9%RN VACANCY RATE3.7%Less than 5%9.2%23.9%5.0% to 7.49%7.5% to 9.9%22.9%10.0% to 12.49%12.5% to 14.9%13.8%26.6%5 NSI Nursing Solutions, IncGreater than 15%

Hospital Staff Registered Nurse TurnoverThis section will follow the same format as “Hospital Turnover” (page3). The following graphillustrates the turnover range for staff RNs since 2016. In 2020, RN turnover increased by 2.8%and currently stands at 18.7%. Since 2016, the average hospital turned over 83% of their RNworkforce. In essence, every 6 years, a hospital will have an entirely new RN staff. The questionremains is Talent Acquisition ready?Last year, RN turnover ranged from 0.0% to 66.5%. Currently, the national turnover rate for staffRNs is 18.7%, with the median being 17.7% and a mode of 15.5%. Hospitals that only measure“FULL/PART TIME” separations reported an average turnover rate of 15.7%, with a median andmode of 14.3%.HOSPITAL STAFF RN TURNOVER RATE20%15%14.6%16.8%12.6%17.2%14.9%18.7%15.5% 15.9%14.7%15.7%All Staff RNs10%FT/PT Only5%0%CY16CY17CY18CY19CY20The cost of turnover can have a profound impact on the already diminishing hospital margin.Today, over half (57%) of hospitals track this cost. Based upon feedback, the average cost ofturnover for a staff RN is 40,038 with the range averaging from 28,400 to 51,700 andresulting in the average hospital losing 5.1m per year. Annually, RN turnover costs a hospitalbetween 3.6m – 6.5m. Breaking this down even further, each percent change in RN turnoverwill cost/save the average hospital 270,800 per year.The following table records the average staff RN turnover rates by region and bed size. Again,hospitals who only include full and part-time employment classifications in their metrics aredirected to the column on the right. The number in parenthesis reflects the year-over-yearchange.Hospitals with over 500 beds and located in the North-East and West experienced RN turnoverbelow the national average and tend to have a greater retention level. The profile of a hospitalwith the highest RN turnover is a facility with between 200-349 beds and located in the SouthEast region.The 2019-20 percent change in regional RN turnover ranges from -1.1% to 7.2%. Only theNorth-East reported a decrease in RN turnover from the prior year. The South-East had thehighest turnover rates and posted the greatest gains. The South-Central region runs close to thenational average.6 NSI Nursing Solutions, Inc

When viewed by bed size, all groups experienced an increase in staff RN turnover, ranging from 0.4% to 5.8%. Although recording some gains, hospitals over 500 beds performed thestrongest and were below the national average. Hospitals between 200-349 beds reported thegreatest increase and the highest turnover rate. Hospitals between 350-500 beds mirrored thenational average.STAFF RNTURNOVERFULL/PART TIMERN TURNOVER13.2% (-0.6%)12.0% (-1.1%)20.0% ( 3.4%)17.3% ( 1.9%)24.9% ( 7.2%)20.8% ( 3.4%)19.2% ( 2.5%)16.2% ( 1.4%)15.4% ( 2.1%)11.9% ( 0.2%) 200 Beds19.4% ( 1.4%)17.1% ( 1.0%)200-349 Beds22.9% ( 5.8%)18.8% ( 3.0%)350-500 Beds18.9% ( 3.0%)15.6% ( 1.0%) 500 Beds17.4% ( 2.1%)14.7% ( 0.4%)18.7% ( 2.8%)15.7% ( 1.0%)REGIONNorth East – (CT, DC, DE, MA, MD, ME, NH, NJ, NY, PA,RI & VT)North Central – (IA, IL, IN, KS, MI, MN, MO, MT, ND, NE,OH, SD, WI & WY)South East – (AL, FL, GA, KY, MS, NC, SC, TN, VA &WV)South Central – (AR, CO, LA, NM, OK, & TX)West – (AK, AZ, CA, HI, ID, NV, OR, UT & WA)BED SIZENATIONAL AVERAGERespondents were also asked to identify the top five (5) reasons why staff RNs voluntarilyresigned. Participants were asked to select from a list of 20 common reasons. Relocation andcareer advancement tied for the top spot on the list. Retirement was the third most commonresponse and marks the first time it has placed in the top three. Whether this is due to the agingof the RN workforce or COVID was not a topic of the survey. Rounding out the top 10 reasonswhy RNs voluntarily resigned are: personal reasons, unknown, education, working conditions,salary, scheduling and commute.Currently listed as the number three reason why staff RNs leave, retirement is projected to remaina primary driver beyond 2030. Hospitals are getting the message with more than half (52.6%)having a strategy that focuses on retaining the older nurse. In 2018, just 21.6% had such astrategy.7 NSI Nursing Solutions, Inc

Registered Nurse Turnover by SpecialtyRegistered Nurse turnover varies by discipline. The following graph compares the average RNturnover rate by specialty for the past two years. The solid yellow line represents the nationalturnover rate for RNs (18.7%). Step down, behavior health, emergency services and telemetryRNs exceeded the national average, with critical care at the average. Looking back over the pastfive years, RNs in behavior health, step down and emergency services were the most mobile witha cumulative turnover rate between 96.6% and 98.5%. Essentially, every five years, thesedepartments will turnover their entire RN staff. All other surveyed departments were below thenational average.When we consider the average age of nurses and the anticipated wave of retirements about tobreak, we need to keep in mind that some specialties will be impacted at a quicker pace. This isparticularly true for surgical services, behavior health and women’s health. Managing retentionshould be a strategic imperative, particularly given the high cost of turnover and the ongoing RNstaffing crisis.RN TURNOVER BY SPECIALTY14.0%Burn Center9.8%15.3%Surgical Services13.2%Women's 7.1%Critical %Emergency20.6%22.7%Behavior Health18.5%Step Down24.4%0%5%10%15%8 NSI Nursing Solutions, Inc20%25%30%

Advance Practice and Allied Health TurnoverFor the past five years, all advance practice and allied health professionals recorded turnover ratesbelow the hospital average. The following graph compares the average turnover rate for advancepractice and allied health personnel in an acute care setting for the past two years. The solidyellow line represents the current turnover rate for acute care hospitals (19.5%).Patient Care Technicians (PCTs) and Certified Nursing Assistants (CNAs) continue to negativelyimpact hospital turnover. Both of which far exceed the national norm. In fact, every four years,the average hospital virtually turns over all CNAs and PCTs.ADVANCE PRACTICE and ALLIED HEALTH TURNOVERPharmacist8.5%8.4%Nurse Anesthetist (CRNA)8.7%8.4%Nurse Practitioner (CRNP)8.4%8.9%Physical Therapist10.1%9.1%Physician Assistant (PA)10.0%9.2%12.8%11.4%Nursing Unit Mgr/Dir201915.9%13.6%Speech TherapistOccupational Therapist12.9%13.8%Radiologic Technologists13.8%13.8%11.8%Medical Technologist202015.6%12.1%Respiratory Therapist18.6%15.9%Registered Nurse18.7%26.5%27.5%Certified Nursing Asst (CNA)26.4%28.6%Patient Care Tech (PCT)0%5%10%15%9 NSI Nursing Solutions, Inc20%25%30%35%

Hospital Turnover by TenureThe following graph illustrates the years of service (tenure) for all employees and RNs who leftduring the survey period. Based upon the survey data, over a quarter (27.3%) of all new hiresleave within a year. This same group accounted for a third (30.4%) of all turnover. As consistentwith previous surveys, close to half (49.9%) of the exited employees had less than two years ofservice. As expected, employees with more than 5 years of tenure experienced a greater level oforganizational commitment.First year turnover continues to outpace all other tenure categories. When looking at the range ofthose employees who terminated with “less than one year of service”, this group can make up83.3% of a hospital’s total turnover. When expanding this to include all employees with less thantwo (2) years of service, the range jumped to 91.6%. Without saying, this is not the typical oraverage facility. However, a large percent of all separations is caused by employees with lessthan two years of tenure.Although not as dramatic, when viewing RNs, a similar trend is noted. Close to a quarter(23.9%) of all new RNs leave within a year, with first year turnover accounted for a quarter(24.1%) of all RN separations. Given the projected surge in retirements, expect to see the moretenured groups edge up creating an inverted bell curve.A significant opportunity to protect a hospital’s investment in Human Capital and recapturerevenue exists. Operational considerations must address how employment decisions are madeand include programs that build relationships, commitment and confidence early in theemployment cycle. When it comes to protecting the more tenured staff, hospitals must also focuson a strategy to retain older workers.HOSPITAL TURNOVER BY TENURE35%30%25%30.4%27.9%24.1%23.7%19.5% 18.9%20%14.2%11.6%15%15.0% 14.8%RN's Only10%5%0% 1 year1 - 2 years2 - 5 years5 - 10 years10 NSI Nursing Solutions, IncAll Employees 10 years

RN Recruitment Difficulty IndexThe RN Recruitment Difficulty Index (RDI-RN) gauges the average number of days it takes ahospital to recruit an experienced RN. Participants were asked to identify the range which bestdescribes the time to fill a RN vacancy, given specialty. The average time to recruit anexperienced RN ranged from 66 to 126 days, pending specialty.The following graph illustrates the average number of days it took to recruit a RN by specialty.The yellow line is the current RN Recruitment Difficulty Index and represents the average time tofill a vacancy regardless of specialty. Currently, this stands at 89 days and is projected toincrease due to the impact of COVID. This elevated rate has been challenging Talent Acquisitionfor years, which begs the question; is this acceptable or should we think differently? Contractingwith a staffing provider can help Talent Acquisition improve their time-to-fill. With an averagetime-to-fill of 30 days, NSI has the national reach and proven track record to quickly hireexperienced Registered Nurses.Registered Nurses in the Operating Room continued to be the most difficult to recruit and is theonly specialty to record a lower time to fill. On average, it takes 97 to 126 days to fill anexperienced OR RN, with the average being 111 days. All other specialties experienced anincrease in time-to-fill. Nurses in critical care were slightly above the index. L&D RNsexperienced the greatest percent increase. At the quicker end of the spectrum, hospitals were ableto fill Med/Surg positions faster than any other specialty, but it still took about two and a halfmonths.RN RECRUITMENT DIFFICULTY INDEX IN DAYS140120115 111911008065848586817477748475 80202020216040200OR RNCCRNL&D RNPCU RNER RNTele RNM/S RNWhen it comes to recruiting RNs, not all regions perform the same. The North-Eastoutperformed all other regions and could recruit RNs quicker than the national average, with anaverage time to fill of 61 days. The West (76 days) and South-East (72 days) also posted belowthe national benchmark. The South-Central and North-Central regions were above the index at113 and 105 days, respectively.11 NSI Nursing Solutions, Inc

Workforce ProjectionsLabor demands are forcing many hospitals to use more costly approaches to staffing beds.Increasing reliance on agency/travel staff, overtime and internal resource pools, and authorizingcritical staffing pay were the most common strategies to meet scheduling needs. In 2020,healthcare jobs continued to grow and are trending up for 2021 with 37% of hospitals expectingto increase their labor force and 40% projecting to increase their RN complement.This mandate to hire more employees will further strain Talent Acquisition. While hospitalsexpect to grow their hospital and RN workforce, only 26% anticipate an increase to therecruitment budget and only 18% plan to increase their recruitment staff. Currently, the ratio ofbudgeted Full Time Equivalents (FTEs) in Human Resources to hospital employees is 1:142.2021 Hospital Projected Increase In:0%20%Hospital Workforce60%37.4%RN Workforce39.8%Recruitment BudgetRecruitment 17.7%80%14.5%11.3%UnsureDue to COVID, travel nurse rates jumped over 200%, with premiums still elevated. Currently,hospitals are spending approximately 62.5% more for travel RNs than they did at the start of2020. To improve margins, hospitals need to control labor costs by decreasing reliance on traveland agency staff. When comparing the cost difference between employed RNs vs travel RNs, theamount is staggering. For every 20 travel RNs eliminated, a hospital can save, on average, 3,084,000. Call Michael Colosi at (717) 575-7817 or [email protected] tolearn how NSI Nursing Solutions, Inc can improve your bottom line.RN Travel & Agency Usage17.2%18.9%MoreSameLessUnsure20.5%43.4%12 NSI Nursing Solutions, Inc

ConclusionThe health care industry continues to be a cornerstone of our economy and must be ready to adaptto the changing landscape. The expanding healthcare rolls, the aging population, the mandate onquality & safety, the squeeze in reimbursements, the competition for patient volume, the shift inthe delivery of care, the shortage of physicians, nurses & allied professionals and a world-widepandemic are all stressing the industry.The value hospitals place on their people will have a direct correlation to their commitment,confidence and engagement. Enhancing culture and building programs to reinforce these valuesis critical to driving retention. Focus on strategies that enhance culture and eliminate those thatdo not.A quantifiable measure of the severity of a hospitals vacancy rate is contract labor and overtimeusage. Trending turnover, based on historical data, is a leading indicator of future organizationalpressure. Management must identify contract labor costs and not view it as an “operatingexpense”, but rather as aggregated within the position control system. Inclusion within thepayroll cost line, will provide greater insight into the actual direct cost of labor.To strengthen the bottom line, hospitals need to build retention capacity, manage vacancy rates,bolster recruitment initiatives and control labor expenses. Breaking through the myopic ways ofhiring travel and agency staff to band-aid the issue or utilizing excessive overtime or premiumpay which stresses the staff, the quality and the patient experience is a start. Building andretaining a quality workforce is paramount to navigate the shifting paradigm. Let NSI NursingSolutions Inc. help!CLOSE13 NSI Nursing Solutions, Inc

(717) 560-3863Recruitment. Retention. Results.2021 Quick Reference GuideHospital Turnover StatisticsHospital Turnover RangeAverage Hospital TurnoverAverage Hospital Turnover (Full and Part Time employees only)Bedside/Staff RN Turnover RangeAverage Staff RN TurnoverAverage Staff RN Turnover (Full and Part Time staff RNs only)Cost of Each RN TurnoverAverage Annual Cost of RN TurnoverAverage Annual Cost/Savings per 1% Change in RN TurnoverPercent of Involuntary Turnover2021 Hospital Retention Goal (To lower turnover by )3.0% to 43.1%19.5%16.7%0.0% to 66.5%18.7%15.7% 40,038 5.05m 270,8406.0%4.77%Hospital Staffing & Recruitment MetricsAverage Hospital RN Vacancy RateAverage RN Time-to-FillPercent Anticipating to Increase WorkforcePercent Anticipating to Increase RN WorkforcePercent Anticipating to Increase Recruitment BudgetPercent Anticipating to Increase Recruitment StaffAverage HR FTE per HeadcountPercent Anticipating to Decrease Travel/Agency UsageStaff Nurse vs. Travel Nurse Cost SavingsAverage Travel Nurse Fee (Current rate due to COVID)*Average RN Pay (includes 28% for benefits)Cost Difference: Staff Nurse vs. Travel NurseFor every 20 Travel RNs eliminated, the average hospital can savea NSI Nursing Solutions, Inc9.9%89 days37.4%39.8%25.8%17.7%1:14220.5%Hourly / 120.00 / 45.87 / 74.13 /Annually 249,600 95,420 154,180 3,083,600*

Overview of Survey Participan

facilities were asked to report data from January through December 2020, and for systems to report each hospital separately. I am pleased to announce that 226 facilities from 37 states, responded. In total, this survey covers 501,764 healthcare workers, and 144,300 Registered Nurs