Which Nursing Specialties Have the Highest Turnover?

Nursing isn’t an easy job. The rookie ABCs of nursing could very well read: A is for angry families, B is for bodily fluids, C is for catheter insertion… the list goes on. But despite the challenges, nurses continue to give the quality, compassionate care that has earned them the title of most ethical professionals for 14 years running.

You’re likely familiar with the term “nursing burnout.” But did you know that in 2015, job turnover for RNs exceeded the national hospital turnover rate? NSI Nursing Solutions published a report exploring this alarming trend and discovered that certain nursing specialties are more prone to high turnover than others. And high turnover is a very expensive problem for healthcare facilities.

The report revealed that the average cost of turnover for a bedside RN ranges from $37,700 to $58,400, resulting in the average hospital losing $5.2M–$8.1M. The report goes on to say that while most organizations view retention as essential, many still lack any formal retention strategy.

One thing you can do, however, is to build your RN career path on a solid foundation of awareness and preparation. Read on to discover the three nursing specialties with the highest turnover rates and what you can do to thrive in your chosen specialty and avoid becoming another statistic.

1. Behavioral health nursing

Turnover rate: 26.5%

Also known as psychiatric and mental health nursing, this specialty consistently tops the charts for high turnover. In the past two years, Behavior Health turned over 57.2 percent of their RN staff, according to the NSI report.

Turnover of highly skilled nurses is a problem for many psychiatric hospitals, according to a Psychiatric Services report. “Nurses are the frontline professional staff for psychiatric patients; without them, the provision of high quality care is difficult.” The source also states that most of the nurses in their study reported risk of assault as a major concern. One of their case studies found a total of 635 psychiatric nurses (41.3 percent) had experienced assault within the past year.

That said, dangerous or aggravating encounters with patients might not be the primary reason behavioral health struggles to retain its RNs. The problem could have more to do with caseloads, time constraints and paperwork.

Administrative problems are the real reason psychiatric nursing is in trouble, according to mental health practitioner, Emma Carroll, in her 2015 article. She stated that it used to be the best job in the world, back when she had time to truly interact and care for her patients. But Carroll went on to write that these days there is little time to make assessments and meet with patients.

Understaffed, overstretched nursing units are a common complaint everywhere in the world of RNs. But in psychiatric care, it can feel particularly devastating. Sometimes nurses are the only people a traumatized or suicidal patient will reach out to.


What nurses can do to thrive: If psychiatric nursing appeals to you, the American Psychiatric Nursing Association (APNA) suggests gaining some exposure first. Volunteering in agencies, hospitals or community programs where you interact with individuals with psychiatric problems is valuable. These experiences will help you acquire a better understanding of the full scope of a psychiatric nurse’s job.

2. Emergency nursing

Turnover rate: 21.1%

Emergency nurses specialize in rapid assessment and treatment, particularly during the initial phase of acute illness and trauma. Since this specialty is more about the severity of trouble and less about a specific demographic of patients, the Emergency Nurses Association (ENA) emphasizes that emergency nurses have to be well-versed in treating a wide variety of illnesses and injuries in every age group and condition.

“The caseload rarely matches the time you have you do your job,” says CRNA, MSN Nick Angelis of Behavewellness.com. The demands of the specialty, however, might not be to blame for the high turnover rate—at least not directly. Angelis claims that emergency nursing tends to attract adrenaline-seekers. “Once a nurse doesn't find that appealing anymore, their days may be numbered,” he explains. “Being surrounded by those types of people can be draining.”

Angelis suggests another issue worth noting deals with relationships and culture. “Several places in each hospital create their own unique culture, including the ER,” he says. He says the “thrill-seeking personalities” in this environment can result in a close, protective group of nurses. On the other hand, it can occasionally create a negative working environment. “Sometimes the chaos and subjectivity of the ER breeds bullying, competition and incivility.”

But you don’t just have to take the luck of the draw when it comes to your environment. Even nurses who feel bullied or aggravated by coworkers in the ER (or the stress of the job generally) can thrive with the right tools and attitude.

What nurses can do to thrive: Angelis believes the key to defeating an overly-competitive culture is to be assertive in your communication with everyone, while also promoting a culture of respect. “This follows the ER adage of, ‘I am here to save your butt, not kiss it’ as opposed to the smiling, passive behavior more common in other areas,” Angelis says.

Additionally, Angelis encourages all ER nurse hopefuls to sharpen their assessment skills since things move quickly in the ER. Critical thinking skills are paramount as every situation involves unique circumstances. “The ability to be adaptable, assertive and compassionate—not necessarily all at the same time—extends the longevity of the ER nurse's career,” Angelis adds.

3. Medical-surgical nursing

Turnover rate: 20.4%

Medical-surgical (med-surg) nursing has evolved from an entry-level position to a distinct specialty that represents the backbone of every institution, according to the Academy of Medical-Surgical Nurses (AMSN). The AMSN goes on to explain that some time ago, every nurse was a med-surg nurse, practicing on medical wards. But the specialty has evolved from the default position to an area of specialization.

“Medical-surgical nurses are the largest group of practicing professionals. It is one of the most demanding nursing specialties,” according to the AMSN. “Who but medical-surgical nurses can manage five to seven patients, plus the ones they have admitted and discharged throughout the day?”

Med-surg nursing is not for the faint of heart. These individuals care for a heavy caseload of patients who are admitted and discharged rapidly. It’s no secret that not every nurse can make it in this high-stakes specialty.

What nurses can do to thrive: Though it’s difficult to pinpoint why med-surg nurses face a particularly high percentage of turnover, they do represent the largest group of practicing nurses. One of the best strategies to thrive in this environment is undoubtedly prevention.

The AMSN states that med-surg nurses need to be knowledgeable in all aspects of adult health and have excellent assessment, technical, organizational and prioritization skills. These two requirements might be the difference between nurses who thrive in med-surg, and those who become part of the turnover.

Med-surg nurses also need to be highly concerned with patient safety and happy caring for patients of all ages, all demographics and multiple diagnoses across all medical specialties. If that sounds like a tall order, you’re not wrong. Med-surg nurses need every moment of their advanced education to prepare themselves for the demanding job at hand.

A world of specialties
Now you’re aware of some of the more stressful, yet incredibly important, nursing specialties out there. There are two types of people: those who see this as a warning, and those who view it as a challenge. If you feel called to overcome the obstacles in order to help vulnerable patients, know that there is much reward that comes along with the pressure.

If you’d prefer applying your abilities in a different area, there are plenty other nursing specialties out there to pursue. Learn more about your options in this Interactive Guide to Exploring Nursing Career Paths.


Do you have thoughts on why turnover rates are so high in these specialties or what can be done to prevent it? Share your comments with us below!



  1. Understaffing is a huge issue. Administrations
    Are always focused on finding a way to make
    More money for the corporation. The nurse
    Is no more than a tool to be used to that end
    There is no one to talk to when it all gets to be too much ch. when you loose a special patient
    Or or just overwhelmed you can’t eat or be
    Tired or sick. Tears are forbidden. If you
    Can’t already tell, after 30 years I am tired.
    And no one cares

  2. I know that educators are also at risk for burnout and career changes. Number one we do not get paid as well as hospital employees so once a nurse does decide to go to academic education, they find they cannot live on what we get paid. Number two the students can be very rude, demanding, and uncivil so at times we must also maintain classroom behaviors, prepare tests, do multitudes of homework grading, clinical, and also laboratory exercises.
    I do it because I enjoy teaching, the students, and my faculty. It is truly a calling that tells you sometimes it is not all about the money.

  3. The administration is responsible for ED turnover rates. Administration institutes clinical ladders for each nurse to achieve the standards set before them, this ladder is tied to the pay scale. The standards are constantly changing with the passage of years making it difficult for nursing to achieve the goals. Administration is always pushing the envelope to determine how many more patients a single nurse can handle. Nursing deals with the constant push to take on more, giving up breaks and often meal times, forbidden to eat at the desk or receive a verbal warning for failure to adhere to company policy. So many policies make the work environment more stressful than it has to be.

  4. I think the high turnover in psychiatric nursing is not only the paperwork, but that the facilities will hire anyone without experience in this department. But if I try to transfer to another department, I have no skills or experience. The attitude seems to be that psych is not “real” nursing. I have had nurses say they transferred to psych as a retirement job. I have even had other nurses talk down to me, as a psych nurse, when I need to transfer a pt for an acute medical problem. It is a speciality that is very misunderstood.

  5. I definitely think being understaffed is a BIG BIG issue. I have seen it from the patient side and to have 9 patients on a medsurg floor, all with lots of things going on it just not safe! And 12 hour shifts in some areas are just not good, I recently was a patient in the trauma ER in a city an hour away (came from local by ambulance), they were running like crazy all the time I was there, till I went to the floor to be admitted. And they all were exhausted. Each case I heard coming in was severe! Intense work like that for 12 hours! Not good, I would think they would burn out!

  6. I definitely think being understaffed is a BIG BIG issue. I have seen it from the patient side and to have 9 patients on a medsurg floor, all with lots of things going on it just not safe! And 12 hour shifts in some areas are just not good, I recently was a patient in the trauma ER in a city an hour away (came from local by ambulance), they were running like crazy all the time I was there, till I went to the floor to be admitted. And they all were exhausted. Each case I heard coming in was severe! Intense work like that for 12 hours! Not good, I would think they would burn out!


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