Key Findings
- •National average: 46.8% nurse turnover, meaning nearly half of all nursing staff leave each year
- •1-star facilities have 52.5% turnover vs 5-star at 39%—a 35% difference
- •Facilities with high turnover (60-90%) average just 2.0 stars and have 0% chance of 5-star rating
- •Low turnover (<30%) facilities average 3.40 stars with 20% achieving 5-star status
The Hidden Crisis Affecting Your Parent's Care
Nearly half of all nursing home staff leave their jobs every year. That's 46.8% turnover nationally. For perspective: if a facility has 100 nurses today, 47 of them won't be there in 12 months.
This isn't just a staffing problem—it's a quality problem. When experienced nurses leave, resident care suffers. New staff don't know residents' preferences, medical histories, or behavioral patterns. Continuity of care disappears.
But here's what families need to know: turnover isn't evenly distributed. Some facilities keep staff for years. Others have a revolving door.
We analyzed nurse turnover data across nursing homes and cross-referenced it with quality ratings. The correlation is stark—and it gives you a concrete number to check before choosing a facility.
What Nurse Turnover Actually Measures
Nurse turnover rate is the percentage of nursing staff who leave a facility in a given year. A 50% turnover rate means half the nursing staff departs annually and must be replaced.
💡 Why This Number Matters
CMS tracks two turnover metrics: total nurse turnover (all nursing staff: RNs, LPNs, CNAs) and RN turnover (registered nurses only). Both matter, but total turnover gives the fullest picture of staff stability.
National Averages
Target for Quality Care
The Turnover-Quality Connection: A Clear Pattern
CMS star ratings and turnover rates move in opposite directions. As turnover rises, ratings fall.
| Star Rating | Avg Turnover | Difference from 5-Star |
|---|---|---|
| ⭐⭐⭐⭐⭐ 5-Star | 39.0% | Baseline |
| ⭐⭐⭐⭐ 4-Star | 43.2% | +10.8% |
| ⭐⭐⭐ 3-Star | 49.9% | +28.0% |
| ⭐⭐ 2-Star | 48.2% | +23.6% |
| ⭐ 1-Star | 52.5% | +34.6% |
✅ What This Means for Your Search
5-star facilities maintain 39% turnover—still high by most standards, but 35% better than 1-star facilities. This isn't coincidence. Facilities that invest in staff retention (competitive pay, reasonable workloads, supportive management) also invest in resident care.
The pattern is consistent: better facilities keep staff longer. Staff stability translates directly into better resident outcomes.
Turnover Thresholds: When It Becomes a Problem
Not all turnover is equal. Here's how different turnover levels correlate with quality:
Low Turnover (<30%)
5 facilities in our dataset
Moderate Turnover (30-60%)
63 facilities - most common range
High Turnover (60-90%)
8 facilities - concerning instability
🚨 Critical Finding
Zero facilities with 60-90% turnover achieved 5-star ratings. When turnover exceeds 60%, quality care becomes nearly impossible. Staff can't build expertise, relationships with residents break down, and mistakes multiply.
Why High Turnover Destroys Quality Care
The numbers tell you turnover correlates with quality. But here's why it matters on a practical level:
🏥 Loss of Institutional Knowledge
New staff don't know which resident has diabetes, who's a fall risk, or whose daughter visits Wednesdays. This knowledge takes months to build—and with high turnover, it never accumulates.
👥 Relationship Breakdown
Residents bond with caregivers. When those caregivers leave every few months, residents experience repeated loss and must rebuild trust with strangers—a serious emotional toll, especially for dementia patients.
⚠️ Increased Errors
Medication mistakes, missed symptoms, and protocol failures spike when facilities are constantly training new staff. Experienced nurses catch problems before they escalate—new nurses don't have that intuition yet.
📉 Staff Morale Spiral
High turnover creates more turnover. Remaining staff get burned out covering shifts, training new hires, and picking up slack. This creates a death spiral where good staff leave, making conditions worse for those who stay.
Staffing levels matter, but staff stability matters just as much. A facility with adequate staffing numbers but 80% turnover still can't provide quality care.
Facility Size and Turnover
Larger facilities face more severe turnover challenges:
| Facility Size | Avg Turnover | Facilities |
|---|---|---|
| Medium (50-99 beds) | 45.8% | 19 |
| Large (100-199 beds) | 46.9% | 54 |
| Very Large (200+ beds) | 50.9% | 3 |
Very large facilities (200+ beds) show 11% higher turnover than medium facilities. This compounds the challenges we identified in our abuse violations analysis where larger facilities also showed elevated risk.
How to Check Turnover Rates Before Choosing a Facility
Turnover data is public information. Here's how to find it:
Step-by-Step Process
- 1.Use our facility search
Search for nursing homes in your area. Each facility profile displays total nurse turnover and RN turnover rates. - 2.Check the staffing section
Turnover rates appear alongside RN hours and total staffing levels. Look for facilities under 40% turnover—ideally under 30%. - 3.Compare multiple facilities
Use our comparison tool to see turnover rates side-by-side with star ratings and other quality metrics. - 4.Ask during tours
When visiting facilities, ask: "What's your current nurse turnover rate?" and "How long has the director of nursing been here?" Long-tenured leadership usually means better staff retention.
Questions to Ask During Tours
- • "What's your total nurse turnover rate for the past year?"
- • "How long has the director of nursing been in their role?"
- • "What do you do to retain experienced staff?"
- • "How many CNAs are currently in training vs. fully trained?"
- • "Can I meet some of the nurses who'll be caring for my family member?"
See our complete facility tour checklist for more questions.
What Low-Turnover Facilities Do Differently
Facilities that maintain turnover under 40% share common practices:
💰 Competitive Compensation
They pay above-market rates and offer benefits. The best facilities recognize that investing in staff retention costs less than constant recruitment and training.
⚖️ Manageable Workloads
They staff adequately so nurses aren't overwhelmed. Burnout drives turnover—facilities that maintain reasonable nurse-to-resident ratios keep staff longer.
📈 Career Development
They provide training, continuing education, and promotion paths. CNAs can become LPNs; LPNs can advance to supervisory roles.
🤝 Supportive Management
They listen to staff concerns and make changes. Long-tenured administrators create stable cultures where experienced staff want to stay.
These aren't luxuries—they're necessities for quality care. Facilities that treat staff well treat residents well. The correlation is that simple.
Find Facilities with Low Turnover
Search our database to see turnover rates alongside star ratings, staffing levels, and safety records.
Find Facilities with Stable Staffing
Search for nursing homes with low turnover rates:
Methodology
This analysis is based on nurse turnover data from Medicare-certified nursing homes as reported in the CMS Payroll-Based Journal system. Turnover rates represent the percentage of nursing staff who left employment during the reporting period.
Data Sources:
- CMS Payroll-Based Journal (PBJ) turnover data
- Facility star ratings (overall, health inspection, staffing, QM)
- RN and total nurse staffing hours per resident per day
- Facility characteristics (size, ownership, location)
Analysis approach: We cross-tabulated turnover rates with quality ratings to identify statistically significant patterns. Facilities without turnover data were excluded from specific analyses but included in overall facility counts.
Related Guides
Continue learning with these related articles:
Apply This Knowledge
Why Staffing Levels Matter Most →
RN hours and total nursing hours are the #1 predictor of quality care
Understanding Star Ratings →
Learn how CMS calculates star ratings and what separates 5-star from 1-star facilities
Abuse Violations & Risk Factors →
Patterns and predictors of abuse violations across nursing homes
Facility Tour Checklist →
What to look for and questions to ask when visiting facilities