Across the United States, there has been an increase in turnover rates in nursing staff within the past few decades. Due to the higher turnover rates, hospital and other healthcare systems are attempting to determine what the cause of the turnover rates are. They are also wanting to determine how to hire talent that is willing to stay at their organization, as well as how to increase retention of the employees, specifically nurses, that are hired. Focusing on turnover rates for nursing positions in healthcare can have a significant, positive impact on a healthcare facility’s bottom line. In an attempt to analyze nursing turnover rates and the expenses associated with them in the United States, NSI Nursing Solutions, Inc. created the 2017 National Health Care Retention & RN Staffing Report. This study was open for all hospitals within the United States to participate, and 136 hospitals across the country responded to their study survey. The top two regions who submitted data include North Central area of the United States at 25% participation in the study, including fifteen states and their hospital systems, and the South East area of the United States at 38.2%, including ten states and their hospital systems. The North East and West parts of the United States were equally represented at 12.5%, and the South Central portion of the United States, which includes Arkansas, had 11.8% of participation in the study. According to the study, from 2013 to 2017, there was a 4.1% increase in RN turnover in healthcare facilities, and “the average cost of turnover for a bedside RN ranges from $38,900 to $59,700 resulting in the average hospital losing $5.13M – $7.86M, annually,” (NSI, 2017, p. 1). This loss in funds due to low retention and high turnover rates will significantly impact a bottom line. Nursing Solutions, Inc.’s (2017) study also found that “the average time to recruit an experienced RN ranged from 55 to 119, pending specialty,” (p. 7). During these days, healthcare facilities are spending dollars on hiring temporary or travel nurses to temporarily fill the employment gap; interviewing and hiring new nurses; and onboarding and training new hires. Also, during the training period, it is typically two nurses to one patient as the first, more experienced nurse trains the new hire. Thus, the hospital is spending twice the amount for two people doing the work that one person could do, and this training period could last from three months to one year. Depending on the department or specialty, the cost of turnover could be as high as $59,700 for one nurse. If that is multiplied across one-hundred or even ten new-hire nurses, the healthcare facility could lose hundreds of thousands, if not millions, just in nursing turnover alone – not including turnover in physicians, support services, and administration. By focusing on retaining the nursing staff, hospitals and other healthcare entities could and should see a more positive impact for their bottom line. The entity will be able then to save those dollars previously spent on nursing turnover and allocate it to projects within the hospital. A second study was performed analyzing the widespread nursing dissatisfaction and burn out rates. In this study, 95,499 nurses responded to a survey that focused the environment nurses’ function in, including on around where exactly the nurses worked, what kind of environment they had in their area, what level of burnout they were feeling, and their overall job satisfaction. Roughly half of respondents, or roughly 47,725 nurses, were working in hospitals and nursing homes, while the other approximated half of respondents held other nurse-title jobs in fields such as pharmaceuticals. Of the roughly half that were working in hospitals and nursing homes, the study found that, “24 percent of hospital nurses… reported dissatisfaction in their current jobs… [and] 34 percent of hospital nurses…reported feeling burned out in their current jobs,” (McHugh, 2011, p. 4). There were also large portions of nurses, approximately 40% of those who worked in hospitals, that were unhappy with the benefits packages that they currently had. The quantity of people who are dissatisfied are also considered to be disengaged nurses. Disengaged, burnt-out nurses can influence a new-grade, new-hire nurse to create another disengaged individual in the entity. Also, twenty-four percent of the approximated 47,724 hands-on nurse employees in this study are dissatisfied. That would put the number of dissatisfied employees at roughly 11,453, with the thirty-four percent of burnt-out employees representing 16,226 nurses. Within this study alone, a combined 27,679 nurses in the workforce are unhappy and unengaged with their work. This impacts the standard of care the organizations offer. This also impacts the perceived quality of care received by patients. If an employee does not enjoy their work, they are less likely to form genuine patient relationships, perform in their areas of work, or even leave the entity all together, creating a nursing shortage within the organization. Also, if a nurse is not engaged and performs low-quality work, there can be adverse effects. These can include financial effects, such as reimbursement rates, that are based on quality. This could also impact the reputation of the healthcare entity. People may choose another facility for care solely on the fact that they had a nurse that did not seem to care for their job or for them as a patient. An interesting fact is that the United States’ nursing turnover and burn-out rates vary with work experience. According to The University of New Mexico (2016), “43 percent of newly licensed nurses who work in hospitals leave their jobs within three years. Additionally, 33.5 percent resign after two years and 17.5 percent work for only one year.” These higher rates of more-experienced nurses are considered to be attributed to nursing burnout. Characteristics that were found to lead to burnout include the demanding atmosphere, lack of support from the organization, and an imbalance in work and social life. Another University in Colorado also discussed nursing turnover and how to improve retention rates. According to American Sentinel University (2018), “the 2017 HealthLeaders Media Nursing Excellence Survey found that 61 percent of nurse leaders listed staff retention as one of their top concerns.” This indicates that employees fear what financial statements of an organization reflect: high nurse turnover. This statistic is important, because it demonstrates that even leadership within nursing departments realizes that this burnout is an issue, and they will want to step up to try and keep nurses employed. American Sentinel also outlined strategies for reducing turnover rates in nursing, including decreasing shift times from twelve hours to more reasonable hours, as this was found to be a common theme among healthcare entities with high turnover rates in the HealthLeaders survey. Also, three other suggestions were also recommended by the University of New Mexico: better accommodating to and recognizing the need for work-life balance in nursing; creating an appropriate and pleasant atmosphere for nurses; and having interdisciplinary collaboration between the nursing staff, physicians, and other important healthcare team members. Retention can be directly linked to employee satisfaction and engagement. The Ontario Health Association, or OHA, conducted a study based upon the healthcare facilities whom are a part of its association. Of the sixteen hospitals and over 10,000 employees, the Ontario Health Association was able to create a chart for retention based on three levels of employee engagement: high engagement, medium engagement, and low engagement. When individuals had low engagement, almost half of the employees were likely to look for a position elsewhere within one twelve-month calendar year. However, highly-engaged employees cut that number down to only 10.3% of individuals who would seek other employment in one twelve-month calendar year. Based on these study results, the Ontario Health Association created the Quality Healthcare Workplace Model that strategically focuses on employee engagement.