Surprising Ways to Reduce Turnover in High-Pressure, High-Skill Jobs

If you are a leader of a U.S. hospital or healthcare system, the following numbers should give you pause. In 2024 alone, more than 287,000 staff nurses left their positions, and nearly 1.6 million say they intend to leave within five years. When a nurse leaves, the cost goes far beyond recruiting and onboarding. Hospitals lose continuity of care, unit-level know-how, and the working relationships that help high-stress clinical units function well. In a field already facing staffing pressure, turnover can quickly become a capacity problem as much as a people problem.

The usual explanation of nursing turnover is straightforward: Nurses are overworked and burned out. That is true, but it is also incomplete. Our research confirms that overtime and the emotional toll resulting from adverse clinical events increase the likelihood that nurses leave. But there is a more useful insight: Not all job demands push people out; some pull them in. Our lessons apply not only to nursing, but also to other high-skill, high-burnout environments such as software development, advanced manufacturing, cybersecurity, and financial trading, air traffic control, commercial shipping, and law firms.

What Drives Nurses’ Turnover

In our study, we followed 420 full-time nurses over 26 months in the intensive care unit (ICU) of a large U.S. hospital system. We analyzed data from electronic health records that record nurses’ care activities, which allowed us to observe their time-stamped actions. This extensive dataset told us not just that a nurse gave a patient medication, but exactly when and for how long, and what other tasks nurses were working on that day. In addition, we had staffing, scheduling, and HR data that told us who ultimately chose to leave voluntarily. In other words, we could see what workload looked like in detail leading up to any decision to leave the hospital. We had one of the most granular views of what actually drives nurse attrition. Two findings stood out.

Overload drains people; meaningful responsibility anchors them.

This finding was counterintuitive. Nurses were less likely to leave when they held greater primary responsibility for patient care—a signal that they were trusted and relied upon. (We defined the level of responsibility as the number of patients for whom a nurse served as the primary nurse during a shift.) In our data, a 10% increase in responsibility reduced the odds of quitting by more than 54%.

This does not mean hospitals should simply pile more work onto nurses. It means leaders need to distinguish between two very different things: overload and meaningful responsibility.

When nurses are trusted with real responsibility, they feel more central to the work of the unit. Responsibility signals that the organization sees them as capable and important, deepening a sense of ownership. And in a setting like intensive care, where the work is demanding and consequential, that sense strengthens commitment. Nurses feel the demands of the job, but the job is also meaningful.

That distinction matters because the current workforce and burnout research tempts hospital leaders to treat every form of workload as harmful, a necessary evil to be minimized and mitigated. In practice, that is too blunt a view of how nurses actually experience the job.

Coworker support mitigates the negative impact of working overtime and sustained work pressure.

When nurses received help from teammates during a shift, the likelihood of them quitting fell significantly: We found that when nurses actively help each other during a shift, it reduces overtime-induced odds of quitting by 40% and work-pressure-triggered odds of quitting by 22%. In nursing, support from coworkers lightens the load while also changing the experience of work. A hard shift feels different when others simply step in and share the burden.

That is especially important in a setting as emotionally intense as nursing. Nurses work in teams. Patient needs can change quickly, and stakes are high. In that environment, teammate assistance is not a nice-to-have. It is part of the operating model.

Put differently, hospitals may be misreading the retention problem. Hospitals often approach retention as if it were mainly a staffing shortage or compensation issue. But part of the problem is work design. Leaders need to pay attention not only to how much work nurses do but also to whether that work gives them a sense of ownership and whether their colleagues step in when the pressure rises.

Applying Our Findings

These findings have immediate practical implications for leaders.

1. Think carefully about how responsibility is assigned.

Staffing decisions are often driven by coverage needs alone. But how responsibility is distributed matters just as much as how many nurses are available for the shift.

When nurses are trained and trusted to manage complex patients, operate sophisticated life-saving equipment, and have the latitude to use their clinical judgement, it signals value and deepens commitment to their patients, their medical unit, and colleagues. Leaders should assign roles to leverage highly skilled workers so they are genuinely accountable for meaningful outcomes.

2. Build redundancy and support into the workforce model.

Coworker support (additional nurses available to assist bedside nurses) reduces the likelihood that demanding work drives nurses out. Conversely, when teams are stretched so thin that no one can step away to help a colleague, addressing work imbalances becomes impossible, contributing to frustration and resentment.

With this in mind, when leaders make staffing decisions, they need to create enough flexibility for nurses to assist one another during intense periods and should recognize and reward helping behavior rather than treating it as incidental.

3. Treat retention as an operational problem, not an HR problem.

Turnover is shaped by daily decisions made at the front line: who is trusted with responsibility, how often people face punishing shifts without backup, and whether strain is shared or endured alone. Managers, not HR, control these variables through scheduling, role design, and contingency planning.

The most effective leaders go further: by partnering with nurses to build these systems rather than imposing them from above. The people most affected by these decisions have the clearest view of where the pressure points are and what would actually help.

Others’ research found that organizations already hold the operational data needed to identify those pressure points, including timestamps, shift patterns, and schedules. In the hands of empowered managers, this data can be effectively employed to test and improve staffing systems in ways that strengthen retention. Leveraging operational data and iterating on what isn’t working is key to ensure retention.

. . .

Our study focused on ICU nurses, but the lesson is broader. Similar dynamics exist where skilled workers operate in high-stakes, high-pressure environments. In such settings, organizations misread attrition as a compensation issue when it is fundamentally a work design issue. Sometimes leaders assume the answer is simply to reduce demands.

While there certainly are instances when that is necessary, it ignores other factors that influence burnout and churn. Retention often depends on building a culture where work feels meaningful and a system where the work is sustainable.

The lesson is clear for leaders of organizations with highly skilled workforces that experience high levels of burnout: Don’t just focus on how to reduce the workload of staff; explore how you might design work so that employees feel both trusted and supported.

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