Skilled nursing facilities face a turnover crisis that goes far deeper than wages. With 50% annual turnover across the industry, the conversation about retention can't stop at compensation.
Yes, competitive pay matters. But we know the reality: dedicated CNAs, LPNs, and RNs are walking away from facilities not because of their paychecks, but because of daily frustrations that chip away at their commitment. And when they leave, they're leaving behind understaffed shifts, overworked colleagues, and an ongoing cycle that can negatively impact the care your organization can provide.
Here are the top hidden drivers of turnover we see in skilled nursing today.
Ask any CNA what makes them consider leaving, and chaotic scheduling usually tops the list. Last-minute shift changes, difficulty picking up shifts, inflexible schedules that make planning anything impossible–these aren't minor annoyances. They're dealbreakers.
The numbers back this up. In a survey of nurses, 58% identified work-life balance as the most crucial factor in job satisfaction. When your staff can't predict their schedule from week to week, even the most dedicated professionals start looking elsewhere.
Beyond the obvious coverage gaps, unpredictable scheduling forces you to rely heavily on overtime (ultimately leading to staff burnout) or expensive agency staff.
Your staff needs to complete annual training. That's not optional. But when the mandatory requirements feel like a waste of time, you've got a problem.
Picture this: Your experienced CNA sits through the same generic slide presentation they've seen for the past three years, covering topics that have nothing to do with the residents they actually care for. The content is outdated, the delivery is painful, and the entire experience leaves them feeling as though leadership doesn't value their time or their professional growth.
A poor training experience doesn’t just consume hours that your employees don’t have to spend. It makes them question your dedication to professional development. Most importantly, it can impact care as staff zone out during training, missing out on the essential knowledge they need to reinforce critical skills and drive behavior change.
Nothing destroys trust faster than paycheck errors. When time and attendance systems are unreliable or overly complicated, the fallout is immediate. Overtime that doesn't show up on paychecks, confusing time-tracking modules that make it difficult to clock in or out, corrections that take weeks to process–employees don’t want to deal with it. Especially with an estimated 68% of Americans now living paycheck to paycheck.
Many CNAs are already working with 1-to-13 patient ratios, among the heaviest workloads in healthcare. When they can't even count on being paid correctly for that work, you've fundamentally broken the employment relationship. The administrative overhead of fixing these errors takes time away from retention strategies that actually work, and you'll often lose good employees over completely preventable mistakes.
First impressions matter. Research shows that nearly 18% of new nurses leave within their first year, and one in four RNs in their first two years left their organization between 2022 and 2023.
Many facilities rush through onboarding, focusing primarily on compliance paperwork while neglecting the human side of the equation. New hires don't know who to ask for help. They don't understand the unwritten rules. They spend their first weeks feeling lost and wondering if they made the right choice. This extends the time it takes for them to become fully productive and creates unnecessary stress for both new hires and their supervisors.
But it doesn't have to be this way. Organizations that implement structured onboarding programs see dramatic results, reducing turnover from 39.1% to 18.4% in one study. Even simple interventions make a difference: 30-45 day manager check-ins improve retention by 6 percentage points, while 6-9 month check-ins boost it by 10 percentage points.
In the daily rush of skilled nursing, positive feedback often falls by the wayside. Problems get addressed immediately. Mistakes get corrected. But when someone goes above and beyond? Silence.
The research is clear: 79% of employees who quit cite "lack of appreciation" as their primary reason for leaving. Organizations with strong recognition programs have 31% lower voluntary turnover than those without.
Your CNAs, LPNs, and RNs chose this work because they are driven by a mission to care for others. When that dedication goes unacknowledged day after day, even the most compassionate professionals begin to question whether their efforts matter. The lack of recognition contributes to emotional exhaustion and disconnection from your facility's mission. Employees may reduce their discretionary effort or begin looking for environments where their contributions are actually valued.
Your benefits package might look competitive in the offer letter. But if your staff can never actually use those benefits, they're worthless.
The 2025 Skilled Nursing Workforce Report found that the biggest drivers of turnover include insufficient benefits (64%) and not having employer-sponsored healthcare (40%). But here's what's often missed: it's not just about what benefits you offer. It's about whether your staff can actually access them.
Vacation requests get denied because of staffing shortages. Mental health days are discouraged. Professional development opportunities are canceled because you can't find coverage. The promise of work-life balance becomes meaningless when employees can never take time off. You're wasting budget on benefits that provide no retention value while your staff seeks opportunities where they can actually access what they're promised.
Addressing these hidden drivers requires more than quick fixes. The facilities that succeed at retention take a fundamentally different approach:
They invest in reliable systems. Easy-to-use scheduling software, learning management systems that deliver online training tailored to their role, accurate, modern time-tracking, and daily pay apps. These aren’t just expenses; they are investments that promote retention and save you in the long run.
They create ongoing feedback loops. Exit interviews are too late; stay interviews and ongoing conversations are essential. Managers, supervisors, and HR teams must continuously collect feedback from teams and act on it before a small issue turns into the next employee exodus.
They measure what matters. Track scheduling stability, training completion rates, payroll accuracy, and benefit utilization alongside traditional turnover numbers.
They empower supervisors. Your charge nurses and unit supervisors need the tools and authority to address employee concerns quickly and effectively. Make sure they feel comfortable bringing issues forward and work alongside them to implement solutions. They are on the frontlines of issues, both big and small.
By systematically addressing these hidden drivers, you don't just save money on recruitment and training—you build stronger teams that provide better resident care and create positive workplace cultures that attract and retain the best talent in healthcare.
The facilities that thrive aren't necessarily the ones paying the highest wages. They're the ones who understand retention is about creating a workplace where professionals feel valued, supported, and set up for success from day one forward.