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The most recent NSI National Health Care Retention & RN Staffing Report reinforces a trend many healthcare leaders are actively managing, registered nurse turnover remains elevated in specialized, high-acuity care environments.
Drawing from data across 450 hospitals in 37 states, the report identified a national RN turnover rate of 16.4% in 2024. Several specialties exceeded this benchmark, including behavioral health (22.8%), step-down units (20.3%), emergency services (19.1%), and critical care (18.3%).
More concerning, cumulative turnover over the past five years exceeded 100% in step-down, telemetry, and emergency departments, indicating complete workforce replacement in less than five years in some service lines.
While turnover is often framed as a recruitment issue, the data increasingly suggest a broader operational challenge. Continued staff turnover drives a cycle of increased hiring and repeated training efforts, both of which carry significant financial and operational costs for hospitals. As new staff are onboarded, senior and experienced clinicians are frequently pulled away from direct patient care to support orientation, education, and competency validation. Over time, this repeated demand places additional strain on seasoned staff, contributing to workload imbalance, fatigue, and burnout. This cycle is not only costly for organizations but also exhausting for the teams tasked with sustaining it.
High-acuity clinical environments depend on consistent expertise, defined leadership structures, and sustainable support models. As workforce demographics shift and retirements accelerate, units with complex care demands may experience strain at a faster pace. In this context, retention becomes closely linked to how advanced clinical programs are structured, supported, and maintained over time.
Extracorporeal Life Support (ECLS) programs sit at the intersection of advanced technology, multidisciplinary coordination, and specialized nursing practice. When ECLS programs lack standardized leadership, clear role delineation, or consistent coverage models, the operational demands often shift to bedside clinicians. Over time, this dynamic can contribute to:
- Increased workload variability
- Role ambiguity in high-risk clinical situations
- Decreased clinical confidence and engagement
One strategy increasingly utilized by healthcare organizations is objective evaluation of existing ECLS programs to better understand how structure, staffing, and processes affect both clinical performance and workforce sustainability.
Comprehensive Care Services provides a full ECLS program evaluation and assessment, offering a detailed and unbiased review of current operations. This assessment includes:
- Staffing models and role clarity
- Coverage consistency and call structures
- Clinical workflows and escalation pathways
- Education, competency validation, and support infrastructure
This process identifies areas of strength to preserve, as well as opportunities where refinement may reduce operational strain and improve overall team performance.
Following evaluation, CCS works in partnership with hospital leadership and clinical teams to analyze findings and align on priority areas for improvement. In many cases, this includes targeted adjustments that support nursing staff by reducing unnecessary burden, improving predictability, and strengthening clinical oversight.
By addressing both operational and clinical dimensions, organizations can move beyond isolated staffing interventions toward system-level improvements that support nurses, providers, and patients.
Beyond program structure, continued education is a critical component of ECLS program stability and nurse retention. High-acuity therapies such as ECLS require ongoing skill reinforcement, exposure to evolving best practices, and regular competency validation to maintain confidence at the bedside.
Comprehensive Care Services offers continued educational programming for ECLS teams, designed to support nurses throughout all stages of practice. These offerings focus on:
- Reinforcing core ECLS principles and clinical decision-making
- Enhancing bedside comfort and readiness in complex scenarios
- Supporting safe, evidence-based patient care
- Providing teams with the tools needed to manage high-risk situations with confidence
Consistent access to education not only supports patient safety but also signals institutional investment in nursing practice, an important driver of engagement, professional growth, and long-term retention.
When additional support is indicated, CCS partners with hospitals to assume responsibility for ECLS programs or integrate with existing teams, with the ability to establish staffing models supported by experienced ECLS experts.
This approach enables ECLS program staff to practice at the top of their scope within a well-defined, supported framework, strengthening morale, improving continuity, and promoting long-term retention without disrupting established care environments.
As healthcare systems continue to confront turnover in high-acuity specialties, program-level evaluation, education, and support infrastructure warrant thoughtful consideration.
How advanced services such as ECLS are assessed, supported, and continuously developed may significantly influence nurse confidence, staff stability, and overall quality of care. For nurse leaders and hospital executives focused on sustainability, investing in structure, education, and clinical support may represent a meaningful path forward.
