In 2023, Dr. Allison Norful and colleagues at Columbia University published a national survey analysis of over three million registered nurses in the United States.
The study, published in the Journal of Emergency Nursing, set out to understand why nurses leave their jobs — specifically, which reasons appeared most often and which factors were most strongly associated with burnout leading to turnover.¹
The top reason nurses cited for leaving: insufficient staffing.
Not pay. Not burnout directly. Not poor management.
Insufficient staffing.
What the Data Shows
Norful's team conducted a secondary analysis of the 2018 National Sample Survey for Registered Nurses, a nationally representative dataset covering over 3 million practicing RNs. They identified seven job turnover reasons that were significantly higher among emergency nurses compared to nurses in other settings — and insufficient staffing ranked first.
The finding aligns with a growing body of evidence that staffing levels aren't just a patient safety issue. They're a retention issue. When nurses work on units that are chronically short-staffed, the experience of working there degrades — workloads become unsafe, errors become more likely, and the reasons to stay become harder to articulate.
Norful's conclusion was direct: "Increasing evidence suggests that clinician well-being influences patient, workforce, and organizational outcomes."
The path from insufficient staffing to nurse departure is well-documented. What's less examined is what sustains the understaffing in the first place.
The Gap the Research Doesn't Cover
When a nurse leaves, a vacancy opens. That vacancy has to be filled.
In 2024, the average time to recruit an experienced RN was 83 days, according to the NSI National Health Care Retention & RN Staffing Report.² During those 83 days, the unit operates short. The remaining nurses absorb the gap. The conditions that drove the first departure are now present for the nurses who stayed.
This is the cycle that sustains nurse turnover — and it turns in part on how fast hospitals can fill open roles.
The bottleneck isn't always sourcing. Hospitals have candidates in their pipelines. The delay often happens after a qualified nurse applies and clears initial screening — when the role sits in a hiring manager's queue, waiting for a decision that doesn't come quickly enough. A candidate who applied on day one may no longer be available by day 14.
That delay — the gap between a candidate being ready and a decision being made — is what keeps units understaffed longer than necessary.
What Comes Next
Norful's research makes a strong case that reducing understaffing is the most direct lever hospitals have for improving nurse retention. The research on that side of the problem is rigorous.
What's still underdeveloped is the operational side: how to move faster once a candidate is in the pipeline, without asking more from recruiters who are already stretched, and without replacing the HR systems hospitals have spent years building.
That's the problem Boundee works on. We reduce hiring decision latency inside existing hospital HR infrastructure — so units stay understaffed for fewer days, and the conditions that drive nurses to leave ease a little sooner.
Not a complete solution. But one measurable variable in a cycle that costs hospitals billions every year.
Sources
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Norful AA, Cato K, Chang BP, Amberson T, Castner J. Emergency Nursing Workforce, Burnout, and Job Turnover in the United States: A National Sample Survey Analysis. Journal of Emergency Nursing. 2023;49(4):574–585. https://doi.org/10.1016/j.jen.2022.12.014
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NSI Nursing Solutions, Inc. 2025 NSI National Health Care Retention & RN Staffing Report. Via Becker's Hospital Review: https://www.beckershospitalreview.com/quality/nursing/hospital-nurse-turnover-vacancy-rates-by-year/