Nursing Workforce Apr 20, 2026 4 min read

Slower Hiring, More Burnout: What the Research Tells Us — And What Comes Next

"Nurse understaffing isn’t just a retention issue—it’s sustained by slow hiring cycles that keep roles unfilled for months, increasing workload and burnout for existing staff. While research focuses on conditions after nurses are hired, a critical upstream factor is decision latency within the hiring process, where delays extend vacancies and reinforce the burnout cycle. Faster hiring alone won’t solve workforce instability, but slow hiring actively perpetuates it by prolonging understaffed conditions."

nurse burnout nursing shortage hospital hiring time-to-hire understaffing nurse retention hospital workforce RN turnover hiring bottleneck

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In July 2024, Dr. Christopher Friese and colleagues at the University of Michigan published a study in JAMA Network Open tracking 16,000 registered nurses across two survey periods.

The headline finding: fewer nurses planned to leave their positions in 2023 than in 2022 — 32% compared to 39%. A modest improvement.

But the study's more important finding was buried underneath that number. Understaffing remained the primary concern across both years. Working conditions were better — but not because the staffing problem was solved. The staffing problem persisted.

Friese's conclusion was direct: "Health system leaders and policymakers should prioritize initiatives that support nurse retention and reduce potential workforce instability."¹

He's right. But there's a step before retention that the research hasn't fully examined yet.

What the Study Measures — and What It Doesn't

Friese's research, alongside a broader body of literature on nurse workforce stability, focuses on what happens to nurses already on the floor. Burnout rates. Intent to leave. Workplace conditions. These are the right things to measure.

What hasn't been studied as carefully is what happens before those nurses arrive — specifically, how long a unit stays understaffed because the hiring process itself is slow.

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 That's nearly three months from job posting to hire. During that time, the nurses already on the unit absorb the difference.

Every week a position goes unfilled is a week of elevated patient loads, increased overtime, and compounding fatigue for the team that's there. Understaffing doesn't begin when a nurse quits. It begins the moment a vacancy isn't filled fast enough.

The Cycle That Sustains Itself

The connection between slow hiring and burnout isn't speculative. It's mechanical.

A nurse leaves. The unit operates short-staffed. The remaining nurses take on additional load. Burnout risk increases. More nurses consider leaving. The unit needs to hire again — and the same slow process begins.

Friese's data shows this cycle is still running. Understaffing remained the top concern in both 2022 and 2023 despite measurable improvements in other workplace factors. The floor got somewhat better. The staffing gap didn't close.

Part of why it doesn't close is that the hiring process has its own bottlenecks — ones that aren't visible in nursing workforce research because they live inside HR operations, not at the bedside. The most consistent of those bottlenecks: the gap between when a qualified candidate is ready for review and when the hiring manager actually acts.

The Variable the Research Points Toward

Friese concluded that hospitals need better retention strategies. That's true.

But retention starts earlier than most frameworks acknowledge. A nurse who joins a unit that's been chronically understaffed for months walks into an environment already under pressure. Their onboarding experience, their first weeks on the floor, their early sense of whether this place is manageable — all of it is shaped by how long the unit waited before they arrived.

Faster hiring doesn't solve burnout. But slower hiring sustains the conditions that cause it.

That's the variable the research points toward, even when it doesn't name it directly.

What Comes Next

The research on nurse burnout is strong. The research on hiring process operations — specifically what causes delays after a candidate applies — is nearly nonexistent.

That's the gap Boundee works in. We help hospitals reduce the decision latency inside their existing hiring workflows, without replacing the systems they already use. Faster decisions. Shorter vacancies. Less time between a qualified candidate and a filled role.

Not because we think hiring speed solves everything. But because the data on what happens when it's slow is clear enough.

Sources

  1. Friese CR, Medvec BR, Marriott DJ, Khadr L, Rurka Wade M, Riba M, Titler MG. Changes in Registered Nurse Employment Plans and Workplace Assessments. JAMA Network Open. 2024;7(7):e2421680. https://doi.org/10.1001/jamanetworkopen.2024.21680

  2. 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/