What the latest workforce data tells health systems, recruiters, and clinicians about keeping the people they already have
Key Points
A September 2026 Reuters report on a Harris Poll survey found that about 70% of US Gen Z healthcare workers expected to explore new roles within a year, compared with 59% of healthcare workers across all age groups. Yet 65% of the same Gen Z group hoped eventually to stay with one employer for five years or more.
The gap between mobility and loyalty appears to be mostly about career growth rather than restlessness. Nearly half of employers named a lack of growth or training as the top reason people leave, while only about one in four employees said they trusted their employer to invest in their future.
Turnover is expensive. The 2026 NSI retention report puts the average cost of replacing a bedside registered nurse at $60,090, and the average hospital's annual loss to RN turnover at roughly $5.19 million.
The American Hospital Association's 2026 Health Care Workforce Scan treats staffing-model redesign, responsible AI adoption, and employee engagement as linked levers rather than separate programmes.
International recruitment into UK nursing has cooled sharply, and WHO projects shortages that remain concentrated in the regions least able to afford losing staff. Keeping the workforce a system already has is therefore not only the cheaper option; it is arguably the more ethical one.
A Note on Evidence and Scope
This article draws on a handful of recent, mostly US and UK data sources, and it is worth being clear about what they can and cannot show. The headline survey was conducted by the Harris Poll and commissioned by Strategic Education and its subsidiary Workforce Edge, an education services business with an evident interest in training being seen as a retention lever. That does not invalidate the findings, but it is a reasonable reason to read the interpretation with care. The core statistic also measures expectation, not behaviour: saying you expect to explore new roles is not the same as resigning, and some secondary coverage of the survey has blurred that distinction. Finally, most of the quantitative evidence below is American or British. We use it because the underlying dynamics (an ageing workforce, administrative burden, advancement frustration, and the cost of churn) are recognisable across many health systems, not because any one country's numbers transfer directly to another's.
The argument of this piece is also narrower than its title might suggest. Retention becoming as important as recruitment does not mean recruitment matters less. It means the two are increasingly inseparable, because a recruitment pipeline that feeds a leaking workforce solves very little.
The Signal: Mobility Is Now the Default Expectation
The Reuters report, published on 16 September 2026, described a survey of 1,514 healthcare employees and 304 employers fielded between 12 June and 1 July. About 70% of Generation Z healthcare workers (broadly, those born between 1997 and 2012) said they expected to explore new roles within the next year. Across all age groups the figure was 59%. Reuters framed the findings as a retention challenge for US employers already facing a projected shortage of nearly 500,000 workers by 2038, as an ageing workforce and rising demand put pressure on staffing.
Two features of this result deserve more attention than the headline number.
First, the intent to look is not confined to the youngest workers. A majority of healthcare workers of every age said they expected to seek a new role. Gen Z stands out in degree, but the broader pattern is a workforce for which changing employers is a normal, expected part of a career rather than an exceptional event. For employers, this means retention cannot be treated as a problem of one generation that will eventually "settle down."
Second, loyalty and mobility coexist. The same survey found that most Gen Z respondents hoped to stay with one employer for five years or more, and that nearly all said job stability mattered to them. A separate summary of the report by the Advisory Board noted that only 44% of Gen Z healthcare workers described themselves as very loyal to their current employer. In other words, many of these workers are not looking for a revolving door. They are looking for an employer worth staying with, and they are prepared to leave if they cannot see one.
The Advancement Gap
The survey's most useful finding for practical purposes may be the mismatch between what employers and employees believe about investment in careers. Nearly half of employers said that a lack of career growth or training was the leading reason workers leave. Yet only about one in four employees said they trusted their employer to invest in their future. Employers, in other words, largely know why people go, but employees do not feel the response.
That is a credibility gap more than a knowledge gap. Many hospitals and health systems do offer tuition support, certification pathways, and internal progression routes. The Advisory Board's account of the survey suggests that what workers want is concrete clarity: what a certification will actually lead to, what time and financial commitment it involves, and what advancement looks like, ideally communicated by managers and peers rather than by a benefits brochure. Younger workers in particular appear to treat vague promises of development as functionally equivalent to none.
For doctors reading this, the pattern will be familiar from medicine's own training culture. A junior doctor who can see a credible route to a specialty post, a fellowship, or a leadership track tolerates a great deal of present-day difficulty. One who cannot see it, or who suspects the route is closed to people like them, leaves. The survey suggests the same logic increasingly governs nurses, allied health professionals, and support staff.
The Economics: Churn Is the Costliest Line Item
The business case for retention is not subtle. NSI Nursing Solutions' 2026 National Health Care Retention and RN Staffing Report, based on responses from 527 hospitals in 40 states, found that staff RN turnover rose to 17.6% in 2025, up from 16.4% the year before and reversing a post-pandemic improvement. The average cost of turning over a single bedside RN was $60,090, and the average hospital lost about $5.19 million to RN turnover across the year. Each one-percentage-point change in RN turnover moved the average hospital's costs by roughly $295,000. The national RN vacancy rate stood at 8.6%.
Turnover was far from evenly distributed. Behavioural health nurses led at 22.5%, followed by emergency nurses at 20.7%, with telemetry and step-down units also above the national average. NSI's own commentary on the highest-turnover units is stark: at those rates, a department effectively replaces its entire RN complement in under four and a half years.
The early-career picture matters particularly. The 2025 edition of the NSI report, as cited by a secondary source, found that 22.3% of newly hired RNs left within their first year. We have not verified that figure against the primary report, and readers should treat it as indicative, but it is consistent with a wider pattern: the period immediately after hiring is where recruitment investment is most likely to be lost. A hospital that spends months and substantial fees to fill a vacancy, and then loses the hire within twelve months, has not filled the vacancy so much as rented it.
These figures are nursing-specific, and the economics for physicians differ, since replacing a doctor involves locum cover, credentialing delays, and often a longer search. The direction of the argument, though, is the same: a fraction of the money spent replacing people, redirected toward keeping them, would in many cases buy more workforce stability than another round of recruitment.
What the AHA 2026 Workforce Scan Adds
The American Hospital Association released its 2026 Health Care Workforce Scan in early December 2025, as an annual snapshot drawing on reports, studies, and case examples from dozens of organisations. It identifies five areas in which hospitals and health systems are reshaping their workforce strategy: redesigning staffing models and workflows with team-based approaches; building the foundation for AI to deliver value; improving engagement and well-being; redefining workforce needs and roles; and supporting a multigenerational workforce.
Read as a retention document, the scan's most important move is to refuse to treat these as separate workstreams.
Staffing models are a retention tool. The scan describes renewed investment in team-based care, and the AHA's accompanying commentary lists alternative career pathways, cross-training programmes, remote or hybrid clinical roles, and mobile workforce pools among the new models. Each of these can be read as a response to the advancement gap described above: they create visible routes for progression, more varied work, and more control over how and where people work, which are precisely the things the Reuters-reported survey suggests early-career staff are looking for.
AI is a retention variable, not just an efficiency variable. The scan stresses that AI delivers value only when paired with redesigned processes, and that leaders are putting policies in place, training staff in safe and ethical use, and disclosing AI use to patients. The AHA's commentary points to AI-assisted documentation, decision support, digital scheduling, and telehealth as ways to reduce administrative burden and extend capacity without proportionally increasing headcount. The workforce survey adds a caution: while 70% of employers believed workers trusted their organisation's AI implementation, only 52% of workers said they at least somewhat trusted their employer to implement it responsibly, according to the Advisory Board's summary. The Reuters report also noted that the share of respondents saying AI skills would be critical to staying competitive fell to about 79% from 89% a year earlier. Taken together, this suggests workers are neither hostile to AI nor uncritically enthusiastic. Documentation tools that visibly give clinicians time back probably help retention; tools introduced without explanation or training probably do the opposite.
Engagement is positioned as a strategic priority. The scan states that organisations making employee engagement a key strategic priority are better positioned to retain early-career clinicians and sustain a workforce that now spans four generations. It points to mechanisms such as shared governance structures, in which frontline staff have a genuine say in how work is organised, rather than wellness initiatives bolted onto unchanged working conditions.
Workforce needs themselves are changing. The scan highlights growing demand for roles in virtual care, cybersecurity, AI, and complex care coordination. For retention, this opens up new internal career lanes, but only if existing staff are offered training to move into them. If those roles are filled externally while current clinicians are told to upskill on their own time, the advancement gap widens rather than narrows.
One caveat is that the scan is a compilation of strategies and case examples, not a controlled evaluation of which interventions work. It is a useful map of where leading organisations are placing their bets, rather than proof that those bets pay off.
Physicians Are Not Exempt
Much of the retention conversation centres on nursing because the data is richer, but physicians show related patterns. The American Medical Association's Organizational Biopsy, which surveyed nearly 19,000 physicians across 106 health systems and organisations in 2025, found that 41.9% reported at least one symptom of burnout, down from 43.2% in 2024 and the lowest rate since before the pandemic. Reported intent to leave one's organisation within two years has also eased, to 31.1% in the most recent data from 35.7% in 2023. That is genuine progress, and it is worth noting that it coincides with many organisations investing in precisely the administrative and workflow improvements the AHA scan describes.
The longer-term picture is less comfortable. An AMA-led study reported in May 2026 found that physicians are leaving clinical practice about nine years earlier than they did in 2008, with burnout, administrative hassle, and unrealistic patient demands replacing personal health concerns and malpractice premiums as the leading drivers. A CHG Healthcare survey cited in the same coverage found that 75% of physicians were satisfied with their jobs but only 18% were highly engaged, and that 45% spent more than 15 hours a week on paperwork. Satisfied but disengaged is a worrying combination for retention: it describes people who are not yet leaving but have little tying them to where they are.
The lesson for employers is that physician retention, like nursing retention, is substantially about how work is organised. Schedule control, adequate team support, and reduced documentation burden recur across the evidence as drivers. Perks and one-off recognition do not substitute for them.
The International Dimension: When the Pipeline Cools
For an organisation whose work spans borders, the most striking recent data comes from the UK nursing register. The Nursing and Midwifery Council's figures show that international joiners fell by nearly a third in 2024–25, from 29,628 to 20,671, and then fell by close to half again in the April–September 2025 window compared with the same months a year earlier (6,321 against 12,534), with particularly steep drops in joiners from the Philippines and India. The NMC's chief executive described the high-growth era of international recruitment as appearing to be over. In the year to March 2026, the register reached a record 867,935 professionals, but its growth slowed to 1.7% from 3.3% the previous year, and the number of UK-educated nurses and midwives joining fell for the first time in several years.
On the other side of the ledger, 30,323 professionals left the register in the year to March 2026, up 5.3% on the year before. Retirement was the most common reason, at 48.4%. Of those leavers, 5,229 were internationally educated, essentially unchanged from the previous year, even though far fewer international professionals were arriving. In 2024–25 only 19.9% of all leavers said they would recommend a career in nursing or midwifery.
Two observations follow. First, a workforce can no longer rely on growth through inflow. When international arrivals drop sharply while departures hold steady, the register's growth must increasingly come from people staying. Second, register data understates the retention problem. The NMC counts people who leave the register entirely, not those who move between employers, change specialty, or leave bedside care for other roles. The churn that actually disrupts wards and clinics is largely invisible in these national figures.
There is also a structural point on the supply side. WHO's State of the World's Nursing 2025 report estimates that the global nursing workforce grew from 27.9 million in 2018 to 29.8 million in 2023, with the global shortage projected to fall from 5.8 million to 4.1 million by 2030. But the improvement is uneven: about 78% of the world's nurses serve only 49% of the population, the African and Eastern Mediterranean regions are projected to see little or no growth in nurse density, and in around twenty countries, mostly high-income, retirements are expected to exceed new entrants. The report also found that only 42% of countries have measures in place to support nurses' mental health. In short, the shortage is not closing evenly, and the countries most able to recruit internationally are also those facing the largest retirement waves.
Why Retention Is Also an Ethical Question
The NMC data also records that Nigeria and Ghana have become two of the three largest sources of internationally educated nurses and midwives joining the UK register, despite both being on the UK's recruitment red list, which is meant to discourage active recruitment from countries facing the most acute health workforce shortages. That is a pattern a recruitment organisation with a humanitarian mission cannot comfortably ignore.
The ethical logic of retention is straightforward, even if its application is difficult. International recruitment is meant, under the WHO Global Code of Practice, to be conducted fairly and with attention to the effects on source countries. A recruit who joins an overseas employer, receives inadequate onboarding, and leaves within a year or two represents a cost borne by their home system, which has lost a trained professional, and by the recruit, who has absorbed relocation, licensing, and family disruption, with little durable benefit to the destination health system. By contrast, a health system that successfully retains its domestic workforce, and the internationally trained clinicians it has already brought in, reduces its marginal need to draw further on countries that can least afford the loss.
This is an argument, not a proof, and it should not be overstated. International recruitment, done well, benefits many clinicians who want to work abroad, and migration can bring remittances, skills, and eventual return. But it is reasonable to say that good retention is the ethical complement to recruitment: the more effectively destination systems keep the people they have, the less pressure they place on the most vulnerable workforces.
What Retention-Grade Practice Looks Like
The evidence reviewed here does not support any single silver bullet, and the strength of causal evidence for most retention interventions is modest. It does point to a coherent set of practices that employers can reasonably prioritise.
Make career growth concrete and visible. Spell out what each pathway or certification leads to, what it costs in time and money, and who has followed it successfully. The gap between employers who say they invest in development and employees who trust that they will is the single clearest finding in the Reuters-reported survey.
Treat the first year as a retention problem, not just an onboarding task. If early attrition is as high as the secondary NSI figure suggests, structured preceptorship, a manager who knows the new starter's goals, and check-ins well beyond the first month are cheaper than re-hiring. For internationally trained clinicians, practical support with housing, family, licensing, and cultural integration belongs in this category.
Redesign the work, not just the perks. The AHA and AMA material both point to team-based models, schedule control, and reduced administrative burden as more durable levers than one-off recognition or standalone wellness programmes.
Earn trust on AI. Involve clinicians in choosing and shaping tools, train them in safe use, and be transparent about where AI is used. The 18-point gap between employer and worker confidence in AI implementation is itself a retention risk.
Measure retention as a leading indicator. First-year attrition, internal transfer rates, stay interviews, and intent-to-stay surveys give earlier warning than annual turnover figures, and allow managers to act before a resignation arrives.
Take line management seriously. Many of the mechanisms above, including schedule fairness, advancement conversations, and psychological safety, are delivered or blocked at the level of the immediate manager. Investing in manager capability is rarely glamorous and frequently decisive.
What Clinicians Might Reasonably Ask
For doctors, nurses, and allied health professionals weighing a move, the same evidence suggests some practical questions to put to a prospective employer. What does development support look like in writing, and what proportion of staff actually use it? What is the first-year attrition rate for people in this role, and what do leavers say? How much control will I have over my schedule, and how is documentation burden handled? If AI tools are used in my workflow, who trained the team and how were clinicians involved in choosing them? For internationally trained candidates: what structured support exists in the first year beyond the first few weeks, and who is my named point of contact? An employer who answers these questions concretely is, on the evidence above, more likely to be one worth staying with.
What This Means for Recruitment Organisations
This is the part of the argument that applies most directly to organisations like ours, and it requires some honesty about incentives. Recruitment businesses have traditionally been paid for placements, not for tenure, and a candidate who moves is, in narrow commercial terms, an opportunity. If retention really is becoming as important as recruitment, that incentive structure needs to be recognised and, where possible, counterbalanced.
In practice that means judging our own work by how long placements last and how well they go, not only by how many are made; being candid with candidates and clients about the realities of a role, so that expectations are matched before an offer rather than renegotiated after arrival; providing aftercare that continues well beyond the start date; and sharing retention-relevant information with clients, such as where early attrition tends to occur, rather than treating it as someone else's problem. For an organisation with a humanitarian arm, it also means treating the ethical dimensions of international placement, including source-country impact and the experience of the clinician after arrival, as part of the quality of the service rather than as a compliance exercise.
Limits and Open Questions
Several caveats should accompany any confident conclusion. Intent surveys overstate actual departures, and we do not yet know what proportion of the 70% will move. Much of the data is American and British, and conditions in the Gulf, Southeast Asia, Africa, and continental Europe differ. The sponsorship of the headline survey and the self-reported nature of employer and employee views limit how far its interpretation can be pushed. Evidence that specific retention programmes reduce turnover, as opposed to correlating with lower turnover, is thinner than the volume of advice would suggest. And the AMA data shows burnout and intent to leave moving in a better direction at the same time as clinicians are leaving practice earlier, a reminder that a single year's improvement is not a trend. Anyone building a retention strategy should expect to test and adjust it rather than adopt a package.
Conclusion
For much of the last decade, workforce strategy has been dominated by the question of where the next cohort of clinicians would come from. That question has not gone away: shortages are projected to persist, and the global distribution of health workers remains deeply unequal. But the latest data suggests a second question has caught up with it, which is how many of the people already hired will still be there in three years.
The Reuters-reported survey describes a workforce that wants stability but will move if growth is out of reach. The NSI figures put a price on that movement. The AHA scan sketches how leading organisations are responding through redesigned work, thoughtful AI adoption, and engagement. The NMC and WHO data show that the pipeline can no longer be assumed to deliver growth by itself, and that leaning too hard on the world's most stretched health systems carries ethical costs. None of this makes recruitment obsolete. It does mean that a health system or a recruitment organisation that measures success only at the moment of hire is measuring half of the job.
Sources
Reuters, "Majority of US Gen Z healthcare workers eye new jobs within the year, survey shows," 16 September 2026 (survey by the Harris Poll for Strategic Education and Workforce Edge)
Advisory Board Daily Briefing, "Charted: Healthcare workers, especially Gen Z, want new jobs," 1 October 2026
Healthcare Dive and Fierce Healthcare, coverage of the Harris Poll healthcare workforce survey (2026)
American Hospital Association, 2026 Health Care Workforce Scan and Executive Summary (December 2025); AHA Center for Health Innovation, "Health Care Workforce: A System Under Pressure, Poised for Reinvention" (9 December 2025)
NSI Nursing Solutions, 2026 National Health Care Retention & RN Staffing Report; Becker's Hospital Review, "The cost of nurse turnover in 10 points," 2026; nurse.org, "Nurse turnover is rising again," 2026
ProLink Works, "How to Increase Nurse Retention in 2026," 27 April 2026 (secondary source for the 22.3% first-year RN attrition figure, which cites the 2025 NSI report; not verified against the primary document)
Nursing and Midwifery Council, The NMC Register data reports (September 2025 and 31 March 2026), and annual leavers' data; Nursing in Practice, coverage of NMC data (2025–2026); Personnel Today, "Number of new nurses from abroad falls by a third" (2025)
World Health Organization, "Nursing workforce grows, but inequities threaten global health goals," 11 May 2025 (State of the World's Nursing 2025); WHO EMRO regional launch notice (12 May 2025); Becker's Hospital Review, "Global nurse shortage to shrink by 2030: WHO" (2025); Dhivehi/MMTV summary of SoWN 2025
American Medical Association, Organizational Biopsy and National Physician Comparison Report (2025 data), as reported by Becker's Hospital Review (April 2026) and AMA; Barton Associates, "Physician Burnout in 2026" (5 May 2026); Radiology Business, coverage of AMA intent-to-leave data
Medical Economics, "Physicians are leaving clinical practice nine years earlier than they did in 2008, AMA study finds," 8 May 2026 (including CHG Healthcare 2025 physician sentiment survey data)
WHO Global Code of Practice on the International Recruitment of Health Personnel (general public record); UK Government Code of Practice red list guidance (general public record)