The Real Cost of Nursing Home Staff Turnover in the US

Nursing home administrators don't need a report to tell them staffing is tight — the daily scramble to cover shifts already makes that clear. What a report can do is put a dollar figure on what turnover is quietly costing the facility, and why training investment is one of the few levers administrators can actually pull to bring it down.

Where turnover stands in US nursing homes today

The Hospital & Healthcare Compensation Service (HCS), in a 2025 workforce report produced with LeadingAge and supported by AHCA/NCAL, found turnover easing slightly but still historically high. Certified Nursing Assistant (CNA) turnover came in at 42.34% in 2025, down from 44.16% in 2024. Registered Nurse turnover was 36.53% and Licensed Practical Nurse turnover 35.29%. Support roles weren't spared either — dining services turnover ran at 40.56% and environmental services at 36.55%. Executive-level turnover fell the most sharply, from 31.97% to 22.12%.

The direction is encouraging — most categories improved year over year — but a turnover rate above one-in-three for nearly every frontline role is still a structural problem, not a blip.

What that turnover actually costs

Nursing-home-specific dollar figures are hard to pin down publicly, but the broader healthcare staffing literature gives a useful benchmark. NSI Nursing Solutions' 2025 National Health Care Retention & RN Staffing Report put the average cost of turnover for a single staff RN at $61,110 — up 8.6% from $56,300 in 2023 — with a typical range of $49,500 to $72,700 depending on specialty and market. NSI estimates that every one-percentage-point change in RN turnover is worth roughly $289,000 a year to the average hospital. That figure is drawn from hospital settings rather than skilled nursing specifically, but the underlying cost drivers — recruitment, orientation, lost productivity, and premium agency labor while a role sits open — apply just as directly to a SNF, and CNA and LPN replacement, while individually cheaper than an RN, happens far more often given turnover rates above 35%.

Layered onto direct replacement cost is the cost of agency and contract staffing used to cover the gap — consistently the largest controllable expense line for facilities running high vacancy, and one of the first places state surveyors and CMS staffing data look when assessing a facility's stability.

Turnover and compliance exposure under CMS rules

Turnover isn't just a budget problem for a skilled nursing facility — it's a survey risk. CMS's Conditions of Participation require facilities to maintain sufficient, competent staffing and to keep training and competency records current for every staff member providing care. A facility cycling through more than a third of its CNAs and nurses each year has to work much harder to keep CMS-required staffing and training documentation complete and audit-ready — and CMS now publishes facility-level staffing data (drawn from payroll-based journal submissions) that ties directly back into a facility's Five-Star rating, so chronic turnover shows up publicly, not just internally.

Where structured CPD and training reduce the bill

Facilities that have made real progress on retention tend to attack the same few levers:

• Front-loaded, structured orientation for CNAs and new nurses — rushed onboarding is one of the most consistently cited drivers of early exits.
• Ongoing, trackable CPD that gives staff a visible path from entry-level to specialized or supervisory roles, rather than a static job with no development.
• Centralized training records so administrators can see competency and compliance gaps before a survey finds them, rather than reconstructing records under pressure.
• Flexible, online delivery that fits around 12-hour shift patterns instead of pulling staff off the floor for a full day.

None of this fixes pay-driven turnover on its own, but it addresses the training-and-support side of the equation that facilities can control directly — and a workforce that feels competent and supported from day one is measurably less likely to leave in the first 90 days, which is where most nursing home turnover concentrates.

FAQs

What is the average nursing home CNA turnover rate?

42.34% in 2025, according to the HCS workforce report produced with LeadingAge and supported by AHCA/NCAL — down from 44.16% in 2024, but still meaning close to half the CNA workforce turns over annually at a typical facility.

How much does it cost to replace a nurse?

NSI Nursing Solutions' 2025 report puts the average cost of turnover for a staff RN at $61,110, within a range of roughly $49,500–$72,700. That figure comes from hospital settings, but the same cost categories — recruitment, orientation, lost productivity, and agency cover — apply in skilled nursing.

Does staff turnover affect a facility's CMS Five-Star rating?

Yes, indirectly. CMS uses payroll-based staffing data to calculate the staffing component of the Five-Star rating, and facilities with chronic turnover typically show more staffing volatility, which affects that score.

What's the single most effective way to cut early CNA turnover?

Strengthening orientation and first-90-days support. Facilities that invest in structured onboarding and give new hires a clear, visible training pathway consistently report better early retention than those relying on informal, on-the-floor training alone.

The bottom line

US nursing home turnover is improving but still runs above one-in-three for most frontline roles, and every point of it carries a real cost — in replacement spend, agency reliance, and CMS staffing-data exposure. Facilities that treat orientation and CPD as retention tools, not just compliance line items, are the ones bending that curve down.

Related reading: what staff turnover really costs Canadian long-term care homes and the true cost of care staff turnover in the UK.