Executive Summary
Early-tenure RN turnover remains unsustainably elevated – even as many health systems have reduced turnover from pandemic-era peaks. Nearly one-third of new graduate nurses (NGNs) leave within their first year. For executives managing margins, this persistent churn is not just a workforce challenge; it is a measurable cost. Replacing one bedside RN is estimated at ~$61,000, creating additional avoidable expenses at scale at a time when margin management is paramount.
Nurse residency programs remain a necessary investment and continue to build baseline clinical competence. However, our benchmarking data suggest that residency is no longer sufficient as a stand-alone retention strategy. The missing ingredient is clinical confidence – a factor tightly linked to whether early-career nurses intend to stay once structured residency supports taper.
Nursing Catalyst’s national benchmarking data show that NGNs with the highest confidence are 39% more likely to report strong intent to stay than their least confident peers. The strategic implication of this is clear: nursing workforce strategy must evolve beyond residency as a blunt instrument and address clinical confidence as a primary retention imperative sustained across the first three years of practice.
Source: 2025 NSI National Health Care Retention & RN Staffing Report, NSI 2025.
Key Takeaways
1. Clinical confidence is the missing X factor in early-tenure retention strategy.
NGNs reporting the highest confidence are 39% more likely to express strong intent to stay than less confident peers.
2. NGNs want to stay at the bedside – but turnover risk rises as confidence dips and work conditions erode resilience.
While 69% of NGNs envision long-term bedside careers, those considering leaving most often cite workplace culture/leadership, workload/burnout, and limited growth visibility as the drivers. These challenges become even harder to navigate when clinical confidence is low.
3. Retention gains come from precision, not more spend.
High-performing approaches stage support to protect and grow confidence beyond initial onboarding by sequencing from early confidence stabilization, mid-transition belonging and mentorship, to late-stage growth pathways.