By: Marcus J. Hopkins, Health Policy Lead Consultant, ADAP Advocacy
According to a recent Wall Street Journal article citing NSI Nursing Solutions, the turnover rate of registered nurses has increased to 18% in 2025 from 11% in 2010 (Te-Ping, 2026). Arguably, nurses are the backbone of the U.S. healthcare delivery system, so this trend is alarming.
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| Source: ADAP Advocacy | iStock |
The article, entitled “Nurses Are in High Demand—but They’re Quitting in Droves,” presents readers with the conundrum of high-stress jobs in healthcare: pay increases do not lead to better working conditions. And the issue isn’t a shortage of nurses—we’re graduating thousands of new graduates every year, and hospital systems rank among the top five employers in 22 states (Levinson & Hulver, 2025); the issue is that nurses are no longer willing to work in the current hospital environment:
Despite the potential of earning median salaries of $97,550/year, nurses are actively retiring or looking to retire from their positions at higher rates than ever, citing understaffing, verbal abuse, workplace violence, general burnout, and moral injury—where nurses, rather than feeling proud of their work, instead feel they cannot meet their patients’ needs (Costa et al., 2024).
To be clear, this isn't a problem contained to Registered Nurses (RNs) or Licensed Practical Nurses (LPNs)—burnout is common across healthcare, affecting physicians, nurses, caseworkers, and people working in and around the industry.
And the problem will only get worse.
Shortly after the height of the COVID-19 pandemic, the Centers for Disease Control and Prevention (CDC) released a series of articles focused on the topic of mental health in healthcare workers. They cited the following topline statistics:
- More than double the number of health workers reported harassment at work in 2022 than in 2018.
- Nearly half of health workers reported often feeling burned out in 2022, up from 32% in 2018.
- Nearly half of health workers intended to look for a new job in 2022, up from 33% in 2018 (Nigam et al., 2023).
The solution they proposed reads like a hospital executive’s worst nightmare (Figure 1):
Figure 1 – What Can Employers Do?
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| Source: Nigam et al., 2023 |
So, what’s so controversial about this seemingly innocuous set of recommendations?
The entire left-hand side of the graphic runs counter to how hospitals have operated for decades.
Let’s examine each of those recommendations:
1. Ensure Adequate Staffing:
Hospitals have been chronically understaffed for decades, particularly with nurses, and those circumstances aren’t getting any better. The Health Resources & Services Administration (HRSA) projects that, in 2027, the U.S. will face a shortage of 107,630 LPNs and 267,900 RNs (HRSA, 2025).
Multiple studies and surveys have shown that RNs repeatedly state that “chronic understaffing” is the primary cause of the issues that drive nurses out of the system. The American Hospital Association—a trade association that “represents 5,000 hospitals and health systems”—lists only three problems: stress, burnout, and retirement:
The report’s omission of chronic understaffing as a root cause is glaring. Executives have made intentional decisions to underinvest in nursing, including understaffed nursing positions, inadequate compensation for permanently employed nurses, and reluctance to create more flexible roles for experienced nurses so they remain in care delivery roles long term. Nursing labor costs comprise a substantial portion of health system budgets, but unfortunately, executives have aimed to shrink costs without recognizing the association of adequate nurse staffing with patient and health system outcomes (Costa et al, 2026).
The reality is that hospital executives—whether at for-profit or non-profit hospitals—place their own salaries above those who are providing actual services to patients and will continue to do so until they are made criminally liable for the injuries to and deaths of patients due to chronic understaffing. It certainly raises the question: how much executive compensation is enough?
And this understaffing doesn’t just lead to worker burnout; it creates conditions that will infuriate already stressed patients who feel their needs are being ignored. This leads us to…
2. Value Worker Safety and Health:
Chronic understaffing means that the nurses currently on site have to contend with staff meetings, significantly high nurse-to-patient ratios (patient caseloads), clinical responsibilities, and unreasonable amounts of medical coding in order to provide health insurers with the information they need to deny process patients’ claims. This means patients often face long wait times for both medical and basic needs, including IV bag replacements, blood draws, and even water. Anyone who’s visited an emergency room in any moderately populated area can attest that, even in settings where time may be a critical factor, it can take hours to even get a bed, much less actually receive care.
In these circumstances—particularly in healthcare settings, where emotions are often already high—patients are more likely to become volatile, especially when they feel like they’re being neglected or ignored. These problems are compounded by growing mistrust in healthcare professionals, stoked by the current Secretary of Health and Human Services, Robert F. Kennedy, Jr. As a result, nurses reported a 26% increase in attacks in 2025 compared with 2017. Another survey found that more than half of nurses reported experiencing verbal threats or aggressive language in the past year, and 27% experienced physical assaults (Kuchno, 2026).
Beyond physical threats to worker health and safety, hospital executives often strictly ration basic equipment and supplies in an effort to cut costs. These moves to decrease line-item costs generally undermine patient care. These cost cuts have led nurses to literally go to other wards to abscond with medical carts and monitors and bring them where they’re needed, rather than leaving them unused elsewhere.
3. Model and Support Taking Time Off
This one is relatively easy to grasp: it’s incredibly easy for management, including executives, to schedule time off; for doctors and nurses, taking time off often requires significant schedule juggling to ensure coverage at hospitals already operating with severe staffing shortages.
Some of this is a failure of imagination. While an 8-hour day is typical in most sectors, it’s not uncommon for nurses to work 12-hour shifts, and a 2008 study found that 35.3% of a nurse’s shift is spent documenting their activities, while just 19.3% of their time is spent directly caring for patients (excluding the administration of medications). Just 7.2% of their time is spent assessing patients and reading vital signs (Hendrich et al., 2008).
It therefore makes sense to schedule more nurses to cover the patient load and hire enough nurses to account for absences. But nurses cost money, and so long as those executives are making money, who cares?
And this is where 340B comes into play.
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| Source: ADAP Advocacy | iStock |
The lucrative 340B Drug Pricing Program has served as a cash cow for eligible hospitals, and there are plenty of them. Nationwide, in fact, about 3,000 hospitals participate in the program, accounting for 6 in 10 U.S. hospitals. One primary way 340B funds could improve patient access to care is by hiring additional staff, whether administrative support staff, physicians, or nurses.
ADAP Advocacy’s own research shows that hospital executives are among the primary “winners” in the 340B Program, as evidenced by huge spikes in their compensation after enrolling in the program. Among the 160 340B-eligible hospitals audited, executive compensation rose by over 200% on average thanks to 340B (ADAP Advocacy, 2026). But that average hides a darker side of this cash windfall, because egregious examples include a 1,133.42% pay bump for Sutter Valley Hospitals’ executive (Sacramento, CA), a 1,421.15% increase for Yale New Haven Hospital’s executive (New Haven, CT), and a 2,803.81% hike for Baptist Memorial Hospital Golden Triangle’s executive (Columbus, MS) (ADAP Advocacy, 2026).
Does a hospital CEO seriously need to make $6,471,125, $8,792,821, or $14,336,581? To improve patient care, wouldn’t spending $1 million to hire 10 additional nurses have a greater impact? Yet nurses across the country still say they face unmanageable shortages that are affecting patient outcomes. Interesting, isn’t it?
Hospitals are fighting desperately to stop reforms to the 340B Program that would require them to report how they utilize 340B-generated revenues. And anyone fighting that hard to prevent transparency can’t be doing so for any good reason. The current nursing shortage is driven by multiple triggers, but we do know at least one solution: hire more nurses!
Disclaimer: All funders of the ADAP Advocacy Association are publicly listed on our website.
Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association; rather, they provide a neutral platform for the author to promote open, honest discussion of public health-related issues and updates.
References:
[1] ADAP Advocacy Association (2026). The 340B Drug Rebate Program and its Potential Impacts on Annual Revenues, Executive Compensation, and Charity Care Provision in Eligible Covered Entities. 340B Map. https://340bmap.org/
[2] Costa, D. K., Valley, T. S., & Friese, C. R. (2024, May). Addressing the Nursing Workforce Crisis Through Nurse-Physician Collaboration. JAMA Internal Medicine, 184(5), 463-464. https://doi.org/10.1001/jamainternmed.2024.0183
[3] Health Resources & Services Administration. (2025, December 18). Workforce Projections. Rockville, MD: United States Department of Health and Human Services: Health Resources & Services Administration: Health Workforce: National Center for Health Workforce Analysis. https://data.hrsa.gov/topics/health-workforce/nchwa/workforce-projections
[4] Hendrich, A., Chow, M. P., Skierczynski, B. A., & Lu, Z. (2008). A 36-hospital time and motion study: how do medical-surgical nurses spend their time? The Permanente Journal, 12(3), 25–34. https://doi.org/10.7812/tpp/08-021
[5] Kuchno, K. (2026, October 20). Bedside nurse turnover reaches 18%. Chicago, IL: Becker’s Hospital Review: Workforce. https://www.beckershospitalreview.com/workforce/bedside-nurse-turnover-reaches-18/
[6] Levinson, Z. & Hulver, S. (2026, May 21). Mapping Hospital Employment By State. San Francisco, CA: KFF: Medicaid. https://www.kff.org/medicaid/mapping-hospital-employment-by-state/
[7] Nigam J. A., Barker R. M., Cunningham T. R., Swanson N. G., & Chosewood L.C. Vital Signs: Health Worker–Perceived Working Conditions and Symptoms of Poor Mental Health—Quality of Worklife Survey, United States, 2018–2022. Morbidity & Mortality Weekly Report, 72(44), 1,197-1,205. http://dx.doi.org/10.15585/mmwr.mm7244e1
[8] Te-Ping, C. (2026, October 19). Nurses Are in High Demand—but They’re Quitting in Droves. New York, NY: Wall Street Journal: Health. https://www.wsj.com/health/healthcare/nurses-are-in-high-demandbut-theyre-quitting-in-droves-d8ead94f
