Michigan Health Care Turnover Spikes in 2020

By: Michelle Wein

As we enter the third year of COVID-19, there are innumerable stories and social media posts about the incredible physical and mental toll the pandemic has had on health care workers. Nurses, home health care aides, and mental health professionals are all exhausted from working long hours in an ongoing fight against a particularly adept and intelligent virus.


It is not surprising then, that there is a workforce shortage. Demand for workers far exceeds supply. In the state of Michigan, mental health occupations are expected to grow by seven percent between 2020 and 2030, nursing occupations by three percent, and patient support occupations (including home health care aides) by ten percent. Job postings for each of these groups of occupations are also trending up, especially since June of 2020, while the supply (the number of new, qualified individuals entering the labor market) has continued to decline since 2011.


So, the question remaining is: If creating enough new health care workers is going to be difficult in the years to come, how do we retain the individuals we have? In other words, what does turnover look like in Michigan’s health care workforce? In 2020, NSI Nursing Solutions Inc., a national high-volume nurse recruitment and retention firm, estimated national Registered Nurse (RN) turnover to be 18.7 percent, which shows an increase of 2.8 percent from 2019.

Using separations and employment data from EMSI (sourced from the Quarterly Workforce Indicators, and modeled to occupation level via staffing patterns), we can produce estimations of turnover in the state of Michigan for various health care occupations. As is shown in the table below, while turnover in nursing occupations (Registered Nurses, Nurse Anesthetists, Nurse Midwives, Nurse Practitioners, Licensed Practical and Licensed Vocational Nurses) was trending down between 2018 and 2019, that number increased by nearly nine percentage points in 2020. Registered Nurses alone experienced a 30 percent turnover rate in 2020, 11.3 percentage points higher than the national average reported by NSI.

A similar story can be told with the rate of turnover in mental health care occupations (clinical psychologists, mental health counselors, child/family/school social workers, substance abuse counselors). After a decrease between 2018 and 2019, turnover suddenly grew by approximately 13 percentage points in 2020.


Finally, the results are perhaps most alarming in patient support occupations (home health care aides, nursing assistants, orderlies, medical assistants, and phlebotomists). Turnover declined between 2015 and 2019, but saw a 21.6 percentage point increase in 2020 for a rate of 91.2 percent. Home health care aides saw an individual turnover rate of over 100 percent in 2020, which means the rate of separation actually exceeded the rate of employment.


Without further statistical analysis to determine an exact causal relationship, it’s impossible to say that the rise in turnover rates for all these groups of health care workers was solely due to the COVID-19 pandemic. However, it is reasonable to infer that the pandemic was a significant contributing factor to the growth in turnover for each of these occupations.


Reducing turnover going forward will be critical to maintaining the supply of the health care workforce, which is crucial to improving patient outcomes and patient satisfaction. Moreover, the cost of turnover can have an acute impact on the ability of hospitals and health care facilities to manage their needs. According to the NSI report referenced above, the average cost of turnover for a bedside RN is $40,038.


Exploring tactics to reduce turnover moving forward, especially in light of the continuation of the COVID-19 pandemic, will be key to the maintenance of the health care workforce.

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