Every hospital knows how much it costs to hire. Few measure as precisely how much it costs to lose someone. When an experienced nurse resigns, when a technician misses work for the third time in a month or when a shift closes with an incomplete team, the impact doesn't stay in the people department. It reaches the patient.
As Evandro Moraes, CEO and general director of Hospital São Lucas da PUCRS, summarizes in an article for Healthcare Management, turnover and absenteeism are no longer an "HR problem" and have become an operational and economic risk that erodes continuity of care and disrupts critical schedules.
Sources: WHO, Anahp Observatory 2025 and Gallup, via Medportal; Healthcare Management.
A self-reinforcing cycle
In a hospital, care runs 24 hours a day and each professional depends on the others. That is why losing people is rarely an isolated event. It usually follows a cycle:
- 01 →
Engagement weakens
Tight schedules, little recognition and distant leadership.
- 02 →
Absences increase
Absenteeism grows as a form of self-protection.
- 03 →
Those who stay are overloaded
Overtime, emergency coverage and exhaustion.
- 04 ↺
Professionals leave
And the cycle starts again, shorter and more expensive.
The post-pandemic period intensified every stage: accumulated fatigue, more leave for mental health conditions and quiet disengagement, when professionals stay on the payroll but reduce their effort to the minimum to protect themselves. The update to Brazil's NR-1 regulation reinforced that psychosocial risk must be handled as a management issue, not as individual weakness.
What reaches the patient
The cost of turnover is paid, first and foremost, by those who are hospitalized:
Interrupted continuity of care
The patient is seen by a succession of different faces. Information gets lost between shifts and a relationship of trust never forms.
Less experienced teams
Every departure takes away knowledge about protocols, routines and patients. The learning curve of newcomers increases the risk of adverse events.
Longer waits and less attention
With short-staffed schedules, response times grow, procedures are rescheduled and professionals have less time at the bedside.
Leaders with no time to lead
When a manager is responsible for dozens of people, early turnover soars: AONL studies point to about 27% in teams of 30 nurses and up to 40% in teams of 90.
The cost that also hits the bottom line
Every departure triggers visible and invisible costs: severance, recruitment, medical exams, onboarding, training, preceptorship time, overtime and emergency coverage, which is usually more expensive. In the United States, where measurement is more detailed, each percentage point of nursing turnover costs a hospital US$ 289,000 per year on average.
For hospitals already facing compressed margins, rising denials and long collection times, this cost arrives at the worst moment. And it creates a trap: without cash, the hospital doesn't invest in people; without investing in people, it loses even more staff and efficiency.
Bureaucracy also drives people away
Not every departure is caused by shifts. Among physicians, excessive administrative workload and medical record bureaucracy rank among the main sources of frustration. In support areas, such as billing, front desk and authorization, what weighs most is rework: missing documents, duplicate entries, bills that come back denied and have to be redone.
This is where Accrua comes in. By running the revenue cycle with AI agents and human validation, we take on the repetitive work that consumes administrative teams and reduce the rework that comes from denials. And by recovering revenue the hospital has already generated and bringing forward days of cash, we help create the financial breathing room that makes it possible to invest in those on the front line.
Caring for caregivers
A competitive salary matters, but it doesn't keep anyone on its own. The factors that most increase retention are, to a large extent, about organization and management:
Predictable schedules
Fair workload, clear swap rules and a transparent hour bank.
Attention to the first 12 months
Structured onboarding, mentoring and frequent conversations during the period when most people leave.
Close leadership
Smaller teams per manager and regular one-on-ones.
Less bureaucracy, more care
Processes and tools that eliminate administrative rework, for care and support areas.
Hospitals that treat people only as a cost pay for it in absenteeism, turnover and lost quality. Institutions that care for their caregivers build stable teams, safe care and sustainable results. Accrua's mission, giving hospitals back the revenue that is rightfully theirs, exists for this: so the money returns to where it makes a difference, caring for people.