Understanding Home Health Nurse Turnover Rates

Andjelka Prvulovic
Last update on:
April 18, 2024 2:45 AM
Published on:

The Bureau of Labor Statistics predicts the home health and personal care assistants’ employment growing 33 percent from 2020 to 2030.


However, high nurse turnover rates are disturbing home health care.


The national average turnover in the home health services reached 22,18% in 2020, slightly increasing from 2019's rate of 21.89%. With deficits across the industry, many home health agencies now struggle to find and retain adequate staff.


If you want your home health care agency to stay competitive, you should promote job satisfaction and create comprehensive strategies to retain staff and minimize churn. To do so, you need a deeper understanding of why nurses quit.

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How Is Nurse Turnover Calculated?

Your nurse and caregiver turnover rate is one of the best indicators of your agency’s long-term success. It can provide you with a thorough assessment of your company culture, recruitment efforts, and brand. 

You should make this metric a priority if you want to reduce employee turnover. 

You need the following pieces of information to calculate your nurse turnover rate:

- The number of nurses on the first day

- The number of nurses on the last day

- The total number of nurse separations during that time frame 

Use the two headcount totals to determine the average number of nurses. Then, divide the total number of nurse separations by the average number of nurses during that time. Finally, multiply the number by 100. 

It may sound complicated, but the process is relatively easy. 

You can gain numerous insights by comparing this rate to the industry average, your competitors’ rate, or your previous data. 

Higher nurse turnover rates indeed signal that you need to take immediate action to prevent the churn and keep your home health care business competitive.

Why Is There a High Turnover Rate in Nursing?

The everyday practice of a home health nurse brings a great deal of stress. 

More often than not, they work in very fast-paced environments. 

Nurses need to provide care for their patients, comfort and encourage family members, and keep up with the best evidence-based practices and procedures. This level of stress often leads to burnout. 

Combined with the work environment characteristics and some specific churn drivers, it can contribute to the high caregiver turnover rates in many home health agencies.. 

Recent research on home health care has determined that nurses usually leave their jobs of their own will -  the rate of voluntary turnover was nearly four times as great as involuntary turnover

Turnover most commonly happens in the first six months of employment and is higher in part-time compared to full-time nurses

Essentially, any leadership decision related to front-line staff can affect the churn. 

Managing nurse turn­over is a process, not a single action. It calls for creating a strategy to identify, support, and reward high performers while clearing out those who perform poorly.  

To create such a strategy, and in the long term, build a company culture that will attract, support, and retain home health care employees, we need to understand deeper reasons behind high nursing turnover.

Let’s look at the most common drivers of churn in home health care so that we can do our best to minimize it.

Scheduling Concerns

Home health care is different from other health sectors in how providers operate. Instead of working in team-based set-ups, home health care nurses work individually, traveling from one home to another. 

Studies imply that a possible driver contributing to the nurse turnover rates is variations in daily schedules

A recent survey has determined a direct correlation between high schedule volatility and likelihood of a home health nurse quitting. Namely, nurses with the most unstable schedules were 50% more likely to churn than the average. 

In comparison, nurses with the most stable daily schedules were 40% less likely to quit their jobs than average.


Schedule volatility, as a potential churn driver, is not that difficult to understand. Without knowing how many and if any hours they’ll work next week and on which days, nurses and other frontline staff have no way of planning their own lives and matching their job responsibilities to their personal commitments. 

Nowadays, when employees are increasingly concerned with achieving work-life balance,  the development of flexibility policies is essential to increasing job satisfaction and retaining the top talents.

Scheduling nurses' shifts can be challenging when your patients' needs are changing, and you have to adapt accordingly. But, you can improve your scheduling and streamline the whole process using reliable home health management software.

With an app like Timeero, your nurses will have more visibility and control over their workdays schedule without hurting the quality of your services.

At the same time, it won't disturb the quality of your service.Your care coordinators will now have real-time insight into staff availability meaning they will be able to match patients with their favorite nurses and actually improve the service. 

Nurses will notice your readiness to offer them more control over their schedule to help them achieve work-life balance. They will be more satisfied with their job, and consequently, nurse turnover rates will fall. 

scheduling Timeero

Lack of Communication

Nurses and other caregivers can burn out quickly and leave work. This can happen without first sharing their problems with their co-workers or seeking support.

Because of all the fieldwork, nurses and carers lack the opportunity to interact with their colleagues and superiors and develop a feeling of connectedness and belonging. Unable to share the issues they’re facing and with no hope for a solution, they quickly become exhausted and decide to leave.

Establishing an open and honest working environment with clear communication channels can do a lot for their job satisfaction and reduce nurse turnover rates. 

Furthermore, having the right health home care software in place, like the Timeero app, will ensure all relevant information reaches them timely. It’s crucial for the software to be easily accessible to all office staff, nurses, and caregivers, from anywhere and anytime, offering various ways to communicate and exchange relevant information. 

Few Benefits

Underpaid and with few benefits, home care nurses are more likely to feel underappreciated, with their job satisfaction rate hitting the bottom.

The basic benefits required by the federal law are Social Security, Medicare, FICA, unemployment and workers' compensation insurance, family and medical leave. 

For agencies with more than 50 full-time employees, providing health insurance is also a must.

However, when understanding nurse turnover rates, we need to go beyond basic benefits and look into staff needs and expectations. 

Extra benefits that better address home care nurses' needs are already offered by some of the top providers in this industry. Besides a competitive salary, such benefits include paid sick days, paid time off, commuting and home care mileage reimbursement, maternal and paternal leave, overtime paid, etc. 

Nurse turnover is not that difficult to understand from this aspect too. If the agency does not appreciate their work enough to provide them with a good salary and competitive benefits, why would they be loyal?

Using home healthcare workforce management software, with time- and mileage-tracking options can help you pay your nurses adequately and reimburse their mileage costs

Lack of Proper Training and Growth

Feeling stuck in a dead-end job without the opportunity to advance their skills and grow can be a potential driver of increased nurse turnover rates. 

On the other side, with enough chances for education and a possibility of career advancement, they will be more satisfied with their work, loyal to the company, and less likely to leave if another offer comes their way.

It’s crucial for nurses to have the opportunity to develop their people skills and improve the knowledge and skills specific to their job. 

A recent study has shown that receiving disease-specific training enhances home health employees’ satisfaction with their job. Equally important is that such training helps them position themselves as valued members of their teams, which is crucial for their retention.

Too Much Work

Due to the high market demands and high nurse turnover rates, agencies often don’t have enough nurses to cover all the patients’ needs. 

In such circumstances, the workload can quickly become too much for them to handle. If the situation persists, it can lead to burnout and additionally increase nurse churn.

Agencies can take some burden off their nurses’ shoulders by using up-to-date technologies and software to streamline administrative work. 

Some software solutions, like Timeroo, can significantly free up nurses’ time by reducing tedious paperwork tasks while ensuring accountability systems.

Lack of Recognition 

Except for the proper pay and benefits, many other factors may affect nurses’ feelings of professional recognition and value, making them more or less likely to leave the job. 

Even though the lack of recognition is rarely the main reason to quit a job, showing appreciation and rewarding your top-performing nurses plays an important role in reducing home health care nurse turnover rates.

Praising nurses and other frontline staff for their hard work and acknowledging their achievements helps them feel more engaged and appreciated. 

The acknowledgment doesn't necessarily need to be financial. It can be a simple gesture like a thank you card or a personal note,  just as long as it's authentic and personalized.

So, What Drives Nurse Turnover?

Many factors contributing to the high nurse turnover are common for employees in general, regardless of the sector they're working in. 

However, scheduling problems and lack of timely and quality communication seem particularly important for home nurses' job satisfaction and their probability to churn. Certain software solutions, like Timeero, can help agencies address these issues, and easily achieve the most common nurse retention goals.

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Andjelka Prvulovic

Andjelka is a sociologist turned digital marketer. She specializes in creating content for SaaS and software companies. When she’s not researching the most effective employee management techniques, Andjelka loves cooking, reading, and fighting for human rights.

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