A new face at the bedside
Residents come to know the people who help them bathe, dress and eat. When nearly half of a typical building’s nursing staff leave in a year, residents keep starting over with someone new.
CMS, 2026Turnover in skilled nursing
What one departure really costs.
Hiring, orientation, overtime and agency shifts add up long before a new hire finds their feet. Here’s how we estimate it, and where every number comes from.
One CNA departure
Belay estimate| Closing out the job | $300 |
|---|---|
| Covering open shifts | $900 |
| Recruiting and sign-on | $1,200 |
| Background checks and credentialing | $400 |
| Orientation and training | $2,800 |
| Settling in | $1,100 |
| Total | $6,700 |
Ranges run from $2,650 to $15,800, from a quick, easy hire to a long search covered by agency staff. See each line
One departure
Where the money goes.
A departure doesn’t end when someone turns in their badge. Someone covers the open shifts, often on overtime or through an agency. The new hire needs recruiting, orientation and time to settle in. Residents meet a new face. And the people who stay carry more.
| What it covers | Our estimate | Range |
|---|---|---|
| Closing out the jobExit paperwork, benefits changes, any paid-time-off payout, and the time HR and managers spend on it. | $300 | $150 to $600 |
| Covering open shiftsOvertime and agency pay above normal wages while the job is open. We assume about 30 days to fill it, with about two-thirds of the open hours covered. Agency aides cost about 80% more an hour than employed aides. | $900 | $300 to $3,500 |
| Recruiting and sign-onJob ads, referral bonuses and sign-on bonuses, which many buildings offer. | $1,200 | $300 to $3,500 |
| Background checks and credentialingBackground and drug screening, and nurse aide registry checks. | $400 | $200 to $700 |
| Orientation and trainingTwo to four weeks of paid orientation, plus the time of the nurse or CNA who trains them. | $2,800 | $1,200 to $5,000 |
| Settling inThe first six weeks or so, while a new hire learns the residents and the routines. Everything takes a little longer at first. | $1,100 | $500 to $2,500 |
| Total for one CNA | $6,700 | $2,650 to $15,800 |
We start with a CNA because CNAs and other aides make up about six in ten of a typical nursing team.
About $4,300 of that is money that goes out the door: recruiting and bonuses, screening, extra pay to cover shifts, trainers’ time and the paperwork of a departure. The other $2,400 is wages paid while a new hire is still learning the job.
None of this arrives as one bill. Costs are easy to underestimate when you can’t see the full picture.
Nurses cost more to replace.
| Role | Our estimate | Range | Range on a scale from $0 to $50,000 |
|---|---|---|---|
| CNA | $6,700 | $2,650 to $15,800 | |
| LPN | $10,400 | $4,300 to $26,600 | |
| RN | $17,100 | $6,900 to $47,000 |
Their pay is higher, we assume their jobs take longer to fill (30 days for a CNA, 45 for an LPN, 60 for an RN), and some come through recruiters who charge a fee.
A typical building
Over $100,000 a year, conservatively. About twice that by our estimate.
Take a 100-bed building, the national median size. It has roughly 50 nursing staff. At 47% turnover, the average for buildings its size, about 24 of them leave in a year.
The most cited figure for one departure is about $4,500, from LeadingAge’s Workforce Cost Calculator, which treats it as a minimum. Its direct-cost part dates to a 2004 review of long-term care in general, not skilled nursing specifically. We use it as our conservative starting point.
Our fuller estimate builds the cost of a departure from today’s wages, agency rates and orientation costs, role by role. The arithmetic is the same:
| Assumption | Departures a year | Cost per departure | A year |
|---|---|---|---|
| At the $4,500 conservative figure | 24 | $4,500 | $108,000 |
| At our estimate for a CNA | 24 | $6,700 | $160,800 |
| At our estimate for a typical mix | 24 | $9,200 | $220,800 |
A typical mix is about 61% CNAs and other aides, 23% LPNs and 16% RNs, from CMS staffing data. We use one turnover rate for every role, because CMS publishes one for all nursing staff.
All three use CMS’s turnover rate, which leaves out many of the people who leave fastest. The real number is likely higher.
The new-hire gap
The turnover CMS doesn’t count.
Many new hires leave before they ever count in CMS’s turnover numbers.
CMS builds each building’s turnover rate from the payroll hours it reports. Someone counts as having left once they go 90 days in a row without working a shift.
But only people who work at least 120 hours in their first 90 days count at all. That’s about three weeks of full-time work. A new hire who leaves before then never shows up in your published rate.
That leaves out a lot of people. A 2026 study in Health Affairs Scholar, using CMS’s own payroll records, found that by 2022-2023, 45% of nursing hires didn’t reach 120 hours in their first 90 days. Counting everyone, turnover ran about 19 percentage points higher than under CMS’s definition, and 16 points higher for RNs.
Those early departures still cost recruiting, screening and orientation. So a building can look steady on Care Compare while it hires for the same jobs again and again, and any estimate built on CMS’s rate, ours included, likely runs low.
Beyond the money
What doesn’t show up on a P&L.
Residents and your team feel every departure. Some of that never shows up in a budget.
A tired team covering the gap
The people who stay pick up the open shifts and help each new hire learn the job, on top of their own work. In an average week, about 15% of nursing hours are worked by someone hired in the last 90 days.
JAMA Internal Medicine, 2023Quality of care
A study of 13,826 nursing homes found that higher staff turnover was linked to lower quality of care, including more citations at health inspections.
JAMA Internal Medicine, 2023Your staffing star rating
Turnover counts toward it. Total nursing, RN and administrator turnover are worth up to 130 of its 380 points, and families see the rating on Care Compare.
CMS, 2026Your numbers
Run your numbers.
We start with the conservative figures above. Change any of them to match your building.
Sources
Where every number comes from.
How we estimate it
We couldn’t find a current, published study of what a departure costs a skilled nursing building, role by role. So we built our own estimate from public data: wages from the Bureau of Labor Statistics and AHCA/NCAL, agency rates from ASPE, and typical screening and orientation costs.
For each role we add up six costs: closing out the job, covering open shifts, recruiting, screening, orientation and settling in. Two assumptions matter most: how long a job stays open, and how much of that time is covered with overtime or agency staff. We assume 30 days for a CNA, 45 for an LPN and 60 for an RN, with about two-thirds of the open hours covered.
For a typical building we use CMS’s February 2026 data: 47% turnover, the average for buildings of 90 to 110 beds (the national median is 45.6%), and a mix of roles from CMS staffing hours, which matches federal employment data.
It’s an estimate, not a benchmark. Each line has a low and a high case, shown above, and your own payroll, agency invoices and hiring records will be more accurate than any of it.
Sources
- Centers for Medicare & Medicaid Services (CMS). Provider Information, Nursing Home Care Compare data, file processed February 1, 2026.
- CMS. Design for Care Compare Nursing Home Five-Star Quality Rating System: Technical Users’ Guide, September 2026.
- Petterson S, Winter KM, Kerns JW, et al. Invisible staffing churn in nursing homes: CMS turnover metrics miss a growing short-term workforce. Health Affairs Scholar 4(5), May 2026.
- Shen K, McGarry BE, Gandhi AD. Health care staff turnover and quality of care at nursing homes. JAMA Internal Medicine 183(11), 2023.
- LeadingAge. Workforce Cost Calculator.
- Seavey D. The Cost of Frontline Turnover in Long-Term Care. Better Jobs Better Care, October 2004.
- US Bureau of Labor Statistics. Occupational Employment and Wage Statistics, May 2023: Nursing Care Facilities.
- AHCA/NCAL. 2025-2026 Nursing Home Salary and Benefits Report (summary).
- US Bureau of Labor Statistics. Employer Costs for Employee Compensation, June 2024.
- ASPE, US Department of Health and Human Services. The use of contract staff in nursing homes remains high after the COVID-19 pandemic. Issue brief, January 2025.
- McKnight’s Long-Term Care News, on nursing home salaries and sign-on bonuses.
- Checkr. Nursing background checks.
- National Council of State Boards of Nursing (NCSBN). Nursys license verification.
- Nurse.com. Certified nursing assistant (CNA) hiring guide.
Our per-departure estimates are Belay’s own, built from sources 6 to 14. Figures from CMS are as CMS publishes them; the averages for buildings of about 100 beds and the mix of roles are our calculations from source 1.
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