09/21/2026
The cost of nursing turnover is not a new issue. What is different in 2026 is the convergence of three forces that make the calculation too consequential to remain inside an HR report.
First, the federal funding environment has changed materially. The One Big Beautiful Bill Act, signed July 4, 2025, includes the largest federal Medicaid cuts since the program began, cutting approximately $940 billion to $1 trillion over ten years according to the Congressional Budget Office. Premier analysis estimates $68.5 billion in hospital revenue at risk over 2026 and 2027. Hospitals in Medicaid expansion states could see operating margins shrink by nearly 19 to 30%. For health systems where Medicaid represents 20 to 40 percent of patient revenue, every dollar of avoidable internal cost now carries more operational weight than it did three years ago.
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The 2026 NSI report puts the cost of one RN departure at $60,090. Here's why that number belongs in your margin strategy, not just HR.