Most operating room leaders can remember the moment. A respected nurse, someone others look to for guidance and support, submits a resignation. The immediate concern may be staffing, but the bigger question quickly follows: “Why did they leave, and what could have persuaded them to stay?”
The 2026 NSI National Health Care Retention and RN Staffing Report puts a number on that pattern. Based on responses from 527 hospitals in 40 states, the report placed national RN turnover at 17.6% in 2025, with first-year turnover at 22.7% (NSI Nursing Solutions, 2026). Nurses are leaving at disproportionately high rates during the exact period when hospitals have invested heavily in orientation, onboarding and clinical development.
What keeps nurses connected
Karen Kesten, DNP, APRN, CCNS, CNE, FAAN, a nurse researcher at George Washington University School of Nursing, asked nearly 200 CNOR-certified nurses a more direct question than a survey usually does: “Why did you think about leaving, and what made you stay?” The answers, reported by AORN, centered on adequate resources and organizational and management support. Where nurses did stay, they pointed to communication, community and recognition (AORN, 2024).
That lines up with more formal data. A 2025 AORN Journal study of 468 perioperative nurses found that roughly 40% reported some degree of turnover intent, and that workplace sense of belonging and structural empowerment independently predicted lower turnover intent (Dwyer, Engstrand and Dyer, 2025). Structural empowerment sounds academic, but it shows up in ordinary moments: whether a new circulator is introduced to the team or just assigned to a room, whether a question gets answered or brushed aside, whether a struggling nurse is noticed before they have already decided to go.
Recognition, done specifically
Generic recognition, a certificate or a mention at a staff meeting, tends to get politely accepted and quickly forgotten. A 2024 review in The Journal of Nursing Administration found that meaningful recognition, by contrast, is linked to stronger engagement, healthier work environments, lower burnout and better retention (Swartwout, 2024).
The difference usually comes down to specificity. Naming what a nurse actually did – the turnover she managed under pressure, the safety issue she caught, the new hire she coached through a hard case – tells that nurse someone was paying attention. That lands differently than a general thank-you, and nurses tend to know it.
Scheduling, workload and the limits of flexibility
None of this happens in a vacuum. Surgical volumes shift. Cases run long. Call coverage has to hold. Perioperative leaders cannot offer unlimited flexibility, but AMN Healthcare’s 2025 Survey of Registered Nurses suggests there is real room to move. Eighty-one percent of RNs said flexible schedules would improve working conditions, and 58% reported feeling burned out most days (AMN Healthcare, 2025).
Where flexibility is not possible, predictability often is: clear call rotations, advance schedule communication and genuine input into shift assignments. Whether a department addresses burnout mainly through wellness perks or through the workload itself makes a measurable difference. A 2026 qualitative study in the Journal of PeriAnesthesia Nursing, drawing on interviews with 23 perioperative nurses in Australia, found that excessive workloads, poor support and inadequate pay drove nurses out, while manageable workloads, professional growth and fair pay helped keep them (Xie, Xu and Duff, 2026).
A visible future in the specialty
The NSI report lists career advancement and education among the top reasons RNs voluntarily resign (NSI Nursing Solutions, 2026). For perioperative nurses, that risk is compounded by how specialized the work is. Precepting, charge nurse development, certification support and structured leadership tracks are what make a future in the OR visible rather than theoretical. A nurse who cannot envision a future within the specialty may be more likely to explore opportunities elsewhere.
None of these threads, belonging, recognition, scheduling, workload, growth, works in isolation, and none of them replaces the basic need for adequate staffing. What they have in common is that they are weekly decisions, not annual initiatives, the kind of thing a charge nurse or manager either does or does not do on an ordinary Tuesday. That is arguably good news. It means the biggest lever on retention is not a policy waiting on budget approval. It is already inside the department, reflected in the daily decisions leaders make about how nurses are supported, developed, recognized and included.
Sources
AMN Healthcare. “2025 Survey of Registered Nurses: Nursing in Transition: Workplace Changes, Challenges, and Solutions.” 2025. https://www.amnhealthcare.com/staffing/nursing/2025-rn-survey/
Association of periOperative Registered Nurses. “Cracking the Code of Nurse Turnover: 3 Essential Triggers and Retention Tactics.” June 12, 2024. https://www.aorn.org/article/cracking-the-code-of-nurse-turnover–3-essential-triggers-and-retention-tactics
Dwyer, Patricia, Shannon Engstrand and Andrea Dyer. “The Influence of Workplace Sense of Belonging and Structural Empowerment on Perioperative Nurses’ Turnover Intent.” AORN Journal, vol. 121, no. 4, 2025, pp. 267-279. DOI: 10.1002/aorn.14317. https://aornjournal.onlinelibrary.wiley.com/doi/10.1002/aorn.14317
NSI Nursing Solutions Inc. “2026 NSI National Health Care Retention and RN Staffing Report.” March 2026. https://www.nsinursingsolutions.com/Documents/Library/NSI_National_Health_Care_Retention_Report.pdf
Swartwout, Ellen. “The DAISY Award: Meaningful Recognition’s Impact on Patients, Nurses, and Organizations.” The Journal of Nursing Administration, vol. 54, no. 7/8, 2024, pp. 404-408. DOI: 10.1097/NNA.0000000000001448.
Xie, Ada, Hui (Grace) Xu and Jed Duff. “Factors Influencing Nurse Retention in the Perioperative Workforce: A Qualitative Study.” Journal of PeriAnesthesia Nursing, article in press, March 26, 2026. DOI: 10.1016/j.jopan.2026.02.001. https://www.jopan.org/article/S1089-9472(26)00024-9/fulltext
