Research Alert: September 23, 2025

Rural-Urban Comparisons of Nursing Staff Turnover Among Skilled Nursing Facilities

This study assessed facility-level turnover rates for nursing and registered nurse (RN) personnel across levels of rurality and by region. A total of 14,986 facilities were included in the August 2023 data released by the Centers for Medicare & Medicaid Services. Of those facilities, 72.3% were in urban areas.

Key Findings:

• Across all facilities, the average percentage of total nursing staff turnover during the year 2022 was 53.5 ± 15.9%. The average total nursing-hours-per-resident ratio was 3.8 ± 1.0 hours.
• RN-specific turnover in skilled nursing facilities was higher in urban areas (51.5%) compared to rural areas (47%).
• There was no clear pattern of turnover across various regions of the United States.
• Nurse staff hours per resident per day, although statistically significantly different, showed negligible differences between urban and rural facilities.

Additional Resources of Interest:

• More FORHP-funded research on Nurses and nurse practitioners
• More information about the University of South Carolina Rural Health Research Center