Healthcare Turnover and Burnout: An Interview with an ER Nurse
- Kimberly Best
- 12 hours ago
- 5 min read
A few weeks ago, I sat down with Jen, a working ER nurse, and asked her what healthcare turnover and burnout really look like from the inside. Jen has spent 14 years in the emergency room. She also happens to be my daughter, which made for an honest conversation neither of us scripted.
I work with healthcare teams across Missouri and Tennessee, from St. Louis to Nashville and beyond, and I have written about the patterns Jen describes for years in peer-reviewed journals. Hearing them again, in her words, from inside a working ER, hit differently. The full conversation is below.
Here is what stood out, and what I want every nurse, hospital leader, and HR professional reading this to understand.
What's really driving healthcare turnover right now?
Days before our conversation, the Missouri Nurses Association released its Fall 2025 Workplace Violence Survey, analyzed in partnership with Missouri State University. The numbers are sobering.
90 percent of Missouri nurses reported verbal abuse. 63 percent reported physical violence. 46 percent had considered leaving their job multiple times because of workplace violence. Missouri hospitals reported more than 21 workplace violence incidents per day in 2023. It now costs an average of $61,110 to replace one staff RN, and each 1 percent change in RN turnover costs or saves the average hospital roughly $289,000 every year.
The financial argument is clear. The human argument is even clearer. And the patient safety argument is one most hospital leaders have not heard yet.
Stanford research has established that hostile hospital units show 11 percent higher patient mortality rates and 9 percent higher infection rates. Workplace conflict is not just a staff satisfaction issue. It is a patient safety issue.
Why do nurses feel trapped in their jobs?
This was the most powerful thing Jen said, and it came unprompted. People assume nurses have flexibility because nursing jobs are everywhere. Jen pointed out the truth. You can move from the ER to urgent care, to oncology, to a clinic, and the same patterns follow you. The verbal abuse, the burnout, the broken communication, the lack of support from leadership.
Nurses do not feel trapped because they are stuck in one job. They feel trapped because the conflict travels with them.
This is exactly why I argued in my published research, "Conflict Coaching as Workforce Retention Infrastructure in Health Care," (2025) 34 Australasian Dispute Resolution Journal 49, that conflict coaching belongs in healthcare workforce retention infrastructure. Hospitals are spending tens of thousands per replacement nurse without addressing what causes the loss in the first place.
What's actually behind nurse burnout?
When most people imagine healthcare conflict, they picture a difficult patient or a yelling family member. Jen confirmed what years of research already shows. The highest source of conflict for new nurses is other nurses.
There is an old saying in the profession that nurses eat their young. It is not a joke. It is a culture problem, and it is what drives so many new graduates out of nursing in their first year. Hospitals fill the gap with travel nurses or new hires, who walk into the same culture, and the cycle repeats.
There aren't "people problems" here. There are skills gaps. Nurses are not taught how to navigate disagreement, give feedback, or repair a working relationship after a hard shift. A one-hour annual continuing education module does not build a skill.
Can one person change a hospital culture?
A whole hospital is too big for one person to shift. But a unit, a shift, a team, a department, these are smaller systems, and the science is clear. Systems theory tells us that recurring conflicts represent stable patterns where each participant plays a consistent role. The patterns persist not because they serve anyone well, but because alternative responses have not been established. The most powerful insight from this research is that it only takes one person to change for an entire system to reorganize.
The system will resist at first. Everyone in the room will double down on the old rules. But the change holds if the person holds.
This is where conflict coaching matters. Coaching gives one person the tools and the practice to be that change agent without becoming exhausted by the work.
What actually reduces healthcare turnover and burnout?
Three things, drawing on decades as a critical care nurse and years of working with healthcare teams across Missouri, Tennessee, and around the country.
First, treat conflict like illness. Conflict can heal or it can harm depending on how it is handled. Hospitals already understand prevention, early intervention, and treatment in clinical terms. Apply the same model to conflict. A charge nurse who notices tension building between two staff members on a Tuesday has a small, addressable problem. The same situation on Friday, after three more shifts of avoidance, has become a much bigger one. Early intervention is cheaper than crisis management in clinical care, and it is cheaper in conflict too.
Second, build skills, not just policies. Most hospitals have a workplace violence policy. Very few have a workplace conflict skill set. The difference matters. A policy tells people what they cannot do. A skill set tells people what to do instead. The Best Conflict Conversation Cards, Workplace Edition, were designed for exactly this purpose. Teams use them in five-minute huddles to practice difficult conversations before they happen, not after. One team I worked with started using a single card per week as a unit meeting opener. Six months later, their charge nurse told me the conversations she used to dread were happening on their own.
Third, invest in coaching for the people who hold the culture. Charge nurses, unit leaders, and managers shape the conflict climate of every shift. Equip them, and the climate shifts with them. Research published in nursing management literature has documented measurable reductions in communication-related incidents and improvements in safety climate when conflict competency is built into the system rather than treated as a personal trait. One study documented a 64 percent reduction in communication-error incident reports after structured communication training was implemented in a single unit. That is not a soft outcome. That is patient safety, retention, and dollars saved, all in one intervention.
What can hospitals and HR leaders do next?
If you lead a healthcare team in St. Louis, Nashville, or anywhere across the United States, the most useful next step is honest assessment. Are your nurses learning conflict skills, or just attending an annual training? Do your charge nurses have someone to coach them through hard situations, or are they figuring it out alone? Does your retention spend match what you know about why nurses leave?
If any of those answers feels uncomfortable, that is the conversation to have. I am presenting on these exact questions at the SHRM National Conference preconference workshop in Orlando this June on mediation skills for HR, and I work with hospitals and healthcare teams as a mediator, conflict coach, and conflict management trainer. I can help your teams design conflict management systems built around your team's specific needs.
The most important conversations are often the ones we are not having. If healthcare turnover and burnout are eating your team alive, this is the conversation to have.
Sources: Missouri Nurses Association, Fall 2025 Workplace Violence Survey (analyzed with Missouri State University). Missouri Hospital Association, 2025 Workforce Report. Best, K., "Conflict Coaching as Workforce Retention Infrastructure in Health Care," (2025) 34 Australasian Dispute Resolution Journal 49.
Work with Kim: Healthcare conflict coaching, mediation, and team training in Missouri, Tennessee, and nationally. Schedule a consult
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