The staffing crisis safety teams aren't talking about: When safety concerns lead to an exodus of health care workers

Many healthcare executives are familiar with the numbers: According to the 2025 NSI National Healthcare Retention and Registered Nurse Staffing Report, the cost to recruit a registered nurse is approximately $60,000 and can be as high as $71,000 or more when factoring in agency expenses, training and lost productivity during onboarding. Replacing an experienced emergency physician can cost more than two to three times the average salary. Yet when it comes to evaluating security investments, these decisions rarely have to do with the people crisis eating away at the workforce from within.

Hospitals invest millions of dollars in clinical recruitment while watching experienced staff leave because of workplace violence issues. But safety budgets are often justified by incident prevention metrics and liability reduction, not by workforce retention. Many organizations have yet to understand how security decisions impact their entire financial picture, from recruiting to retention to operational efficiency.

The real cost of an unsafe environment

Workplace violence affects healthcare workers five times more than other industries. In 2024, 91% of emergency physicians reported that they or a colleague had been threatened or assaulted in the past year. More than 80% of nurses experience workplace violence within 12 months.

The 2025 Registered Nurse Survey found that only 39% of nurses plan to continue working in their current position and organization, with 58% reporting experiencing burnout. While burnout has many causes, the ongoing stress of working in an environment where violence is inevitable ranks among the most significant. Emergency department nurses, behavioral health workers, and night shift workers cited safety concerns as the top reasons for leaving their jobs.

When an emergency department nurse with eight years of experience resigned after a violent encounter with a patient, the hospital lost more than just clinical expertise. It loses institutional knowledge, team cohesion, and investment in personal development. It will take several months for replacement nurses to become sufficiently efficient. during that transit

We did not calculate security ROI

Healthcare organizations often evaluate security investments based on theoretical incident prevention: “If the system prevents one lawsuit, it will pay for itself.” This is one consideration within the larger financial impact picture.

Suppose a 400-bed hospital loses 10 experienced nurses each year due to safety issues. At a conservative replacement cost of $50,000 per nurse, this equates to $500,000 in direct turnover costs. But indirect costs multiply: temporary staffing expenses, overtime pay for remaining staff, reduced patient satisfaction scores that impact reimbursement, and the compounding effect of separations triggering additional separations.

In a highly competitive health care market, institutions with a reputation for workplace violence problems have a hard time attracting top talent. Nursing candidates research hospitals before applying. They talk to current employees and check social media. A facility's reputation for employee safety (or lack thereof) directly affects its ability to recruit and the fees it must pay to do so.

Investments in security that prevent employee turnover can keep recruiting competitive, maintain team stability, and protect an organization’s reputation as an employer of choice. These benefits dwarf traditional security ROI calculations, but rarely appear on spreadsheets justifying security budgets.

Hidden operational losses

In addition to recruitment and retention costs, there's another budget leak that many health care systems haven't fully quantified: the operational expense of managing the security incident itself.

The chief security officer of a major university healthcare system recently shared compromised data from his organization. In the first half of January alone, he spent five full days in court over security incidents.

If the CSO makes $250,000 a year, has two to three staff members making $150,000 each to assist with incident investigations and court appearances, and each incident requires approximately 50 hours of combined time for investigation, management and legal proceedings, that would be a minimum of $13,750 per incident in leadership time alone. Five court appearances in half a month revealed more than $68,000 in monthly budget leaks, just the time senior staff were diverted from strategic work.

Hospitals grappling with workplace violence often fail to capture this “leakage” in budgets and efficiency metrics. These costs are hidden across departments: security leadership time, HR investigation time, legal counsel, employee interviews, document review and deposition preparation. Each incident creates a diversion of attention and resources that rarely figure in security ROI calculations.

Organizations that quantify these hidden costs find that the cost of inadequate security far outweighs investments in effective solutions. However, budget conversations often focus only on the cost of the equipment rather than the overall financial impact of the secure environment they create.

realign investments

Hospital CFOs don't evaluate MRI machines solely on their ability to prevent malpractice lawsuits. They measure diagnostic capabilities, patient throughput and competitive position. Security deserves the same multidimensional analysis.

Environments where employees feel protected show significant differences in workforce stability. When clinical teams believe their safety is a priority, they stay longer, perform better, and recommend colleagues for open positions. This creates a reinforcing cycle: better retention leads to a more experienced team, which improves patient outcomes, which strengthens the institution's reputation, making recruitment easier.

The challenge is that the labor retention benefits of investing in safety are apparent over time, while the costs are immediate. A new security system can cost $500,000 in upfront costs. The annual avoidable turnover savings of $500,000 only become apparent when actual turnover is compared to projected rates. CFOs need frameworks that make these connections clear.

What is the actual effect

Effective prevention of workplace violence requires a layered approach that combines policy, culture, environment and technology. But even the most advanced security infrastructure will fail if employees don’t trust leadership’s commitment to their security.

Successful planning begins with transparent acknowledgment of the scope of the problem. Underreporting remains prevalent in health care because staff fear retaliation or view violence as “part of the job.” Organizations that are making progress are creating reporting systems where employees feel empowered to record incidents without professional consequences. As a result they saw more accurate data.

Environmental change is important. Secure entrances, controlled access to high-risk areas and improved sight lines all contribute to safer spaces. But these physical changes must be connected to the response protocol. Workers need to know that when they signal distress, help will arrive quickly and reliably. Trust in responsiveness affects whether employees feel safe enough to stay.

Technology works when it empowers, not when it monitors. Real-time communication tools can call for help immediately and can de-escalate a situation before it becomes dangerous. Data from these systems should inform continuous improvement, identifying patterns that allow for proactive intervention rather than reactive responses.

Today, a new graduate nurse weighs pay, location and culture when choosing between two job opportunities. They are also increasingly asking, “Am I safe?” Facilities that can answer “yes”—reliably, backed by systems and track records—will attract the best talent. Those who still view security as an afterthought will fight for those who remain.

Patients deserve care from professionals who do not operate in fear. Clinical staff deserve an environment that protects their health. Hospitals that recognize the connection between these facts and workforce economics will define the next generation of health care employment.

Photo: sturti, Getty Images

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