New York system saves nearly $250M from RN recruitment, retention
NYC Health + Hospitals, an 11-hospital system based in New York City, has saved nearly $250 million through strategies to reduce nurse turnover costs and reliance on travel staff.
In 2024, the health system saved more than $150 million by decreasing its reliance on travel nurses and filling 3,000 registered nurse positions. So far in 2025, the organization said it has logged another $88 million in savings through its nurse residency program.
The system also decreased its nurse turnover rate from 46% in 2019 to 7.3% so far in 2025 — well below the national average of 16.4%.
Natalia Cineas, DNP, RN, senior vice president and chief nursing executive at NYC Health + Hospitals, told Becker’s the accomplishments are due to several initiatives and efforts.
One driving factor is the New York State Nurses Association contract that ensures equitable pay between public and private-sector nurses, Dr. Cineas said. The contract, which runs from March 2023 through September 2028, stipulates NYC Health + Hospitals must increase staff salaries by approximately 37%, or at least $32,000, over the contract period.
“Over time, we’ve seen nurses in the public sector get paid less than the private sector,” Dr. Cineas said. “We worked really hard just to level set that in the last contract.”
The system’s nursing workforce has more than 9,600 employees. More than 2,000 have graduated from the organization’s nurse residency program, which provides new nurses with support, mentorship and coaching related to clinical practice.
Additionally, to elevate nurses’ voices, NYC Health + Hospitals hosts more than 180 shared governance councils across its enterprise.
“That is a mechanism of ensuring that nurses are empowered through structural empowerment, where nurses have a voice in their practice, where nurses are thinking about evidence based practice [and considering] our quality outcomes,” Dr. Cineas said about the councils.
Other drivers for the millions of dollars in savings and lower turnover rate include a management system that standardizes communication between the night and day shifts, a nursing clinical ladder, nursing fellowship programs and a well-being buddy system for peer-to-peer support.
The care delivery daily management system “marries theory and practice together,” according to Dr. Cineas.
The management system is structured to begin safety huddles with theory — with topics covering social determinants of health and compassion — from theorists Jean Watson, PhD, and Madeleine Leininger, PhD.
The care delivery model also comprises a 5-minute sit-down, which strengthens the connection between patient and nurse, and several clinical elements, including medication administration, head-to-toe assessment, and admissions and discharges.
Overall, the care delivery daily management system works “to make sure that all of our 3,000 nurses that we’ve hired are supported at the beginning of the shift,” Dr. Cineas said.
“I think our most significant success is how we, as a system, have come together to close the gap” in RN recruitment, Dr. Cineas said. “That took human resources, that took nursing education, that took operations, that took marketing and communications. It was a team effort.
“I think our greatest success was making that a priority at the system level and the local level,” she added. “It was just wonderful.”
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