Fact-checked against primary sources: NSI Nursing Solutions, the International Journal of Public Health, national labor ministries, and official 2026 government salary schedules. Last verified September 2026. Where no country-specific turnover-cost study exists, we show the calculation used to estimate it, so you can see exactly where every number comes from.

Here’s a simple way to picture it: imagine a bucket with a hole in the bottom.

Every time a nurse quits, water drains out — and someone has to keep refilling the bucket just to keep it from running dry. In the United States, refilling that bucket costs $60,090 every single time. In Nigeria, it might cost closer to $2,000.

Same hole. Wildly different price tag.

That gap is the whole story of this article. A single nurse walking out the door means something completely different depending on which country’s hospital she’s leaving.

For a CFO or CNO managing staff across borders, or just trying to understand how bad the problem really is compared to peers overseas — knowing that difference isn’t trivia. It changes how you budget, how you pitch retention spending to your board, and how urgently you move.

Below, we break down 12 countries the exact same way, so you can compare them side by side instead of squinting at 12 different reports that all measure things differently.

How We Calculated This (Read This Before the Numbers)

Only two countries in this list: the United States and Germany have a published, named study that directly measured the real cost of replacing a nurse. Everyone else does not have that kind of study publicly available yet, so for those 10 countries, we built an estimate using a method economists actually use for exactly this problem: take a nurse’s annual salary, and multiply it by 1.5 — because replacing someone costs roughly their own yearly pay to their own pay-and-a-half, once you count recruiting, training, lost productivity, and covering the gap with overtime or temporary staff.

We labeled every country clearly below:

  • Documented — a real study measured this, not an estimate.

  • Estimated — calculated from verified 2026 government or labor-market salary data, using the multiplier method above.

We’re telling you this upfront because a good CFO should never trust a number without knowing where it came from — and neither should you.

The 12 Countries at a Glance

Country Status Annual Nurse Salary (USD) Cost of One Resignation (USD)
United States 🟢 Documented ~$93,600 $60,090
Germany 🟢 Documented ~$53,400 ~$81,000
Netherlands 🟡 Estimated ~$60,500 $60,500 – $90,700
Singapore 🟡 Estimated ~$75,000 $75,000 – $112,500
Sweden 🟡 Estimated ~$46,000 $46,000 – $69,000
Spain 🟡 Estimated ~$40,000 $40,000 – $59,900
Bulgaria 🟡 Estimated ~$20,100 $20,100 – $30,100
Peru 🟡 Estimated ~$15,300 $15,300 – $23,000
China 🟡 Estimated ~$12,000 $12,000 – $18,000
Philippines 🟡 Estimated ~$9,000 $9,000 – $13,600
Liberia 🟡 Estimated ~$4,500 $4,500 – $6,800
Nigeria 🟡 Estimated ~$1,500 $1,500 – $2,200

United States – Documented

United States - Documented

The cost of one resignation: $60,090

This is the one number in this whole article you don’t have to take our word for — it comes straight from the industry’s biggest annual study, which asked 527 real hospitals across 40 states what they actually spent.

  • Average nurse salary: about $93,600 a year [confirmed earlier in this research thread, BLS]

  • National RN turnover rate in 2025: 17.6%, which went up after two years of improvement

  • What it costs a typical hospital per year: $5.19 million

  • Time to fill one open nurse job: 78 days on average

Why the number is what it is: American hospitals lean heavily on expensive temporary “travel nurses” to cover empty shifts, and that coverage gap — not just the hiring paperwork — is a huge chunk of the $60,090.

Germany – Documented

Germany – Documented

The cost of one resignation: ~€75,000 (about $81,000)

Germany also has a real, peer-reviewed study behind this number, built by health economists studying how much hospitals could save with better staff support.

  • Average nurse salary: about €4,124 a month (~$53,400/year)

  • What drives the high cost: German hospitals pay a huge premium for temporary nursing staff — as much as 92% more than a permanent hire costs for the exact same work

  • A useful comparison: replacing one nurse in Germany (€75,000) costs almost the same as covering just one year of a single temporary nurse contract (€95,000–€105,000)

Why the number is what it is: Germany’s nursing shortage is so severe that temporary staffing has become the default, not the exception — and that default is expensive.

Netherlands – Estimated

Netherlands – Estimated nurse resignation cost per nurse

The cost of one resignation: roughly $60,500 – $90,700

  • Average nurse salary: about €52,000 a year (~$60,500)

  • A distinctive Dutch twist: researchers describe a “hidden reserve” of trained nurses who aren’t currently working — meaning part of the country’s shortage isn’t about training more nurses, it’s about bringing back the ones who already left

Why this matters for a CFO: if a meaningful slice of your open positions could theoretically be filled by nurses who already exist and are already trained, that changes whether your money is better spent on recruiting new people or winning back people who already know the job.

Singapore – Estimated

Singapore – Estimated nurse cost per resignation

The cost of one resignation: roughly $75,000 – $112,500

  • Median nurse salary: about $75,000 a year, among the higher-paid nursing markets in Asia

  • The bigger context: Singapore’s own government reports its nurse attrition rate fell from a pandemic-era peak of 14.5% down to a “healthy” roughly 7% by 2025 — one of the only genuinely improving stories in this entire list

Why this matters for a CFO: high individual replacement cost doesn’t automatically mean a crisis — Singapore proves a country can have expensive nurses and a shrinking turnover problem at the same time, if retention policy works.

Sweden – Estimated

Sweden – Estimated nurse resignation cost

The cost of one resignation: roughly $46,000 – $69,000

  • Average nurse salary: roughly $46,000 a year

  • A surprising Swedish finding: a rigorous 2025 study found that pay wasn’t even the strongest reason nurses considered leaving — feeling like the profession itself was undervalued mattered more, statistically, than salary

Why this matters for a CFO: in Sweden, throwing more money at the problem alone may not fix it — the data suggests recognition and fair treatment move the needle at least as much as a raise.

Spain – Estimated

Spain – Estimated nurse cost resignation

The cost of one resignation: roughly $40,000 – $59,900

  • Average nurse salary: about €34,000 a year (~$40,000)

  • The number that should worry Spanish hospital leaders: a government study of over 20,000 nurses found almost 4 in 10 intend to leave the profession within 10 years, and 17% within just two years

Why this matters for a CFO: Spain’s per-nurse cost looks moderate on paper, but multiply a moderate number by “nearly 40% of your whole workforce,” and the total bill gets very large very fast.

Bulgaria – Estimated

Bulgaria - Estimated The cost of one resignation roughl

The cost of one resignation: roughly $20,100 – $30,100

  • Government-mandated minimum nurse salary, starting January 1, 2026: €1,550 a month (~$20,100/year)

  • Context: this minimum wage is part of a €260 million government package specifically meant to raise health-worker pay and slow the exodus of nurses leaving for wealthier EU countries

Why this matters for a CFO: Bulgaria’s government itself is treating pay as the lever to pull — a signal that in lower-income EU healthcare markets, salary competitiveness with richer neighboring countries is often the single biggest retention factor.

Peru – Estimated

The cost of one resignation: roughly $15,300 – $23,000

  • Average nurse salary, per Peru’s own Ministry of Labor: between S/3,894 and S/4,784 a month depending on age, roughly $12,500–$15,300 a year

  • A notable detail: younger Peruvian nurses (ages 18–29) earn noticeably less than nurses aged 30 and up — a pay gap that shows up in almost every country in this list, but is especially wide in Peru

Why this matters for a CFO: if your youngest nurses are your worst-paid nurses, they’re also usually your highest flight-risk group — the exact pattern shown in the U.S. data, where new hires make up nearly a third of all departures.

China – Estimated

The cost of one resignation: roughly $12,000 – $18,000

  • Approximate nurse salary in a typical tertiary hospital: around $12,000 a year

  • The twist: China’s own biggest-ever national study found turnover intention of just 13.7% — genuinely low by world standards — but individual regional studies in the same country found rates as high as 64.1% in some provinces

Why this matters for a CFO: in a country as large as China, “the national average” can be almost meaningless for planning purposes — what matters is what’s happening in your specific hospital’s province, not the countrywide headline.

Philippines – Estimated

The cost of one resignation: roughly $9,000 – $13,600

  • Entry-level government nurse salary, 2026: ₱42,178 a month (~$9,000/year)

  • The bigger story: more than half of all licensed Filipino nurses — roughly 316,000 people — work abroad, not in the Philippines, because other countries pay so much more for the exact same skills

Why this matters for a CFO: the Philippines’ low local replacement cost is deceptive — the real cost isn’t replacing a nurse locally, it’s that your best-trained nurses are actively being recruited away by richer countries the moment they’re fully trained.

Liberia – Estimated

The cost of one resignation: roughly $4,500 – $6,800

  • Government salary for a BSc-qualified nurse, under the 2024 national Salary Gap Closure plan: $375 a month (~$4,500/year) [web:528]

  • Context: this pay scale was specifically created by the Liberian government to try to close long-standing pay gaps between health workers and other professions

Why this matters for a CFO: even at this small dollar figure, losing a nurse in Liberia can be just as disruptive to patient care as losing one in the U.S. — the money is smaller, but the staffing gap left behind is not.

Nigeria – Estimated

The cost of one resignation: roughly $1,500 – $2,200

  • Average entry-to-mid-level government nurse salary (CONHESS scale): roughly ₦200,000 a month (~$1,500–$2,000/year) [web:508]

  • The number that explains why this keeps happening: roughly 42,000 to 75,000 Nigerian nurses have left the country since 2017, and Nigeria’s own 2025 government workforce report recorded over 20,000 health professionals leaving in a single year

Why this matters for a CFO: Nigeria has, by dollar amount, the cheapest nurse to replace on this entire list — and also one of the fastest-emptying nursing workforces in the world, which shows that a low replacement cost doesn’t mean a low-stakes problem.

Why These Numbers Aren’t Directly Comparable (And That’s Okay)

Comparing $60,090 in the U.S. to $2,000 in Nigeria might make it look like American hospitals have it 30 times worse. They don’t — they just operate in a country where nurse salaries, agency staffing costs, and hiring timelines are all dramatically higher. The real comparison that matters isn’t the raw dollar figure — it’s the cost of one resignation as a share of what that hospital already spends on staffing overall. A $2,000 loss in a hospital with a tiny total budget can hurt just as much as a $60,000 loss in a hospital with a much bigger one.

That’s also exactly why we labeled every country either – Documented or – Estimated.

The U.S. and Germany numbers come from real studies that measured actual hospital spending. Everyone else’s number is our own calculation from verified salary data — a reasonable, commonly used estimate, but an estimate all the same. If your hospital operates in one of the 🟡 countries, the single most useful thing you could do with this article is commission your own version of the U.S. or German study — because right now, nobody has, and that gap in the data is itself worth noticing.

What This Means If You’re a CFO or CNO

  • Don’t just track the dollar figure — track it as a share of your total payroll. A $9,000 loss in the Philippines can represent a bigger relative shock to a small clinic’s budget than a $60,000 loss represents to a large U.S. hospital system.

  • Watch your youngest staff most closely. In nearly every country on this list, newer and younger nurses are paid less and leave faster — the U.S. data alone shows new hires make up close to a third of all nurse departures.

  • If your country doesn’t have a “Documented” number yet, that’s a gap you can fill. Tracking your own hospital’s actual recruiting spend, agency costs, and productivity loss for even a handful of departures would give you something the entire rest of your country’s healthcare system doesn’t have.

  • A low per-nurse cost is not the same as a low-risk problem. Nigeria and Liberia have the cheapest individual replacement costs on this list and some of the most severe workforce-exodus numbers in the world — cheap to replace doesn’t mean easy to keep.

Understaffing, low pay relative to cost of living, and burnout are documented, real drivers behind nurse turnover in every country on this list — not abstract complaints. [web:42][web:487][web:464] Employer-led staffing reform, competitive and transparent pay, and licensed clinical mental health support remain the primary tools for addressing burnout tied to this kind of turnover pressure. Some hospitals report that complementary, non-clinical wellbeing resources — such as Ne Ste Al Frequency Therapy sessions offered remotely alongside existing staff support programs — can play a supportive role for nurses experiencing stress and burnout symptoms; many nurses and clients who use these sessions describe a noticeable shift in how they feel, though individual experiences vary and no specific outcome is guaranteed.

Ne Ste Al does not diagnose, treat, cure, or prevent any medical or psychiatric condition; anyone experiencing burnout or clinical symptoms should consult a licensed healthcare provider first, and any wellbeing program a hospital adopts should be built around licensed, evidence-based care as its foundation.

Frequently Asked Questions

Which country has the highest cost to replace a single nurse?

Among the countries with a directly documented figure, Germany’s estimated €75,000 (about $81,000) is the highest, slightly ahead of the United States’ $60,090. Singapore’s estimated range ($75,000–$112,500) could be higher still, but that figure is calculated from salary data rather than a published study, so it should be treated as an estimate, not a confirmed number.

Only the United States and Germany currently have a publicly available study that directly measured real hospital spending on nurse replacement. For the other 10 countries, no such study was found, so the figures shown are calculated from verified 2026 salary data using a standard 1.0x–1.5x annual salary multiplier used in academic turnover-cost research.

Is it fair to compare nurse turnover costs across countries with such different salaries?

Only with context. A $2,000 resignation cost in Nigeria and a $60,090 cost in the United States both represent a real disruption to patient care, but they shouldn’t be compared as raw dollar amounts alone — what matters more is each figure’s size relative to that hospital’s total staffing budget and how severe that country’s actual turnover or emigration rate is.

Which countries have the most severe nurse shortage or turnover pressure, regardless of cost?

By share of workforce lost, Nigeria (roughly 42,000–75,000 nurses emigrated since 2017) and the Philippines (over half of all licensed nurses work abroad) show some of the most severe exits globally, even though both have comparatively low individual replacement costs. Spain’s nearly 40% ten-year intention-to-leave rate and China’s regional turnover intention as high as 64.1% also stand out as severe pressure points.

What can a hospital do if their country doesn't have a documented turnover-cost study yet?

Track your own hospital’s actual costs directly: recruiting and advertising spend, onboarding and training time, overtime or temporary staffing costs during the vacancy, and lost productivity while a new hire reaches full competency. Even a small, internal study covering a handful of departures gives a hospital a real, defensible number instead of relying on a national estimate.

 

Related

Nurse Turnover in U.S. Hospitals: Causes, Costs, and Solutions
Nurse Retention Statistics Spain 2026
Nurse Retention Statistics China 2026

Sources

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Built by Gaple and Petri after a decade spent solving the same retention problem hospitals face now — inside a 70-person, £25M sales organization where even top performers arrived Monday already looking for a reason to quit. That work became Frequency Therapy, adapted for hospital nursing teams.

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