Healthcare’s Flatlining Workforce and the Rise of Zombie Burnout

The healthcare worker shortage is growing, and the hiring rate is beginning to reveal the extent of the impact: the healthcare workforce has fallen to near-zero net growth in 2026.

Hiring in healthcare has declined every year since 2022, while termination has been essentially flat since 2024. The net growth gap has closed from 3.4 percentage points in January 2023 to just 0.61 in August 2026.

So where does healthcare go from here?

Using exclusive BambooHR platform data, as well as workforce survey results, the 2026 Healthcare Workforce Report unpacks how current conditions are impacting recruitment and turnover, and what this could mean for healthcare in the long run.

The hiring rate in healthcare has dropped to 4.3% year-to-date through August 2026, continuing a multi-point decline in hiring since 2022.

But this hiring slowdown isn’t a problem of low demand—in fact, job postings for clinical hiring became substantially more prominent from 2019 to 2025. For example:

• The share of RN postings increased by a relative 63%
• Nurse practitioner positions increased by more than 3x
• Behavioral health titles increased by more than 2x

Rather than low demand, the decline in hiring is likely due to the worsening shortage of healthcare workers, a challenge that’s weighing heavily on healthcare institutions. 47% of healthcare leaders say that staffing shortages have forced them to adjust, delay, or limit the care or services they provide.

In response, healthcare recruiters seem to be getting more competitive, upping the ante to attract healthcare workers. In 2022 and 2023, mentions of signing bonuses in clinical job postings spiked, appearing in more than 10% of clinical job descriptions. Evidently, competing on upfront compensation wasn’t sustainable: By 2025, the share of clinical job posts mentioning signing bonuses dropped back down, falling below 6%.

Facing both staffing and financial hurdles, many healthcare organizations are also turning to more flexible models: Flexible staffing arrangements (such as PRN and per diem roles) became more common from 2019 to 2025. Recruiters are spinning this to candidates as a perk, emphasizing flexibility and wellness support in job descriptions.

From 2019 to 2025, job descriptions were more likely to mention:

• Work-life balance (up more than 5x)
• EAPs (up more than 4x)
• Flexible schedules (up 3x)

Unfortunately, while contract or agency work can help solve staffing gaps, it’s not always a price performer—43% of healthcare leaders say the cost is putting financial strain on their organization. But with seemingly no other options, nearly half of healthcare leaders (45%) report no change in their agency contract reliance over the past two years.

The workforce data shows no coming respite from healthcare staffing challenges. As the job market grows increasingly competitive for employers, recruiters will need to get creative to find ways to attract clinical talent. Likewise, new clinical workers entering the field should be prepared to consider nontraditional roles.

This uptick in involuntary turnover coincides with a rise in the cost of care, as healthcare providers are facing increasing financial burdens, such as inflation, unpaid patient debt, and the loss of government subsidies. 94% of healthcare leaders say that inflation has meaningfully impacted their organization, between rising supply costs, rising wages, and rising patient financial need.

Notably, 43% of leaders say they’re swallowing those costs entirely, rather than passing them on to patients. But the money has to be accounted for somewhere, and labor is typically the greatest expense for healthcare providers. With involuntary turnover going up, it appears that the workforce is taking the hit.

Administrative and billing roles have a slightly higher rate of involuntary turnover than clinical roles, a consistent gap over the last few years that shows no sign of narrowing as clinical worker shortages continue to be a top concern.

However, trimming admin roles could be increasing the burden on the rest of the workforce: 74% of healthcare workers say they accept heavy administrative demands as a part of the job that competes with their core responsibilities. One-third of healthcare workers (32%) report that their administrative workload has grown significantly in recent years and is a major contributor to their stress and burnout.

Involuntary turnover rates paint a troubling picture for the future of healthcare: Institutions are desperate for more workers, but at the same time, seem to be struggling to keep on the employees they currently have.

Conversely, the share of voluntary turnover (resignations out of total turnover) has declined. The average share of voluntary turnover out of total turnover in 2025 was 56%, compared to 61% in 2023. Year-to-date through August 2026, the voluntary turnover share has dipped down to 56%.

The decline in the amount of resignations out of total turnover may contradict an intuitive narrative about the healthcare industry that’s taken hold: “Burnout is high, so healthcare workers will choose to leave.” But the workforce data indicates a different story.

Burnout is a problem. Over half of healthcare leaders (55%) say that staff burnout is the most pressing challenge right now at their organization, and two-thirds of healthcare workers (65%) experience some form of compassion fatigue, burnout, moral distress, or secondary traumatic stress.

The lowering share of voluntary turnover could suggest that healthcare workers are just very resilient. Healthcare eNPS^Ⓡ* (Employer Net Promoter Score) jumped up to 40 in the first half of 2026, so the workers choosing to stick around may have simply found a way to cope with the challenging environment.

Another possible explanation—a bleaker one—is that healthcare workers have entered a mode of zombie burnout: Worker energy and morale is depleted, but they’ve shut down the feelings of distress and keep going to work anyway.

With these numbers in mind, healthcare leaders will need to rethink how they measure employee wellness. Surviving (e.g., retention) is not the same as thriving.

*Net Promoter, NPS, and the NPS-related emoticons are registered U.S. trademarks, and NetPromoter Score and Net Promoter System are service marks, of Bain & Company, Inc., NICE Systems, Inc. and Fred Reichheld.

Like many industries, healthcare struggles with first-year retention. Following a significant rise in first-year turnover rates (going from 25% in 2019 to 34% in 2023), the healthcare industry hasn’t recovered. Instead, for the last three years, the first-year turnover rate has plateaued, lingering at an elevated level. As of 2025, first-year turnover had risen to 36%.

The biggest insight from the data: Career movement may not be the carrot leaders assume it is. Healthcare workers who receive a title change (such as promotions, transfers, or reclassifications) within their first year end up exiting in their second year at a higher rate than those who received no title change in their first year.

Unsurprisingly, turnover goes up more for the workers who receive a title change in their first year without a concurring compensation increase. Clinical workers are especially prone to moving on if they receive a title change with no pay raise within their first year. Those worried about healthcare worker retention should take note: Compensation not matching the demands of a role is the second-greatest cause of healthcare worker distress, right behind understaffing.

First-year turnover patterns point to a greater need for a holistic approach to supporting and engaging new hires. Professional development needs to come with fair compensation, and fast-tracking a worker’s career won’t make up for issues with culture or work-life balance.

All proprietary source data is derived from the BambooHR platform, covering approximately September 2022 through August 2026. This analysis is based on aggregated and anonymized data from BambooHR customers, drawing from a dataset that includes millions of employee records and workforce events across organizations globally.

To enable comparison across organizations of different sizes, several normalized metrics are used throughout the report. These include hiring and turnover proportions (hires or terminations relative to total employees).

The report also incorporates an analysis of BambooHR job-posting data. The healthcare posting dataset contains over 200,000 unique, deduplicated postings from healthcare employers. To provide a more consistent historical comparison and avoid incomplete-year effects, the primary trends reported here use postings from 2019 through 2025. Role categories were identified primarily from cleaned job titles, while recruiting, benefits, technology, and workplace-support signals were identified using predefined keyword and phrase patterns applied to cleaned job descriptions. Results are reported as shares of annual healthcare postings rather than raw posting counts. Because job-posting language is unstructured and terminology varies across employers, these measures should be interpreted as indicators of changes in hiring language and job composition rather than exhaustive measures of the underlying workforce phenomenon.

All survey source data is derived from a study BambooHR conducted using an online survey prepared by Method Research and distributed by RepData among n=1,248 adults (age 18+) globally. The research was split among two separate audiences who each saw a unique set of questions.

n=926 full-time salaried employees in the US who are desk, frontline, or hybrid workers. This includes a subgroup of at least n=150 each from the construction, technology, education, healthcare, finance, and food and beverage industries. The sample has a spread of gender, age, work type, company size, and geography groups represented.

n=322 adults (age 18+) in the United States who are business owners or C-suites in small or mid-sized organizations. This includes a subgroup of at least n=50 each from the construction, technology, education, healthcare, finance, and food and beverage industries. The sample has a spread of small and mid-sized businesses represented.

Survey data was collected from March 24 to April 9, 2026.

BambooHR^® is the leading HR software platform that sets people free to do great work^®. Intuitively designed and user-friendly HR, payroll, and benefits administration in one unified ecosystem means less focus on process and more on growing what matters most—people.

With AI-powered insights and comprehensive reporting, HR leaders gain the data they need to craft strategies to enhance employee engagement and retention while effectively measuring success. Trusted by HR professionals in over 34,000 companies across 190 countries and 50 industries, BambooHR supports millions of users throughout their employee journey.