In 2016, Nursing Solutions estimated registered nurse (RN) turnover in the United States at 14.6%, down from 17.2% the previous year (2). However, we are experiencing a growing trend in turnover. According to Hunt, based on current projections, the United States will experience a shortage of nearly one million nurses by 2020 (6). The current financial fallout according to the 2017 National Healthcare Retention & RN Report is that the average cost of turnover for an RN ranges from $37,700 to $58,400; each percentage increase in turnover rate costs the hospital an additional $410,500 (8). In non-financial terms, nurse turnover results in decreased quality of care, patient loss, and high replacement costs, averaging 82 days (Hunt 3). High turnover among professional nurses can be mitigated by improving the work environment, creating mentorship programs, and establishing residency programs. Say no to plagiarism. Get a tailor-made essay on "Why Violent Video Games Shouldn't Be Banned"? Get an Original Essay Improving the work environment is an effective way to reduce high turnover rates among professional nurses. According to Shimp, “the nursing practice environment has a direct impact on nurse retention, turnover, and staff perceptions of the adequacy of staffing and resources” (258). The work environment may not be an obvious issue in the retention effort, but it is important. Christmas describes it this way: “the most subtle influence is the tone of any workplace, often called the work environment” (316). From this type of evaluation, several institutions that employ the services of nurses have undertaken a retention campaign seeking to improve the working environment. When this is the strategy to reduce turnover rates, the key aspect of that effort should involve staffing levels and resource availability, measured as patient to nurse ratio (Lieneweber 48). Current efforts to improve staffing levels include legislation at the federal level and some regulations at the state level. “At the federal level, legislation was created in 2008 to amend or introduce new staffing guidelines for the healthcare industry;” At the state level, California established a patient-nurse ratio law in 2004, seven other states have followed similar laws and regulations (Shimp 240). The result of the California law that went into effect in 2004 was an increase in applications for RN licenses by more than 60 percent and "by 2008, vacancies for registered nurses in California hospitals plummeted by 69 percent" and in 2010 study concluded that the legislation had achieved its goal of increasing nurse retention and recruitment (Department of Professional Employees 4). Defining and monitoring the patient-nurse ratio should be a legislative and regulatory priority. “A study of 601 nurses found that 43% of nurses would actually prefer an increase in staffing levels over an increase in salary planning” (Hunt 5). Therefore, high turnover rates among registered nurses can also be reduced by establishing residency programs. Both new nurses and nursing leaders conclude that new nurses are unprepared for the demands of the profession, “when faced with such a serious problem, a postgraduate residency program offers a solution” (Trepanier 207). With this recognition, institutions such as hospitals are starting to engage in residency programs to increase the,.