Healthcare retention by age: Why Gen Z and Millennial workers are most likely to leave

More than half of healthcare workers under 35 (52%) plan to look for a new job within the next 12 months, according to a survey of 676 U.S. and Canadian healthcare workers. That number drops to 41% among workers aged 35 to 44 and 30% among those 45 and older. That’s where retention efforts will pay off most: early in a career, and in the mid-career group just behind it.

Firstup’s State of Employee Engagement in Healthcare report breaks results out by role: corporate office employees, managers and supervisors, and hourly workers. We went back to the data and looked at it by age instead of role. The age view shows a sharp drop in near-term intent to leave at 35, and a distinct group of 35- to 44-year-olds who plan to look within the year.

Hospital data shows a similar pattern for nurses. NSI’s 2026 National Health Care Retention & RN Staffing Report found that 22.7% of newly hired RNs left within a year, and first-year exits made up 29.0% of all RN separations.

About the data: This analysis uses responses from Firstup’s [State of Employee Engagement in Healthcare](https://firstup.io/whitepapers/state-of-employee-engagement-in-healthcare/) survey (June 2026), filtered to the 676 respondents in the U.S. and Canada who work in healthcare. They include hourly workers, managers, and corporate employees.

Healthcare workers under 35 are the most likely to leave, and they aren’t waiting long to start looking. More than a third (35.6%) plan to look immediately or within the next six months, nearly double the rate of the 35- to 44-year-olds (20.4%).

What stands out is that most of these workers don’t describe themselves as disengaged. About three-quarters of under-35s (77.2%) say they’re engaged or highly engaged, only a few point below older groups. Yet 51.7% still plan to look for a new job within the year. If you rely solely on engagement scores to spot who is ready to leave, you’ll likely miss many of them.

Early-career workers asked for more growth, better communication, and more connection with coworkers than older workers did.

Older workers value different things. 60.4% of workers 45 and older said understanding how their work contributes to the organization’s goals is a reason they’re engaged, compared with 49.0% of those 18 to 34.

Some priorities don’t change with age. About half of every age group said that demonstrating care for their well-being would make them more engaged (49.7% of 18-to 35-year-olds, 52.6% of 35- to 44-year-olds, and 52.8% of those 45 and older). Greater recognition and rewards matter to all generations too. Among workers planning to leave, “I don’t feel recognized and rewarded” was also the most common non-pay reason in all three groups, at 57%, 46%, and 53%.

Younger workers tend to rely more on their mobile devices, including SMS and an employer mobile app. Older workers prefer team meetings and direct engagement with their manager.

Younger workers report more fallout from missed updates. Asked about issues resulting from missed updates, only 14.1% of 18-34s said none of the listed issues applied, versus 23.7% of 35-44s and 27.5% of workers 45 and older. And 14.7% of workers under 45 reported a safety impact, compared with 8.9% of those 45 and older.

Reaching everyone directly makes a difference. Nebraska Medicine wanted a stronger connection between leadership and its roughly 10,000 employees, many of them frontline nurses who don’t sit at a desk. By reaching employees directly instead of relying on updates passed down through managers, the health system now reaches about 90% of its workforce.

Workers under 35 face a higher attrition risk than their older colleagues. More than a third (35.6%) plan to start looking within six months, and they asked most for a path forward, clearer communication, and connection to coworkers. A structured first-year retention program can deliver on all three through regular manager check-ins, visible development options, and recognition.

Workers aged 35 to 44 aren’t far behind. One in five (20.4%) plan to look within six months, and 41.2% within the year. What keeps this age group? Mostly a path for advancement: 61.6% say it would persuade them to stay, which makes career conversations and development opportunities critical for this group.

For workers 45 and older, the risk is lower, and the priorities differ. 60.4% say understanding how their work contributes is a reason they’re engaged, and 59.2% prefer team meetings or 1:1s with their manager. Equipping managers for those conversations matters more here than adding channels.

Firstup’s Nurse Retention solution starts with the first year. It provides a preconfigured 12-month journey that adds content and touchpoints by role and milestone, triggered by HRIS events like a start date. Manager prompts and engagement analytics help leaders see who is drifting, and the same platform can send targeted messages at later milestones.

1. Check your own turnover by age and tenure. Are your first-year staff leaving at a higher rate than everyone else
2. Ask about intent to leave, not just engagement. A simple question like “When are you likely to look for a new job?” shows who’s close to leaving in a way engagement scores don’t.
3. Find out how each group wants to hear from you. Younger workers are more likely to want text and mobile, while older workers lean on team meetings and their manager.
4. Build a first-year program for new hires. Regular manager check-ins, visible development paths, and recognition address what younger workers asked for most. Firstup’s Nurse Retention solution includes pre-built content you can tailor to your first-year nurses.
5. Start career conversations with staff in their mid-30s to mid-40s early. One in five in this group plan to look within six months, so don’t wait for annual reviews.
6. Give employees a way to communicate back. A two-way feedback channel lets workers raise concerns before they turn into resignations.

See how the Firstup Nurse Retention solution can help your health system give every new nurse a stronger start. Book a demo →

Sources: Firstup, State of Employee Engagement in Healthcare (June 2026), filtered to 676 U.S. and Canadian healthcare respondents; NSI Nursing Solutions, 2026 NSI National Health Care Retention & RN Staffing Report.