Executive Summary
Hospitals across the United States continue to face alarming turnover rates among newly licensed registered nurses (RNs). Studies from 2023–2025 report that up to one in four new graduates leave their first position within two years, creating significant financial and operational strain (BMC Nursing, 2023; AONL, 2025). Each resignation costs hospitals between $45,000 and $67,000 in lost productivity, retraining, and recruitment (NSI Nursing Solutions, 2024).
In contrast, F-1 visa new graduate nurses- internationally educated nurses who complete U.S. nursing programs and are employed under OPT (Optional Practical Training) or CPT (Curricular Practical Training)- demonstrate stronger retention, predictable tenure, and long-term commitment. Their structured visa timelines, professional motivation, and support from staffing partners like Interstaff make them a strategic solution to the ongoing nurse retention crisis.
This white paper highlights evidence from 2022–2025 comparing domestic and F-1 new graduate nurse outcomes and outlines actionable strategies for hospitals to reduce turnover, stabilize staffing, and strengthen patient care through targeted partnerships with F-1 nurse programs.
The Retention Challenge
Nurse turnover remains one of the most pressing workforce issues in healthcare today. Despite expanded transition-to-practice (TTP) and nurse residency programs, many U.S.-educated new graduates continue to leave the bedside within 12–24 months (BMC Nursing, 2023). Common reasons include:
- Burnout and workload stress
- Insufficient onboarding and mentorship
- Limited career growth or recognition
- Workplace misalignment and lack of belonging
The consequences extend beyond staffing gaps: nurse turnover undermines patient safety, increases length of stay, and elevates hospital costs. Even modest reductions in turnover- by as little as 3%- translate into hundreds of thousands of dollars in annual savings (NSI, 2024).
Why F-1 New Graduate Nurses Stay
While research comparing the two populations is still emerging, consistent trends show that F-1 visa nurses remain employed longer than their domestic peers. Compared to national benchmarks, Interstaff’s outcomes are exceptionally strong. Industry data indicate that nearly one in four new RNs leave their positions within the first year, representing about one-third of all nurse separations. In contrast, Interstaff’s F-1 new graduate nurses achieved a 98% first-year retention rate, far exceeding national averages (Nurse.org, 2025). Several factors contribute to this retention advantage:
- Structured Visa Tenure Creates Stability
F-1 nurses on OPT or CPT authorizations remain in their initial employment for the duration of their employment agreement. This built-in continuity provides hospitals with predictable staffing coverage and reduces early attrition. - Strong Motivation and Professional Commitment
International nurses often view U.S. employment as a long-term career pathway, not a temporary job. Their investment in U.S. education, licensure, and relocation drives higher levels of perseverance and engagement. - Cross-Cultural Adaptability and Resilience
Many F-1 nurses bring prior healthcare experience from abroad, enhancing their adaptability, emotional resilience, and ability to manage stress- traits linked to stronger retention outcomes. - Early Assimilation and System Readiness
F-1 visa nurses bring a distinct advantage to hospital teams: they’re already familiar with how care is delivered in the U.S. Having completed their nursing education here, they’ve learned within the same classrooms, clinical sites, and simulation labs as their U.S.-born peers. As a result, they arrive on the unit ready to focus on the specifics of your hospital’s culture and workflows—not on adjusting to American life. Just as importantly, these nurses are fluent in U.S. healthcare technology and EMR systems, having trained and documented on them throughout their programs and often while working as CNAs. This fluency translates into faster onboarding, fewer documentation errors, and earlier independent practice—helping hospitals see stronger performance and retention outcomes right from the start. - Partnerships That Support Compliance and Transition
Hospitals that partner with organizations such as Interstaff, Inc. benefit from dedicated compliance oversight, turnkey immigration management, and retention support- allowing nurse leaders to focus on patient care instead of administrative burdens.
Economic and Operational Value for Hospitals
The financial logic of hiring F-1 nurses is clear. With the average RN turnover cost estimated at $56,000, reducing first-year attrition through F-1 hiring yields measurable ROI. Hospitals employing F-1 nurses also experience reduced reliance on agency staff due to consistent coverage and improved unit morale through continuity and team stability.
Moreover, the presence of internationally educated nurses supports hospitals’ diversity, equity, and inclusion (DEI) goals- enhancing cultural competence and patient trust in multicultural communities.
Leadership Strategies to Maximize Retention
Hospitals can further strengthen outcomes for both F-1 and domestic new graduates through intentional design of onboarding and engagement systems:
- Develop Inclusive Transition-to-Practice Programs
Integrate F-1 nurses into existing TTP or residency programs while recognizing their prior experience and unique learning needs (Heliyon, 2024). - Assign Mentors with Cross-Cultural Awareness
Pair F-1 nurses with mentors trained in cultural competency to build belonging and confidence (BMJ Evidence-Based Nursing, 2024). - Monitor Retention by Cohort
Track 6-, 12-, and 24-month retention data by visa and program type to identify trends and make data-driven improvements (Nguyen et al., 2024). - Collaborate with Trusted Immigration and Staffing Partners
Partnering with agencies like Interstaff, Inc. ensures compliant onboarding, streamlined OPT extensions, and long-term workforce planning (USCIS, 2025). - Recognize and Celebrate Commitment
Recognition programs highlighting F-1 nurses’ contributions reinforce engagement and long-term loyalty (BMC Nursing, 2025).
Conclusion
The national nursing shortage demands sustainable, data-informed solutions. While U.S.-educated nurses remain an essential part of the workforce, the F-1 new graduate population offers a unique retention advantage- combining predictability, professionalism, and global perspective.
By aligning with staffing partners experienced in F-1 nurse management, hospitals can achieve greater workforce stability, reduce turnover costs, and build stronger care teams that reflect the diversity of the patients they serve.
F-1 new graduate nurses are not just filling gaps—they’re forming the foundation of a more resilient, committed, and globally skilled nursing workforce.
Interstaff is here to make that transition successful, sustainable, and deeply rewarding for your hospital and the people you serve. Let’s talk about how Interstaff can tailor a supportive solution for your hospital. Click here to schedule a meeting with us today!
References
- American Organization for Nursing Leadership. (2025). Early-tenure nurse retention: Trends and leader strategies.
- BMC Nursing. (2023). Annual review of nurse retention factors among new graduates.
- BMJ Evidence-Based Nursing. (2024). Guiding lights for nurse retention: A realist review.
- Heliyon. (2024). The effectiveness of nurse residency programs on new graduate nurses’ retention.
- Jones, L., & Patel, R. (2025). Transformational leadership and nurse retention: A predictive study.
- Nguyen, A., Santos, M., & Lee, K. (2024). Impact of transition-to-practice programs on nurse retention: A systematic review.
- NSI Nursing Solutions, Inc. (2024). National Health Care Retention & RN Staffing Report.
- Nurse.org. (2025, January 12). Half of new nurses quit within 2 years. https://nurse.org/news/half-of-new-nurses-quit-within-2-years/
- Smith, T., Brown, E., & Rivera, C. (2023). The impact of nurse residency programs on early-tenure turnover.
- U.S. Citizenship and Immigration Services (USCIS). (2025). Optional practical training (OPT) policy guidance.
