Sometimes, staff turnover is crucial to improving organisations: 10 Downing Street, for example. But high turnover is clearly not a good thing everywhere. Workers learn how to do their roles well over time and recruitment costs in both cash and management time. Hospitals are clearly in the “we don’t want really fast turnover” category. They need to hold on to nurses and doctors to retain knowledge and ensure that they have enough capacity to provide care. Higher pay helps. But with private sector pay growing at 6.2% v 2.2% in the public sector you can bet that retention problems will grow. You can announce spending cuts and public sector wage caps, but not force people to take public sector jobs. But non-pecuniary factors matter too and are the topic of interesting new work using data from all English hospitals, more than 300,000 nurses and 50,000 doctors. It finds that weak staff engagement, such as self-reported commitment to the job, sees nurses heading for the exit. That in turn has a direct effect on senior doctors, sending them pegging it from a hospital that is losing nurses. It doesn’t work the other way around: nurses do not follow their doctors out of the door. This is interesting; it should also affect policy. Whoever ends up running the NHS when the current mess is over might encourage hospital managers to focus on improving engagement with nurses. They should recognise that preventing nurses quitting also helps ensure that doctors stay put. Why? Because, the researchers argue, what senior doctors really hate is having no nurses to whom they can delegate. Torsten Bell is chief executive of the Resolution Foundation. Read more at resolution.foundation.org