Re: What is the major reason nurses leave?
Simply put, nurses are paid below the reservation wage (the level at which too many would have reservations about the job at that wage) because we buy into the concept that we are 'called' and being called has a value of its own.
This has been the case in nursing for decades. And in the past, it was a working model. You don't HAVE to pay full price for the work of someone that sees other rewards besides money. If you doubt this is true, ponder for a moment the moral suspicion that many nurses STILL harbor for nurses 'in it for the money'. Professionals ARE 'in it for the money'.
Now, add to this the restructuring of healthcare in the '80s that changed the focus from 'patient' centered to 'cost' centered care and you end up with nurses so strung out at 'flexed' staffing that they simply don't have the opportunity to fulfill their 'calling'. At that point, the value of being called is no longer a real reward and so, nurses begin to truly look at the bottom line.
And that bottom line, as I said, is BELOW that of a true reservation wage. So, true to form, too many nurses have reservations and walk away.
There is no shortage of nurses; there is a shortage of nurses willing to do the job at the wage being offered.
The ultimate result: Admins will have to either re-align wages to meet true reservation wages, or re-structure work roles and environments to allow for the time to feel 'called' to the work. My bet is that they cannot or will not understand the latter and so, the price of hiring a nurse will continue to go up.
But, that's ok. Being paid a real reservation wage is a key ingredient of being a 'professional'. And with those real wages come respect. The more valuable the commodity, the more respect it deserves.
To answer your question directly: all of the above. They are all inter-related. Wages are not an issue alone, but in tandem with the other issues you suggest, current wages aren't enough to bear the work demand without 'reservation'. As far as the issues related to respect in your question: you don't respect something that isn't fully earned. And since the labor of nurses hasn't been fully 'earned' by paying a true reservation wage, the lack of respect is transparent and palpable. Being forced to pay a real reservation wage will cause a prudent employer to re-examine the issues that cost them that real commodity within the workplace.
For example, it cost 76,000 dollars to bring a critical care nurse up to independent practice in an American ICU. That is the cost to recruit, pay bonuses, and train. At that cost, even a 15% turnover is a far losing proposition. Eventually, it will HAVE to dawn on TPTB that creating environments that retain such nurses is cheaper than endlessly replacing them.
It might take awhile, but that knowledge - read respect - will come to management. That is the value of having to pay full price for a commodity; you also have to respect it. Or more to the point, the bottom line is really the bottom line, or, as they say, money talks.
~faith,
Timothy.
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