What is the major reason nurses leave?

banditrn · Oct 25, 2006

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.

Timothy - you are one smart guy!!! :)

I think #'s 1,3, &5 pretty much do it for me, altho the money is a factor, too. There have been a few nites where I felt like I did nothing but wipe poop, and couldn't believe that I was getting paid so well to do something like that.

Other nights, well, unless you're in the field, it's hard to explain to someone how truly hard it really is.

My husband is a project manager for a commercial building contractor - he's a genius at it, and loves his job. His job can be very stressful at times, too. But if he were to screw up, no one's going to die - hopefully. And he gets paid more than I do.

I just gave notice to the LTCF where I work, and have applied at another that staffs better. If this doesn't work out, I truly think I'm done.

banditrn · Oct 25, 2006

I agree with most of the previous answers. The one thing I would like to add is the "too high standards of performance" we as nurses are expected to maintain. Doctors make mistakes, serious ones, and somehow are allowed to continue to practice. Nurses are expected to do our jobs, monitor the other workers on the floor and keep an eye on other departments and physicians as well. Nurses have become accountable for a lot of things we just do not have any control over. Like the unit clerk that enters the wrong type of test, the pharmacy sends the wrong dose of med, the CNA does not report a spike in Temp or BP, and a dozen other things I could mention. I am only human, I do try to practice in a competent manner, I can only do so much though. I am sure there are many other nurses who have reached the same conclusion. There simply is too much responsibility and accountability for nurses and not enough for other staff members, including doctors, in today's medical settings.

Very true, gitterbug. I see this becoming more and more of a problem - if anything goes wrong, blame the nurse. We're supposed to be omnipotent, I guess.

santhony44, MSN, RN, NP · Oct 25, 2006

I agree with most of the previous answers. The one thing I would like to add is the "too high standards of performance" we as nurses are expected to maintain. Doctors make mistakes, serious ones, and somehow are allowed to continue to practice. Nurses are expected to do our jobs, monitor the other workers on the floor and keep an eye on other departments and physicians as well. Nurses have become accountable for a lot of things we just do not have any control over. Like the unit clerk that enters the wrong type of test, the pharmacy sends the wrong dose of med, the CNA does not report a spike in Temp or BP, and a dozen other things I could mention. I am only human, I do try to practice in a competent manner, I can only do so much though. I am sure there are many other nurses who have reached the same conclusion. There simply is too much responsibility and accountability for nurses and not enough for other staff members, including doctors, in today's medical settings.

There is a term for this, that I just can't quite call to mind. It refers to being held responsible for a lot of things while at the same time being fairly well powerless to change things that need to change.

I think that does frustrate a great many nurses.

santhony44, MSN, RN, NP · Oct 25, 2006

Timothy: I think you've got it!

Even those of us who do believe that what we do is a "calling" need to feel that we are fulfilling that. Leaving work every day feeling that you didn't really get much of any value accomplished and that you left a lot undone is too much frustration.

I want to believe that I'm accomplishing something and making a difference. I also want to be well paid while doing it!

Era · Oct 30, 2006

:madface: all of the above reasons. :cry: more so now that the nhs is in crisis and very chaotic. no-one seem to care anymore ( it feels very much like this where i work ). has anyone ever notices that nurses are so often used as an emotional/stress/anger punch bags? by that i mean that when people have a bad day.... ie. sisters/management and even b***dy porters feel they can verbally abuse us! hence the fact that i am now trying to complete a course on graphic design and when succeed in doing so, i can work part time as a nurse and work from home being creative.

i still love being a nurse but there are days when you just leave work in tears coz of lack of support.

UM Review RN, ASN, RN · Oct 30, 2006

I'm not as happy as I thought I'd be. I thought I'd be able to do more for patients being a nurse, and I do--but with a lot less thanks, a lot more responsibility, and a tremendous amount of pressure.

If it wasn't for this board, I'd be going to work every day wondering what I'm doing wrong and wondering why I feel so frustrated.

But now I know--it goes with the territory. And the territory looks pretty bleak.

mom23RN · Oct 30, 2006

Personally for me it was children. After I became a mom I just couldn't bear the thought of returning to work and leaving her.

Of course now that I WANT to leave her the staffing issue is the one that keeps me away.

mamason · Oct 30, 2006

Personally for me it was children. After I became a mom I just couldn't bear the thought of returning to work and leaving her.
Of course now that I WANT to leave her the staffing issue is the one that keeps me away.

Ditto...Exactly!!!!

Moneypitt · Oct 31, 2006

For me it is the abuse. That is why I wish I could leave nursing. I can't do my job because the acuity is too high for the amount of patients that I have. I am expected to do a lot of CTA work and my job too. No slam on CTA work, I just can't do both with 6 acutely ill patients. And being treated like a servant by my patients. Don't get me wrong. I love many of my patients, and wish I could do it all. But I am only human, and the super hero expectations with litlle reward, a lot of abuse, is too much for me these days.

If I had fewer patients I could deal with it. If I had more help I could deal with it. If the patients were nicer, and by that I mean not verbally, or physically abusive then I could deal with it. But when it is way too out of balance I can't. That is why I would like to leave, but don't know how I can afford too.

s1716698 · Oct 31, 2006

gday:uhoh3:

i think many nurses leave because of bullying and abuse from other nurses, there is a need for nurses to learn to be assertive and stand up for themselves, assertiveness is something you can learn,

regards s1716698

dream'n, BSN, RN · Oct 31, 2006

When I look back on the jobs I have left, poor management seems to be the key reason. When I reviewed your list I can see bad management as a causative factor for each problem. Too high of ratios and acuity; management problem. Poor scheduling; management problem. Bad treatment by other staff/management; certainly a management problem. Low pay; definitely a management issue. Inability to provide care due to administration; management problem. Seems that management is the key to job satisfaction to me. Sometimes in healthcare it seems that there are WAY too many chiefs at meetings in their suits and not enough Indians in the trenches providing the actual patient care. And if your supervisor is great, what about your supervisors manager, or even the supervisor's manager's manager. As the saying goes, ... it all rolls downhill.

emmycRN · Oct 31, 2006

I agree with Timothy. We've bought into the "nurse as self-sacrificing martyr/angel" model for too long. I am so sick of seeing nurses (myself included) who put up with only using the bathroom once in a 12 hour shift, eating a 5 minute meal at the nurses station, lifting loads too heavy for superman with no assistive equipment whatsoever, and putting up with abusive team members (md's mainly), without so much as a peep of protest!!! Why? Because we're nurses and we are there for the patients. Yes we are, or are we? We have neglected ourselves for too long and in my opinion that is why we have a shortage of bedside nurses. Not too many people lining up to be an angel these days. In my humble opinion recruiting new nurses with cute posters and sappy slogans will NEVER work. The only thing I see being effective is addressing the root of the problem. Which is what we are all discussing in this thread, the pathetic conditions nurses are expected to work under.