Why Do Nurses Quit?

[Nurse Beth]

Jamie looked at the framed group photo on the wall of Cohort 22, the 24 new grad nurses who started a year ago in 2015. They all look so happy and eager. Where are they all now?

Of the 24, 16 remain employed. Christina returned to the Bay Area and Shelby is in an NP program. Lindsay went on LOA and never returned. Alex worked ICU for one year, then left to work in State Corrections for better benefits and pay.

Is this an exodus? A revolving door? Lynda, the nurse recruiter complains "I bring nurses in the front door, but they bleed out the back door"

Every year the hospital hires in two new cohorts of 25 nurses. Every year, at least 50 nurses leave the facility.

Just one of the downstream effects is that preceptors become burnt out on precepting new grads because of the turnover "You put your heart and soul into training them..then they leave!"

In the United States, nursing workforce projections indicate the registered nurse (RN) shortage may exceed 500,000 RNs by 2025.

It's estimated that 30%-50% of all new RNs elect either to change positions or leave nursing completely within the first 3 years of clinical practice.

Here's a few answers to commonly asked Why are nurses leaving? questions :

Why do nurses leave after transitioning from school to clinical bedside?

Reality Shock: Some new grads do not survive the shock. Nursing school is insufficient preparation for nursing. Often there is an overwhelming lack of support for nurses in their first year.

Passing meds on two patients with an instructor available does not prepare a new grad for passing meds on six patients with doctor and family interruptions, Lab calling with critical values, and ED calling report on a new patient.

Is stress a factor in nurses leaving?

Nursing school is exhausting, but working as a nurse is a different kind of exhaustion. Nursing demands constant vigilance. Nurses are always "on" - there is no cubicle to hide in, no office in which to decompress and escape. This proves more exhausting for some than for others.

The sheer intensity of nursing comes as a huge shock.

Is staffing levels a contributing factor in nurses leaving?

Caring for four ICU patients or eight high-acuity Med-Surg patients is simply unsafe and untenable. Across the nation, California is the only state with mandated nurse-patient ratios.

Is mandatory overtime a reason for nurses leaving?

New nurses either:

• Come in to work extra shifts. How does working three twelve hour shifts on, one day off, four on sound? (as relayed to me yesterday by a nurse with less than one year experience in ED)
• Learn to say "No", a boundary many struggle with

Is floating to other units a concern for nurses?

Floating to other units is a major stress. Care is not always taken to ensure competency-based assignments, or to support the newbie floater.

What do some non-nursing tasks push nurses away?

An inordinate amount of time is spent on tracking down supplies, ordering forms, screening calls, ordering diets ...all tasks that could be handled by non-licensed support staff.

Nurses need to focus their energy on critical thinking- how do I get the patient from Point A to Point B along the continuum of recovery/wellness during my shift?

How do new nurses react to the additional responsibilities?

Realization that the buck stops here. New grads experience the fear of making a mistake and possibly harming a patient. This can literally be paralyzing for the new nurse.

How does poor management lead to nurses leaving?

Nurse managers are strongly linked to job satisfaction. Managers who are not trained lack the necessary communication and leaderships skills. Favoritism abounds and poor performance is tolerated. Poor performers are not eliminated.

Poor management ultimately results in turnover.

What are some reason why new nurses struggle?

Lifting patients and other physical demands take their toll. Work hazards such as exposure to hazardous drugs are a safety concern.

Nurses are subject to physical assault/verbal abuse which causes job distress.

How challenging is the nursing work environment for new nurses?

I think what happened to me is what they call "nurses eating their young". Yesterday I couldn't get my patient's IV re-started before shift change. I tried but missed and the patient didn't have any meds due. It was so busy and I had SO many other things to do. During handoff, the other nurse loudly humiliated me in front of everyone. "You left the patient without IV access?" Everyone got quiet and I didn't know what to say. Even some family members heard. I thought it is a 24-hour job, that's what they said in orientation. Did I do something wrong?" As seen on social media

How can nursing turnover be reduced?

• Increasing staffing and limiting nurses' work hours. Flexible work schedules and job sharing help nurses with children stay in the workforce
• Creating a culture of safety
• Providing strong, supportive nursing leadership
• Creating a Just Culture
• Including nurses in decision-making related to patient care delivery and practice

It's honestly been so tough transitioning from a nursing student to new grad nurse. I have good preceptors, and coworkers, but I wonder if I'll ever be fast enough to keep up. The patients are very sick and I get worried about the protocols and everything I might be forgetting. But yesterday my patient's wife hugged me at the end of my shift and said how much she appreciated my care. I felt good and it reminded me why I wanted to be a nurse and that I can make a difference. I know I'm still learning and not up to speed yet. I totally needed that hug. As seen on social media

As a nurse, I love nursing and promote my chosen profession. At the same time, I'm well aware of the dissatisfiers that drive nurses away from nursing and the bedside.

What is driving nurses away from nursing?

References

Aiken, L. H., Sermeus, W., Van den Heede, K., Sloane, D. M., Busse, R., McKee, M., ... & Tishelman, C. (2012). Patient safety, satisfaction, and quality of hospital care: cross sectional surveys of nurses and patients in 12 countries in Europe and the United States. Bmj, 344, e1717.

ANA 2011. Health & Safety Survey Hazards of the RN Work Environment. Retrieved December 8, 2016. 

Jones, C. B. C. B., & Gates, M. (2007). The Costs and Benefits of Nurse Turnover: A Business Case for Nurse Retention. The Online Journal of Issues in Nursing, 12(3).

[Curious1alwys, BSN, RN]

PedRN2B said:

What we put up with shouldn't be going on and that has nothing to do with me being there for 1 year or 29 years. If I didn't care about my trying to keep my patients safe, pain free and happy (as much as possible lol) . work would not be so stressful but im there for the patient and I truly care about them so instead it will take a toll on me.

EXACTLY. I always say it's either us (the nurse) or them (the patients). One is going down in the end. And most nurses burn out because those that care choose them.

[AvaRose]

I'll be leaving shortly due to micromanagement from administration and a culture where asking questions is met with threats of "corrective action" for not knowing everything about your patient and what to do in every situation since we have so much time on our hands to be able to do everything perfectly. Oh and also the night shift nurses who tattle on me if I have to endorse anything over to them...god forbid they actually have to wake up from their naps during night shift to do some work.

So after only 3 1/2 months of being an RN I'm pulling the plug. Not sure yet if I'll turn in my license but it seems stupid to pay for something I won't use ever again. I've already rewritten my resume to explain my change of heart in what I'm looking for in a job so I have something to say when they ask why I'm not looking for work in my "field". I'd rather be unemployed frankly at this point rather than go back to work. Sadly I'm still too chicken to give my notice...new year's resolution I guess ?

[Kt1109]

I am a new grad, been working about 4 months, and have considered leaving many times and I actually enjoy my job. My reason is being forced to work nightshift, it has thrown my body out of wacky, I'm nauseous, I don't sleep, I randomly breakdown and cry, and I feel isolated from friends and family. I knew that I was going to have to work nights for many years, but I didn't know my body would react like this

[danielle2000, MSN, RN]

I get it why so many nurses are running to the hills. Misery, lack of adequate pay, and being treated like a servant than a professional. Nursing have so much power, but will not use to facilitate change. If every nurse walked off the floor hospitals would have to shut it down and divert their patients elsewhere! Just on that strength alone you would think our work situation would change. We take kibbles and bits while upper management get fat bonuses for screwing us out of good benefits, and we just roll over showing our backside and take it. NO SOLIDARITY!!!! It wasn't long ago when one of those dim-witted woman on The View insulted our profession and we came out swinging causing a major rift!!!! Why does it take someone to insult this profession for us to act, but not with the same zest when it comes to our work conditions? As a RN of 16 years I decided for ME!!!! it was time to seek an higher education pursuing advanced practice nurse. Where I work the nursing staff acts like sheep in a pen. I can't fight everyone's battles so I made conscious decision to keep it moving!!!!! We stand together or we all fail. Things will change when we do!!!

[AnnoyedNurse]

Oh be quiet Wuzzie. You're in denial. Please go read the other posts on this site. A nurse asks for advice, and all of you oldies tell her to suck it up or over it or some other rude remarks!

If nurses showed more love to one another, especially new nurses, then nurses wouldn't be leaving the bedside. In my current job, I had some senior nurses including the one precepting me try and attempt to force me to take my lunch on the unit. Of course I refused and they kept making it a challenge for me to take lunch. So I told them, my charge nurse, and my manager, "if these ******* think I'm going to eat at my desk and still clock out for lunch, then I'm walking my ass straight to HR."

Ive met countless nurses who are *******. They hate their lives and they make nasty comments. I put them in their place each and every time, even when I was a new grad. But I was also 25 as a new grad, former army medic and accomplished salesperson, so maybe I was more gutsy. Nurses don't mess with me anymore lol. New grads should learn that they must stand up for themselves.

On on another note, I'm leaving nursing. It sucks and we're underpaid, and there is only a certain about of verbal abuse I can tolerate! I am not everyone's punching bag!

[BabyFood26]

People are not even giving intelligent responses anymore that we can grab good feedback from.

I'm unofficially claiming this thread to be dead.

But, Nurse Beth, I always look forward to your articles. You're an amazing writer and your advice is always practical and useful!:)

[Wuzzie]

AnnoyedNurse said:

Oh be quiet Wuzzie. You're in denial. Please go read the other posts on this site. A nurse asks for advice, and all of you oldies tell her to suck it up or over it or some other rude remarks!

If nurses showed more love to one another, especially new nurses, then nurses wouldn't be leaving the bedside. In my current job, I had some senior nurses including the one precepting me try and attempt to force me to take my lunch on the unit. Of course I refused and they kept making it a challenge for me to take lunch. So I told them, my charge nurse, and my manager, "if these ******* think I'm going to eat at my desk and still clock out for lunch, then I'm walking my *** straight to HR."

Ive met countless nurses who are *******. They hate their lives and they make nasty comments. I put them in their place each and every time, even when I was a new grad. But I was also 25 as a new grad, former army medic and accomplished salesperson, so maybe I was more gutsy. Nurses don't mess with me anymore lol. New grads should learn that they must stand up for themselves.

On on another note, I'm leaving nursing. It sucks and we're underpaid, and there is only a certain about of verbal abuse I can tolerate! I am not everyone's punching bag!

Would you care to point out where I told ANYONE to ""suck it up" or anything that was offensive enough to earn this extremely rude post. I have never and will never abuse any of my co-workers and I have stood up on multiple occasions for people who were being mis-treated. Did you not read what I wrote? And FTR the OP was an article not somebody asking for advice.

And I'd like to point out that what you said was nasty so I'm well within my right, according to your rules, to put you in your place. Explain to me how your comment directed at me was you "showing love" to me?

[AnnoyedNurse]

You're funny. I said what I said because you claim that it's articles such as these that promotors the nurses feed on their young. You're in denial. Nurses DO have a complex. Maybe reporting to doctors and our inability to have control over our profession leads many nurses to "control" the newbies. It's documented that new grads and new employees are bullied in nursing. I don't show you love because you deny that truth about bullying in nursing and anyone who denies that deserves no love from me.

[Wuzzie]

AnnoyedNurse said:

You're funny. I said what I said because you claim that it's articles such as these that promotors the nurses feed on their young. You're in denial. Nurses DO have a complex. Maybe reporting to doctors and our inability to have control over our profession leads many nurses to "control" the newbies. It's documented that new grads and new employees are bullied in nursing. I don't show you love because you deny that truth about bullying in nursing and anyone who denies that deserves no love from me.

I have NEVER denied that bullying exists. I was bullied. Real actual bullying. Bullying that risked my job. What I want stopped is scaring the crap out of new nurses and instead helping them to learn to deal with the difficulties they will face in nursing. Teaching them how to take criticism, how to stand up for themselves. Not every nurse gets bullied. Not every seasoned nurse is a bully. Yet they are hearing in school that they WILL be eaten. That ALL older nurses are hateful when, in fact, most are not. Look at the posts from people who quit. Almost all of them never mentioned that it was bullying that made them change jobs.

Not one of my posts was hateful. All I mentioned was I wish a better example of what was really micro-aggression had been used. The quote was immature sounding and I think a more relatable one would have had more impact which would have been helpful to those who are actually being bullied.

You make sweeping generalizations that ALL new nurses are bullied and even more sweeping accusations about me that simply are not accurate. You clearly didn't read what I wrote in its entirety and instead have focused on a few remarks taken out of context. You are actually doing exactly what you are decrying. Some people would define your snide remarks as bullying. I don't. They don't rise to that level.

I don't feel the need to utilize snide remarks, to belittle or denigrate anyone including you. But let me tell you this, your words will have more impact here if you actually practice what you preach.

I wish you the best in your new endeavor and thank you for your service.

[pitt81]

""If I took report and this was the situation you'd bet I would say something very directly to the nurse who was sooooo busy. We could debate this all day long I suppose but I still think it's a poor example of an unfriendly environment."

I think openly and loudly humiliating someone and insinuating that a newer nurse, who is obviously going to be weaker in terms of time management, was "soooo" busy is part of the issue. Newer nurses are slower, they don't know all of the nuances of a unit quite yet, and when they are purposefully humiliated in front of everyone it can do enough damage that they feel targeted and move on to something else.

The post is about why nurses quit, specifically new graduates. The quote was from a new graduate. You can't get any more authentic than that, whether it be your personal experience or not."

I totally agree with you. Part of the stress of being a new nurse is prioritizing what to do first. Perhaps this new grad felt it was more important to give another patients there scheduled meds and felt the IV could wait. I am not saying that what she /he did was right, but one thing I know is humiliating someone never helps. It just builds resentment which leads to new grads leaving( which by the way was the point of this article). At my first job at a busy telemetry unit, they hired 9 new grads and all quit by the end of the first year. A common theme for the reason why they quit was due to some sort of public humiliation that they endured from some of the staff. So yes I understand that no one likes bring up NETY again and again, but that is a real reason why new grads leave their 1st job. So if we want to retain our new grads we have to find a better way of treating/educating them.

[pitt81]

I totally agree with you. Part of the stress of being a new nurse is prioritizing what to do first. Perhaps this new grad felt it was more important to give another patients there scheduled meds and felt the IV could wait. I am not saying that what she /he did was right, but one thing I know is humiliating someone never helps. It just builds resentment which leads to new grads leaving( which by the way was the point of this article). At my first job at a busy telemetry unit, they hired 9 new grads and all quit by the end of the first year. A common theme for the reason why they quit was due to some sort of public humiliation that they endured from some of the staff. So yes I understand that no one likes bring up NETY again and again, but that is a real reason why new grads leave their 1st job. So if we want to retain our new grads we have to find a better way of treating/educating them.

[pitt81]

Kate_Peds said:

"If I took report and this was the situation you'd bet I would say something very directly to the nurse who was sooooo busy. We could debate this all day long I suppose but I still think it's a poor example of an unfriendly environment."

I think openly and loudly humiliating someone and insinuating that a newer nurse, who is obviously going to be weaker in terms of time management, was "soooo" busy is part of the issue. Newer nurses are slower, they don't know all of the nuances of a unit quite yet, and when they are purposefully humiliated in front of everyone it can do enough damage that they feel targeted and move on to something else.

The post is about why nurses quit, specifically new graduates. The quote was from a new graduate. You can't get any more authentic than that, whether it be your personal experience or not.

I totally agree with you. Part of the stress of being a new nurse is prioritizing what to do first. Perhaps this new grad felt it was more important to give another patients there scheduled meds and felt the IV could wait. I am not saying that what she /he did was right, but one thing I know is humiliating someone never helps. It just builds resentment which leads to new grads leaving( which by the way was the point of this article). At my first job at a busy telemetry unit, they hired 9 new grads and all quit by the end of the first year. A common theme for the reason why they quit was due to some sort of public humiliation that they endured from some of the staff. So yes I understand that no one likes bring up NETY again and again, but that is a real reason why new grads leave their 1st job. So if we want to retain our new grads we have to find a better way of treating/educating them.