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).

[sarah2416]

I believe the main reason newer nurses leave is because of the "moral distress" that comes from working in corporate healthcare. Hospitals are being run by rich people trying to squeeze huge CEO pay out of Medicaid and Medicare patients. You can't run a hospital like a Walmart and expect thing to go well. If a Walmart employee gets overworked and shelves don't get stocked, no one dies.

Every time the hospital that I work at has gone through low staffing times, staff have been required to do more than is really safe for the patients. But all of these low staffing times have been their own fault. A few years ago, we had a massive lay-off because we had one summer of low patient census. Things picked right back up again (duh), and suddenly everyone is supposed to handle a full patient census with way less staff. They eventually started mass hiring, but the staffing ratios never actually went back to what they were. Once the big wigs see that nurses can handle stupid patient assignments, they keep it that way. Nothing ever gets any better.

So everyone with experience continues to leave. A 12 hour shift shouldn't feel like a 12 hour Crossfit workout. You should be able to walk without limping when you clock out. You shouldn't have to clean incontinent bed-bound patients by yourself all the time because everyone else is also so busy running around like a chicken with their head cut off that if you waited for someone to be free to help you, the patient would have already lost the first several layers of skin.

The hospital is evidently content to just keep bringing in the new grads. I personally suspect it's because they're cheaper than the experienced nurses anyway. I have worked for one hospital in the little over 2 years since I became a nurse. I started on a progressive care unit and then moved to an ICU (both day shift positions). On both units, I was made a preceptor within 6-8 months of being off orientation. Think about it - with less than a year of experience being an RN, I was teaching new grads how to be nurses. In a cardiac surgical ICU, a new grad gets 8 weeks of orientation on the unit. They're being trained to take CRRT patients and VAD patients before they've been there 6 months total. They're receiving fresh open heart surgery patients within their first few weeks off orientation. I can distinctly remember times of trying desperately to keep a fresh open heart patient alive in the midst of significant hemodynamic instability and looking around for anyone to help, only to realize everyone around me was newer than I was. Add in the fact that in a teaching hospital, the residents don't know much either and it's terrifying.

I've been to ortho docs and physical therapy for issues that I believe are directly related to lifting too much and putting an average of 18-20K steps on my poor tired feet every shift. I dread going in to work most days. I hate that I don't have the time to do what I have started to consider the "fluffy nursing stuff" like patient mobility, patient education or making a human connection with patients or their loved ones. Things that should be standard nursing stuff, not "extras" that I rarely have time or energy for.

I personally have a very high level of self-confidence and am assertive by nature. I'm no wilting flower type. I was flat-out bullied by my preceptor on my first unit. Directly confronting her about, and directly reporting it to my educator and manager accomplished nothing. I have witnessed bullying of other nurses by the few experienced ones that are still around. I've stood up to the bullies, I've comforted the victims. I have brought these things to the attention of management over and over and seen NOTHING done about it. I have seen shift coordinators (who function like assistant managers) do some of the bullying. It keeps happening. I've seen patients suffer because of bullies refusing to help newer nurses. In this female-dominated profession, there is a lot of back-stabbing, bullying, favoritism, and general meanness that reminds me of junior high and high school. Only back then such problems didn't adversely affect the health and well-being of innocent by-standers like they do our patients. It's sickening. And anyone who wants to deny that this happens is delusional.

I went into nursing as a second degree student in my 30s. Going back to that rather assertive personality of mine, I got all the experience I could during my nursing school clinicals. I had the experience of taking full med-surg patient assignments and full ICU patient assignments with my preceptors during school. I wasn't clueless when I walked into this field. I just sold my soul to the devil of corporate healthcare - I took a scholarship with a work requirement because I was broke. Thank god that's over now. I'm a damn good nurse and I've excelled under the ridiculously poor conditions that have comprised my first two years in this profession. I do all the stuff that makes the office-types happy - I've got a bunch of extra letters I can string after my name; I go to conferences; I sit on hospital wide committees and have unit-specific extra responsibilities. None of it actually matters down in the trenches. Now that I have that magical "2 years experience" under my belt, a lot more is available to me and I have a far more options in choosing my employer and my workplace. Never again will I work somewhere without a union. Never again will I work somewhere with high turnover rates. Never again will I work somewhere that hires almost entirely new grads. And just in case anyone is wondering, Magnet designation, Level I everything certification, and top rankings that are plastered all over town on billboards don't necessarily mean anything for nursing work conditions. I believe this is just the state of most of corporate healthcare nowadays. And anyone who sits around wondering why nurses are leaving in droves needs to get out of their ivory tower office and take a typical patient assignment for a shift or two. They're figure out the answer quite easily.

[AnnoyedNurse]

Sarah- best description of why nursing has gone to **** and exactly why nurses are leaving. I'love never work full time in nursing ever again!

[AvaRose]

This week was the lowest of the low. On Thursday I got a verbal "write-up" because night shift accused me of leaving things unfinished. Even when I later proved that I had finished the things they said I didn't do the write-up stood because admin also believed I was the reason their newest nurse quit during orientation which is total BS (she quit because the commute was too hard for her). Then later that day one of my patient's started to desat and it took me, the DON, and the doctor working with the patient for nearly 2 hours to get her back up to 90% (she was down to 80%). I finally got everything done at 830pm (2 hours late) Thursday night and then came back Friday morning with a splitting headache only to find out that the patient had died at 10 pm Thursday night. Despite that I started my Friday like normal and made it through morning med pass even though I felt like I was going to be sick any minute. I finally had to step outside to cool down and was ill in the parking lot. I told admin and they tried to find someone to cover my shift but couldn't find anyone so tried to coerce me into staying even though I was diaphoretic, nauseous, and had a headache so bad I could hear my pulse in my ears. They finally said I could go home but before I could leave the other day shift nurse told me I had to finish all the charting for my patients and turn off all the IVs I had started earlier. That took another hour. I got home just in time to get sick again and have spent all weekend so far either sleeping or in the bathroom. I have tomorrow off to hopefully feel better but then I have to go to work on Tuesday. I don't dare call off...I've already cost myself over $200 being sick plus my co-worker thinks I was faking the whole thing.

[AnnoyedNurse]

Honey, I'm so sorry you're dealing with this. That's not the best work environment. I think you need to focus on getting better and do not go to work until you are feeling better. You cannot provide excellent care unless you are 100% healthy and able to do everything your patients and coworkers need.

Personally, I would have a one on one with my director of nursing. Explain to her how I am feeling and tell her I am willing to be a dedicated nurse, to stay thick and thin for the hospital, and I am willing to help support the change. If she is receptive, then great. If not, I'd look elsewhere- there are great nursing work environments despite the horror stories we do hear.

Stay at strong and remember you health and wellbeing should also be an utmost priority to you and also to your employer. If they don't care about you, why you you work for them? There are many employers who love their employees and understand that life happens. You are not trapped nor are you alone.

Best wishes!

[RosesrReder, BSN, MSN, RN]

This is part of the problem. People are running away from the bedside and the problem isn't being fixed. Imagine if everyone did just that (run away)? Eventually, there wouldn't be anyone one at the bedside and your job security probably would not exist.

[RegularNurse]

Reasons Nurses Leave:

1. Most bedside nursing positions are horrible, and the good ones are taken by nurses who will never quit because they are great jobs.

2. The only barrier to better jobs is a measly 40 credit grad degree

3. Why fight the system when you can just change your place within it.

4. Med surg/Tele/ICU jobs will always be a ton of physical work. Few young people want to endure that long term. No administrative measure will change the core of bedside nursing. This is why these jobs have high turnover, even when controlled for everything else.

I love how all these professional bloggers etc. fail to acknowledge that nurses quit entry level bedside positions because there are simply better jobs available. Nursing is a legit 4 year degree now. Who the heck would want to spend the rest of their lives doing heavy labor with that level of education?

[KandidNurse]

well put!

[Jblanco]

"There are times when being friendly isn't in our patient's best interest."

The issue is not one of friendliness vs unfriendliness, rather its a matter of respect. The nurse said she was "loudly humiliated" by the other nurse. There is no justification for disrespecting another nurse, even if you believe they were responsible for "poor patient care" as you mentioned. How does that correct the issue? If you truly believe the outgoing nurse made a mistake, use the opportunity to suggest how she could have handled the situation differently. Even after being a nurse for five years I find myself learning all the time, I would gladly welcome another nurse's suggestion/input. However, I wouldn't appreciate being yelled at for a perceived mistake. We should be kind and compassionate to one another, not only to our patients :)

[NuGuyNurse2b]

RegularNurse said:

Reasons Nurses Leave:

I love how all these professional bloggers etc. fail to acknowledge that nurses quit entry level bedside positions because there are simply better jobs available. Nursing is a legit 4 year degree now. Who the heck would want to spend the rest of their lives doing heavy labor with that level of education?

Personally I would never leave if I got paid well. By "well" I mean anything beyond $40/hr. Right now I'm batting way below that magical number and it's simply not enough considering the rigorous education, physical labor, responsibility (everything falls on the RN...) and mental/emotional toll that the job requires. And my place loves those customer surveys so it doesn't matter what you did for the patient. I love it when family members who never visit are filling out those things and saying how bad we are.

[martymoose, BSN, RN]

maybe if we weren't treated like crap and given unsafe assignments that risk our license everyday, people wouldn't leave.

Nursing is one of the most ridiculous jobs out there.

I'm rather upset that I wasted all these years and money thinking things might get better.Nothing like going to your job daily and worrying about the situations and short staffing you are subjected to.

[LadysSolo]

nuguynurse2b, are you kidding me? I realize it depends on where you live, but as an NP on salary, I average $35.00/hr when I do the math. I have NEVER made $40/hr., and I have a master's degree with 35 years experience (23 as an RN, 12 as an NP.)

[AnnoyedNurse]

Hence why I am not going to get my NP...as a matter of fact I am now Per Diem working once a month while I transition out of nursing.