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).

[anitalaff, BSN, RN]

mrnurse(x2) said:

after three decades in nursing, i have seen change that is not for the better. When i began in 1989, i was a graduate nurse for three months before i ever sat for boards. I then waited another three months for board results to be told i could function independently. Effectively a 6 month orientation. I was then exclusive days for 1 year, despite my desire to work nights. The disadvantage to new nurses that come as any other nurse sets up failure. Mistakes when i was new were seen as learning opportunities, now they are strikes against you. The general attitude that employees are expendable prevails and even veteran employees with decades of loyalty are no longer valued. The cost to develop a new nurse is no more than an experienced nurse today because there is no difference in orientation time. That leaves the new grad in a position to fake it until they make it, a very dangerous place for the nurse, patients and coworkers. It really is a scary time to be a new nurse.

thank you for posting this response!!

[NocNurs]

I'm a new RN, but I have been a LPN for almost 20 years, I don't have an unrealistic veiw or expectation but I can say this. The biggest stressor in nursing for me is the recent (last 10 years or so) change in what all health care areas are focusing on: a ridiculous expectation of customer satisfaction. The outcome is very few satisfied customers and nurses who are sick of being pushed into a role of satisfaction and not nursing. Do I want my pt and families comfortable? Yes. Is that really possible when pts and families are in a scary and uncertain situation? Is it OK to send a nurse after sodas for a pts perfectly able bodied visitor? No. But in the eyes of management I should deliver those sodas with a smile. I have to smile and be ok with an insane amount of demands, verbal abuse and questioning of my abilities because Dr. Google has afforded the average person with more then enough education to do my job. The disrespect is insane and health care facilities are not focusing on fixing it in any way. I leave work feeling defeated because 3 out of 10 pts. and their families feel as though the customer is always right. I have to feel guilty that pt. A who is very ill, had to get the very minium of care because pt. B has a more demanding family.

[guest358111]

Great article! I think that many of the reasons nurses quit were brought up in the article...something that has stood out to me lately is the thought that part of reality shock/burnout/wanting to quit is simply having to be around sick people all of the time! As much as we want to help...that has got to play a part in it. Every job has its stresses, I get it, but we do have to realize that many times we are seeing people on the worst day(s) of their life/year. I find that pretty draining.

[Dodgern]

I think new nurses leave because they had the "Rose-colored glasses" view of nursing. No-one has ever really told them what we do....

This is NOT an insult! Nursing is a high-stress career! We literally save lives. Our assessment and care of our patients dictate their outcomes.

Being responsible for human lives is HIGH STRESS!! Without our knowledge and care, the least little change would go unnoticed~~~ because of this, they die.

My aunt tried nursing school "back in the day" and decided it wasn't for her. It did NOT dissuade me!

I have been an RN for 27+ years! I have gone through the ranks~~new nurse to "seasoned" nurse. I have worked many areas of the hospital from NICU to all the floors to all the adult ICUs~~I worked in the float pool! I wouldn't be the RN I am now without the multitude of experience I gained! I also learned what area I enjoyed most~~~GI!!! The closest to the OR I can get without having to wear a mask for 12hrs/day!! I found out that I get clausterphobic wearing a face mask for too long!

New nurses need to know that nursing is not wearing a little cap and bringing water and snacks to the patients is NOT reality.

The average patient in the hospital is a level 1-2 now~~~very sick to intensive care level! Many patients are on telemetry and SPO2. Most of the floors are wired for these! The days of flowers and watching TV , these patients are few and far between!

I was very fortunate to have very supportive RNs around me when I graduated~~in the 1980s!!! New nurses now a days have to try and keep up with technology, experienced RNs and savvy interns and MDs! You need to be flexible, willing, and wanting to learn because healthcare is evolving EVERY DAY!!!

The other downfall making new nurses leave~~~patient satisfaction~~~ Frankly, basing my raise on whether my patient got the crackers/cookies/pillow fluff/TV fix/family member meal~~~ETC on time SUCKS!!! This has NOTHING to do with my patients getting better!

I AM a patient advocate. I AM there for my patient no matter what he/she needs. I am NOT there to make sure their visitor gets a meal, shampoo, a toothbrush, a meal ticket~~~~MY PATIENTS MATTER!!

The patient satisfaction should include the simple things~~~did you get your pain meds on time? Did you get your bedbath? Did you get better and go home because we took such good care of you?

I KNOW that their comfort matters... I know that they need to be informed but the other things should NOT be on that questionnaire!!!

Our jobs are stressful yet rewarding!! Otherwise, I would NOT still be here doing my job!!!

[RealNurseMom, BSN]

I am a new nurse done my first year, on a very busy medsurg type floor. What's making me feel burnt out is staffing ratios and lack of assistance from patient care techs and clerk. If I have 8 patients (which happens waaaay too often) and a PCT who disappears or takes vital signs for 2.5 hrs so that she can't do anything else during that time, many times no clerk or a clerk that is sleeping when the call bell goes of... So I'm the clerk, PCt and Rn and have 8 patients. Since I care about my patients and need to have them happy and safe I'm the one that suffers. I don't take a break (because that would mean giving the other Rn 16 pat - and she's already not sitting down and drowning in work and I can't give her my patient who's Brady to the 30s or my pat with chest pain needing a work up) pManagement is sporifice/non existent on nights. Now this isn't all the time - sometimes we have an amazing clerk and PCT who are phenomenal and then have a terrific night! Even with 8 patients. I thank them to no end and they know we appreciate them as they make a world of a difference. But I can not do 3 people's jobs and be understaffed Rn wise. I'm not lazy and I love my patients and my job but there's a certain point where it's just too much. Another thing is lack of resources - broken beds/lack of IV pumps or non working ones/phneumatic sleeves not working/ the anount of time it takes to get a commode when u order one.... Takes up too much of my time when I have too much to do.

and those that are saying we have "rose colored glasses on" as new grads are Wrong. 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.

[Not_A_Hat_Person, RN]

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.

That's if the new grad is lucky enough to land a hospital job. If they work in a SNF, they may be passing meds to 16, 26, or more residents, with the same lab calls and interruptions.

[beekee]

I'm a new grad working in a hospital, just 4 months. I had, effectively, 4 shifts of orientation. Then, I was set loose with a full load. I work nights. I've had nights where the aide is covering for 3-4 sitter breaks, plus his own break, meaning no aide for 4 hours. I have usually have 2-4 admissions per shift. My floor routinely runs out of basic supplies - briefs, sheets, blankets, bedpans, juice, etc - so I am constantly running around to find supplies. Heck, we even have to fight for a vitals machine as there are 2 for 30 patients so the aides hide them, which is awesome when you think your patient might be tanking. And yes, I am responsible for lab not coming, supplies being out, the bed not being made, anything not getting on the scheduled, etc. it's exhausting.

What keeps me going? Most more seasoned nurses are also exhausted from the pace, but every once in awhile I meet a nurse who seems to be able to handle it all with ease and grace. I'm gunning to be that nurse some day. But I'm not sure I'll make it.

[Spidey's mom, ADN, BSN, RN]

Wuzzie said:

Sure you can. You can take the drama out of it. We have no idea if she was "loudly" humiliated. I know when I'm called out it sure seems loud to me when in actuality it isn't. When I screw up (which fortunately isn't very often) I feel humiliated but whose fault is that? Her hyperbole makes me question how authentic her report of the interaction was. And when people don't own their mistakes, as she didn't, it makes me suspicious.

And I stand by my position that we need to stop perpetuating this NETY concept and instead focus on how to better prepare new nurses for the rigors of actually being a nurse!

Wuzzie said:

Like any of us have forgotten. I remember every painful detail even though it was 30 years ago. Look, I don't disagree with you but this NETY thing is getting out of hand and setting new grads up to fear starting out. They are told they ARE going to be eaten so they start looking for it. Add to that the new generation of nurses we are seeing that cannot handle criticism of any kind, in any format no matter how kindly it is meted out. People are spewing "NETY" if someone doesn't say good morning to them for crying out loud. Do a search here and you will see what I mean. None of us are disagreeing that we should be nice to each other but sadly there are mean people in this world and some of them become nurses. My stance is instead of scaring the crap out of new nurses how about better preparing them to handle the stressors, and yes that includes mean people and being corrected when they screw up (which they will), before they start their first job. I would be happier with the phrase HETO (Humans Eat Their Own) which is much more accurate.

Wuzzie said:

No, my ultimate point is that we need to stop telling new nurses that they are going to get eaten (they are now being told this in school) and figure out how to better prepare them for the rigors of nursing which includes but certainly isn't limited to dealing with mean people and receiving criticism which is never easy and often painful. I have stated this over and over but all I'm getting back is myopic responses focusing on my wish for a better example of an "unfriendly environment" than what was provided in the article. I never said that loudly humiliating a person is acceptable nor do I participate in such behavior. I simply offered another point of view of the situation which has now descended into assumptions being made about me. As such I will bow out and let everyone go on with their day.

Wuzzie - I wanted to tell you that your points stood out to me as well when I read the original post. As someone who has been around AN for awhile, I think you have a very valid point.

There is a nurse who goes around the country lecturing on NETY or bullying in nursing. She goes to nursing schools and she focuses on how rampant bullying is in nursing and that's what I take exception to.

The example in the OP's post is not bullying in my opinion. It was rude and wrong to say it so loud and have patients and their families hear it.

Learning to stand up for yourself is a good thing. Perpetuating the myth that new nurses all get bullied and treated badly is not a good idea. Or even true.

So thanks for your comments Wuzzie.

As to why nurses leave, personally as an older nurse, I have come to truly dislike the bureaucracy that overshadows caring for my patients. Taking that computer into the room with me to chart as I give care drives me crazy. The IT guys are constantly having to fix some glitch in the system. A few months ago our entire system went down for a few weeks and we had to paper-chart. Hallelujah! I was so happy.

As another poster mentioned, those patient surveys also get in the way of good patient care and the scripted responses we nurses have to give are especially irritating.

As for new nurses, I think the posts about how nursing school used to be and how much orientation went into being a new nurse are very good points.

[Spidey's mom, ADN, BSN, RN]

This just popped up in "new posts" by our friend Ruby, who made this excellent point!

Quote

If you're the type of person who looks for unfairness or bullying everywhere you go, you'll find it in nursing . . . whether or not it actually exists. Better to go into it looking for smart, helpful team workers who will save your butt when it needs saving and teach you something while they're doing it. You'll find more of those if you're looking for them. And if you cannot handle criticism, get over it. Lives are a stake here, and if I see you doing something stupid, I'll tell you about it BEFORE you can harm your patient. In private if possible, but if not, not. One thing nursing schools don't teach -- and should -- is the ability to handle negative feedback constructively. It's a valuable skill in any career, but it's vital in nursing.

https://allnurses.com/for-those-considering-a-career-t413646/

[Leonardo Del Toro, RN]

I think nurses leave for a variety of reasons. Some do because they simply didn't realize what they were getting into; some are just shocked by how brutal and hostile nursing environment can be at times, and I mean the co workers and managers they end up having to deal with.

The missing link here is nursing preparation. Nursing school is simply not enough. Rather we need schools that are able to train and teach nurses at the bedside. Something unlikely to happen until we stop having the attitude we can sue everyone and everything.

The other huge problem is that now health care is profit based and nurses are treated like factory workers. Some nurses realize very quickly that patient care is only a fraction of what they will be doing. An as a the article point out very well; nurses end up doing a bunch of chores that has little to do with what they've been for.

I sometimes wonder "why I still doing this" as I walk to work. I wish I could do more patient care. I feel sometimes that I'm doing the patients a disservice but not being able to help them.

[thida]

I graduated as a new RN with BSN degree when I was 22. I was very excited about my nursing career and was ready to change the world. I started my first nursing job at a big hospital on medical/surgical unit on night shift. I did not like night shifts because it made my brain/mind very loopy and cloudy. 1.5 years later, I switched to day shift on cardiac/telemetry unit. This was a little better. However, it was very stressful because patients' acuity was high and things can change any second. My work phone constantly went on. It was hard to take lunch break and bathroom break. I was in nursing field for 8 years. One day, I decided that enough is enough. I took charge of my career and changed my life. Now I am an Internet entrepreneur and living the dot com lifestyle. No more boss, no more patients, no more running around like a chicken without head.

[Leonardo Del Toro, RN]

I know...I work in a SNF, I pass meds to an average of 20 patients. Very complex med pass with lots of pills, narcotics, injections, treatments, while I pass meds I'm interrupted every 5 minutes, phone calls, order changes, lab requests, medication delivery, family asking about appointments...pain med....pain med....pain med. But then there are admissions. The whole thing get taken to a new level of complexity: assessments, entering meds, consents. Nurses are responsible for everything...and then some. No wonder they end up leaving. The next nursing shortage will be a disaster