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).

[NuGuyNurse2b]

LadysSolo said:

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.)

You basically answered your own inquiry - it totally depends on where you live. I got hired at a hospital as a new grad that was offering me $34/hr...

[Libby1987]

LadysSolo said:

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.)

Where do you live/work?

Our new hires with less than 2 years of experience, irrelevant at that, with 2 yr degrees start above $40/hr. M-F days. Affordable part of California.

[LadysSolo]

NE Ohio.

[Generic ER Nurse]

I just dropped out of my BSN program today and have come to the full realization that I am DONE with nursing after 6 years. DONE. I imagine this is what it feels like for an overseas soldier, at war, getting a letter that says the war is over and you will be home in a few months. It feels amazing.

[AnnoyedNurse]

Congrats! I did the same thing. But don't be bitter about nursing- we did change lives, we helped people, and we cared for the sick. We did our time, and now we move on! Good luck!

[SmilingBluEyes]

Some of the garbage in this thread:

"preventing call-ins" as expressed by some as if people have no right to call out or "owe it" to their boss to explain exactly WHY they call out for starters. It's not kindergarten or the military. Most heinous example: the one where the nurse was called into OC Med and forced to explain that repeated miscarriages were why she called out. Disgusting.

[Dragonnurse1, ASN, RN]

beekee said:

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.

Yes beekee, I was like you. I graduated my program in 1993. I graduated on a Friday and was working on the following Monday. I got 2 weeks of orientation to the hospital policies, you know the introduction to the MSDS, videos, evacuation plans, and went to my unit - the ED. I spent 2 weeks on days, I was basically running a holding unit of patients (4) and did not really get any orientation by my preceptor. 2 weeks and I went to nights and my first night my first patient was a pyridium overdose. Not a single "experienced" nurse stepped up to help, I was on my own. The physician had never seen such an overdose, neither had the nursing supervisor or pharmacist. I was pushing methylene blue on my first patient. A new grad, pushing a medication and following treatment protocols from the Doc's personal medical reference book. A new grad pushing a medication that was going to make your patient seize and I had no experienced nurse step up to help me. Want to talk about being scared, stressed, frantic and alone? E-wal tube, foley, charcoal, IV's, getting meds from the pharmacy and no help from the experienced nurses. I cried all the way home that next morning but it gave me determination.

For me it was sink or swim but I graduated from a program that taught us how to think and function. During clinicals we had to go by the hospital and "pick up" our patients, we had to review the charts and the mars, we had to read through the doctors orders, research the diagnosis, we had to write med cards for every medication and be able to identify not only the reason for the use but the possible side effects. We had to write care plans, multiple page care plans with documented reasons for our actions. We were the only nurse the family saw during our shifts as our CI only watched.

This is how I started and 9 years, 4 months and 17 days later I was forced to leave nursing due to a severe latex allergy. I watched new grads come in behind me, I watched as both ASN and BSN grads came into the department and I watched as every BSN collapsed and left the ED one after 16 weeks of orientation. I watched as only 2 ASN's lasted in the ED. I listened to the new grads talking about finding a Baby Doc (the residents) to marry. I watched as evenings would leave to hit the bars before going home. I was there when one person of that group came back to us the same night as a gun shot victim.

I was there when our ED physicians confronted the hospital management about the "customer satisfaction" standards that were just really starting. When the ED physicians told management that the people we treat are patients not customers and that in medicine the "customer is NOT always right". I was there when one physician, jokingly of course, suggested we set up in the ambulance bay and offer work excuses, on Saturday and Sunday nights, for a flat fee and we include beer and fried chicken with them. I was there on nights when our shift came on to being 30 to 40 patients deep in the waiting room, empty rooms in the back and Physicians complaining bitterly about the lack of willingness to work on the part of days and evenings.

I was there when my manager called me into the office to tell me about a complaint by the family of a patient about my "attitude" while splinting an ankle. I was there when I asked what the physician said about my splinting and the patients perception of my care. I was there when the manager grudgingly, I repeat grudgingly, had to tell me the physician said my splint was better than any he had seen come out of our ED and that the patient was grateful because it saved him from the possible loss of his foot. She was ready to blow a gasket when I told her that was all that mattered to me, the patient's care was all that mattered to me and NOT what the patient's family had to say. My biggest problem while working was the physicians all wanted me to help, said so in front of other nurses and that some patients families asked for me by name. My other problem was I was not afraid of management but nights had limited interaction with them but I would talk back and tell them when something was a dumb idea or down right wrong. It did not help that nursing supervisors would tell others in the ED to ask me questions at night and call only if I did not know the answer. I was chosen to attend WMD casualty training, burn training, to go to the closest meeting when Chest Pain Units were being set up, as the only one from the ED to attend. I was, after all, JUST an ASN.

I was thrown into the deep end of the pool with other new grads, I CHOSE to swim, I CHOSE not to sink, I chose to run to the strange and unusual, I chose to keep learning after work instead of partying and I chose not to be eaten by more experienced nurses. I chose to push hard but I paid for it in a few ways. I cried a lot on my way home, I had one nurse on my shift at all times that I was close to and we "debriefed" every morning, we, nights, would meet on the parking deck after really bad nights and held our own "debriefing" as the hospital never provided ways to handle the really bad stuff. We finally found a way to help our own, on our shift and to stand up for each other including pulling a surgeon into an empty room and letting him know to never disrespect a nurse in my presence again. My "name" is not Dragonnurse without reason. However I digress. I chose not to be "that nurse" that never helped the new, never openly bashed a new nurse I chose to be what I wish I had had that first night with my first overdose.

Believe it or not I was the quiet, shy one in nursing school but my program was tough and at that time they were proud of that. NETY is real but it is often the result, I think, of exhaustion and frustration with other aspects of the nurses job in today's environment of everyone for themselves and greedy hospital groups.

[beekee]

Dragonnurse1, funny you should comment n my post. Just tonight, I came home and decided I'm done with nursing. I can't do it. Frankly, I can't understand how anyone can. If I thought it was going to be half as bad as it has been, I would have never done this. It just isn't me.

[quixotic.dy]

Libby1987 said:

As long as thousands continue to bank roll these programs who stop at practicing with max 2 patients by 4th semester and never train and require a demonstrated ability to come close to working conditions, it's going to be more of the same.

Agree 100%. I'm a new grad nurse who applied for a very competitive and respected program that just happened to decide to raise tuition and double enrollment the semester I started nursing school. This lead to so many growing pains it was ridiculous and my cohort was short changed as the school tried to figure out how to teach twice as many students not to mention the number of brand new clinical and lecture instructors I had. So it was like the blind leading the blind. The worst and biggest change was changing the precepting to just another clinical with 4 students and an instructor on the floor every week and we still had to be babysat while we passed meds. They were fine with us only having 3 patients to pass that clinical despite most of the hospitals in town, you will have 8-10 on a medsurg floor, 4-6 in IMC, and 1-3 in ICU (which is all the norm not the exception).

I was lucky enough to be able to work as a nurse Apprentice (same scope as a LPN just unlicensed and only for nursing students) so I got to experience some of real nursing, including floating ALL THE TIME.

The real experience was seeing how different nurses handled 8 patients and most were sinking.

I haven't started my first job yet (soon though!) and I'm excited and scared because I know my nursing school prepared me to pass NCLEX not actually be a nurse.

I sure hope that after a year I won't be ready to run for the hills.

[pearybrown]

Interesting article. I would add that the patients tend to have higher clinical needs with more technical needs as well. You get increased acuity with less experienced staff to cover them. A real grind.

[NuGuyNurse2b]

^ there's still a good chance you will be running for the hills. i'm over 1 year of nursing and there are days when I go home double checking my sanity. The other day I was hanging blood on a patient who's never had a transfusion before, I was getting an admission, we only had 2 aides on the entire floor, my other patients were waiting on pain medications or something else. I was tired, mentally drained, and ready to punch someone by change of shift. And this is from someone who went in knowing the nature of the beast.

[~Shrek~]

Also night shift. I quit my first job because I was working 11pm to 7:30 am. I gained 20 lbs and became extremely depressed, and I never had a history of depression. I was lucky that my family was there to support me, and quit I found another job that was extremely unsafe to the point that I got injured twice and wasn't enrolled in worker's compensation. I posted on here and was told I was spoiled, entitled, living in an ivory tower, etc.

I didn't think I would ever find another Nursing job and I decided to pursue another career. I was lucky that somewhere in there I got my current job because if I had not, I would be in an MBA program or engineering school right now.

Also, I was bullied by a colleague for not having hospital experience. I experienced full on lateral violence for a few months then worked on my own. Every move I made, she would scream at me in front of the patient. Now I am okay but I will never forget the lateral violence experience.