Why Do Nurses Quit?
Estimates are that up to 30-50% of nurses leave their position or quit nursing altogether in the first year. What drives nurses away?
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. What are the reasons?
Reality Shock: Transition from Nursing School to Clinical Bedside Nurse
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.
Stress and fatigue
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.
Lack of safe staffing levels
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.
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
Floating to other units is a major stress. Care is not always taken to ensure competency-based assignments, or to support the newbie floater.
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?
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.
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.
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.
Unfriendly Work Environment
"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 hand off, 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
Costly Nurse Turnover Could be Reduced by:
- Increasing staffing and limiting nurses' work hours. Flexible work schedules and job sharing help nurses with children stay in the work force
- 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 do you think are the reasons why nurses quit?
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. http://nursingworld.org/FunctionalMe...ety-Survey.pdf
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).Last edit by Joe V on Jun 14, '18
About Nurse Beth, MSN, RN
Nurse Beth blogs at nursecode.com
Joined: Mar '07; Posts: 1,405; Likes: 4,207Dec 13, '16I think that newer nurses leave direct patient care initially because of the culture shock mentioned in the article. Indoctrination is an evolving issue that seems to be bleeding through where many are not going to work as a "floor nurse" but were always meant to be a manager/NP/etc instead but they just graduated....
I also think that more experienced nurses leave direct patient care because of the building stressors of customer service/scripting, expected handholding of other disciplines without any thing being taken off of our plate - or increased support/recognition - (ex: core measures, or when's the last time PT, pharmacy, or anyone not a nurse admitted they screwed up or didn't do something!), lack of supplies or supplies being central and easily accessible, and then the cherry on top...nurse to patient ratios that set us up for failure given all the previous issues mentioned.
Dont get me started on degree inflation eitherDec 13, '16What are the reasons nurses quit?? All of those stated in the article and then some. Bottom line is that job satisfaction (at least in the hospital setting) has steadily declined as workloads and stress has steadily increased. Bedside nurses are held accountable for EVERYTHING. It used to be that the nurse was responsible for the nursing care. Now everything is the nurses responsibility/problem (ie lab didn't come/blood draw, meds not delivered by pharmacy, PT/OT didn't come, Doctor didn't come, lunch/the right lunch didn't come, no supplies on hand, no working equipment, no CNA, family wants to speak to you again, pain meds every 2 hours, routine meds 5 times on your shift etc etc etc). And don't forget the endless charting. The hospitals cut back while at the same time the patients are requiring more time, either because of (medical) acuity, or because the pt/family is demanding (even though medical issues don't require that much time, but you know, customer service..). Bottom line is that nurses are running around attempting to get everything done but it is always a loosing battle and someone is always complaining because its never enough! Do we really need to ask why nurses are quitting??Dec 13, '16I honestly think it's largely due to people having realistic expectations of what nursing actually is. I do think it would be valuable for all pre-nursing students to be required to either follow a CNA for a few shifts or actually become one and work before being allowed to enter a nursing program. This would save the students money and time and the workforce from loosing so many people in the first year.
I have been an LPN/CNA for years so I know my job as an RN when I graduate and what it will look like somewhat, it's going to be hard and tough the first year, but I know it gets better after that because it always has before when I transitioned into a new role. New nurses not having that knowledge are going to be more inclined to quit when they are faced with harsh realities of the nursing field.
Also the lack of knowledge about pay is widespread. When it comes down to it, when you consider all we do and all that we are accountable for, we really are not paid that well until you become a veteran nurse. It is a lot of stress and lot of being a low man on the totem pole to you actually get where you want to be. And lets face it, people in general really do not like to work hard for pay that is decent but not on par with never taking even a 10 minute break during a 12 hour (Realistically a 13-14 hour) shift.
It is also the general environment of healthcare. One day, I hope our healthcare administrators catch on that happy nurses=happy patients.Dec 13, '16An influx of nursing schools/programs which are attracting (in my opinion) the wrong people. Additionally, not all of them preparing students in a more practical way. New grads are just sorely under prepared for the real world of nursing. The goal of some, or most, is to herd 'em in, and make sure they graduate as many as possible to save face.
A lot of individuals getting into nursing whom are not mentally or emotionally equipped to cope. Possibly a generational factor...? ... Not sure
Unrealistic expectations of what nursing is supposed to be for new grads and great disappointment to more seasoned nurses of what new nurses/nursing has become, making it difficult for everyone to work cohesively.
A decrease in the comradery/teamwork approach, leaving lots of new and seasoned nurses alike feeling overwhelmed. A sort of division, it seems like.
Honestly, I feel strongly that it comes back to so many programs and schools making nursing look like a cake walk and attracting individuals whom are not suited for this type of work. Graduation rates are nothing to gloat about. Even statistics regarding how many new grads that got employed shortly after graduation. Like this article pointed out... Practically half are quitting after just a year.
Somethings gotta change...Dec 13, '16I remember being a new grad and experiencing the "floating" that, ultimately, caused me to find a new job. Being new, I had the fewest points, meaning that I was the first pick to float every time. My first week and a half off of orientation I floated to tech on other floors. After that, I was spending probably one shift a week floating to do non-nursing work. Safety sitting, suicide watch, tech work, etc. I remember being back on my home unit after a long string of floating, I had a patient that was not looking so great. I had no clue what I was doing and another nurse came to my aid. I left my shift scared. I felt completely incompetent.
Reflecting back on it, I realized that I was taking a long time to complete very simple nursing tasks, such as priming IV fluids. Things that I was very good at, now I was fumbling through because I had been doing non-nursing work for several weeks. I was truly embarrassed and I was concerned about my own ability to complete the job. I felt bad leaving that job, but in the end, I suffered greatly being so new and being pulled from the bedside to watch monitors. My already novice skills deteriorated very quickly.
There is a lot more paperwork and charting in nursing than ever before. I truly think the learning curve for a new nurse today is higher than it was 15 years ago. I'm not saying that nursing itself is harder, I'm just saying that they've added so much more, while giving so much less in terms of resources. When you're already new and don't have adequate time management skills, it's easy to be swallowed up by the extra clerical duties and waitressing that they expect you to do.Dec 13, '16Far too much emphasis on recruiting and nowhere near enough emphasis on retention. You can go out and get all the new grads you want, but what incentives are being offered to the established staff to keep them beyond that magic year?
In the last month, I've had my standard start of shift yanked away. I don't know until the night before what time I should show up the next day. My coworkers have to make redundant arrangements for child care because they don't know what time they'll be home. As the manager said, "It's less than an hour", but that hour can mean a huge headache, plus hey, it's nice to know what time I should show up more than 10ish hours in advance.
In the last month, I've had an average of 8 hours cut from each paycheck because one tiny group is being targeted for involuntary low census- the wealth isn't being spread among the entire department. Because of having already used up all my PTO for other low census days (some voluntary, some not), I'm now to the point of having to take time without pay- and I'm still biting my nails over having enough saved for my upcoming vacation, which I must have in reserve per policy.
In the last month, I've struggled to pay bills due to those low census days without pay. I had to swallow my pride and ask my sister to pay a bill for me (why my sister? because I've helped her in the past and knew she'd not ask questions).
In the last month, I have been actively looking for a new job. I'm going to be picky about it, because I want an employer that values its employees. I don't feel like I have that where I am.
Bottom line? Value employees that are already employed, show that they are valued, and maybe the never-ending staff turnover will decrease.Dec 13, '16I agree with Salty Sally. New grads have unrealistic expectations when they come to work. It is not necessarily their fault. I just don't think they are as prepared as they think they are. I was lucky. I am an older new nurse (5 years) and I was able to get a specialty new grad residency. They invested a lot of time orienting me. Trouble was, others did their 2 years and went back to where they came from. I already am an established resident of where I am so I am not going anywhere.
There is a sense of apathy and I am trying to work with more veteran nurses to see if see if we can ALL find a renewed enthusiasm (maybe that is too strong of a word-interest, maybe) in our unit. Baby steps. We have new nurse that started a Secret Santa. That is a good beginning!!Dec 14, '16I really wish articles like this would refrain from utilizing the NETY thing. It just perpetuates it. Surely you could have found and example that was more appropriate and less "drama alert".Dec 14, '16Quote from WuzzieYou know what's funny, I had the same thoughts as you. In the end, I used the example because it's the verbatim experience of a new nurse, and her choice of words.I really wish articles like this would refrain from utilizing the NETY thing. It just perpetuates it. Surely you could have found and example that was more appropriate and less "drama alert".
I don't believe articles perpetuate the behavior. I think some nurse's treatment of new nurses perpetuates the behavior.Dec 14, '16Quote from Nurse BethI'm going to have to disagree. There are many new nurses who have never heard of this NETY concept but once they do they go looking for it and this results in confirmation bias. We see it hundreds of times on this site alone. I was severely bullied at one of my jobs but I still think this whole NETY thing needs to go away. In addition, the example you gave is full of too many holes to be used as an example of the unfriendly environment you use as a cause for nurses leaving. The patient may have been NPO and without fluids for an entire shift or may have had an intermittent arrhythmia with potential for instability. I could keep going. Not having any scheduled meds is no excuse for poor patient care. She tried once. Did she ask anybody else? Did she ask for help? 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. There are times when being friendly isn't in our patient's best interest. The unfriendly part comes when the staff has too much to do and not enough time to do it which leaves them stressed and sometimes short when they answer questions. This is often interpreted by new nurses as mean and disrespectful when in fact the "offender" is simply trying to keep her/his head above water.You know what's funny, I had the same thoughts as you. In the end, I used the example because it's the verbatim experience of a new nurse, and her choice of words.
I don't believe articles perpetuate the behavior. I think some nurse's treatment of new nurses perpetuates the behavior.Dec 14, '16I agree with above statements of unrealistic expectations and schools attracting and accepting ill suited personalities as part of the problem. Also that schools not adequately preparing their graduates. Not only for the workload but also training to deal with difficult personalities, strategies for meeting customer service needs*, professional advocacy, problem solving and coping for the first couple of years.
*I may be wrong but I cannot recall once reading about positive ideas and work arounds to meet, or better, to anticipate, divert, prevent etc some of the customer service demands. All I really read is resentment and just wanting it all to go away.
That is not to dismiss staffing issues but I believe that if our industry produced people better prepared with the above skills, along with strong clinical skills, there'd be less problems with nurses lackimg a better seat at the table.
I also think preparing grads with the above skills may not be best accomplished by nursing instructors, perhaps schools need to bring in a different type of talent to address those aspects of preparedness.
And finally, responsibility owned by pre nursing students to demand and even defer enrollment until better preparedness is provided by nursing programs. 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.
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