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Nurses are Fleeing the Hospital

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Nurses have simply had enough and are walking out of acute care. How far will it go? Have we seen the peak yet?

by Nurse Beth Nurse Beth, MSN (Columnist)

Specializes in Med Surg, Tele, ICU, Ortho. Has 30 years experience.

What are the main reasons Nurses are quitting?

Nurses are Fleeing the Hospital

Here are some conversations that are taking place at hospitals everywhere across the country. Do they sound familiar?

Did you hear Kim is leaving?”

“Kim !?? Kim in Step down?? Nooo! You don’t mean Kim! She’s been here forever!”

“Ya! and I hear 2 more step down nurses turned in their notice.”

Nurses left behind while their colleagues and friends grieve the loss. Years, decades, even, of experience walk out the door, leaving those behind to pick up the slack and cope with working with an inexperienced workforce.

Later on at the same hospital, at the evening command center safety huddle, it's reported that 28 nurses are out on leave.

The educators in Staff Development are informed that 26 travelers are coming on Tuesday of this week, and must be onboarded. 

Where are all the nurses going? 

My sister works in a hospital across the country from me and nurses are running out of her hospital as well. “Where are they going?”, I ask. “Anywhere”, she says. “Just out of here.”

Tipping Point

It’s one thing to work hard and pull together for a national emergency. It’s another to work hard with no end in sight and to not feel valued. 

COVID was the tipping point. COVID took a stressed-out, unappreciated workforce and pushed it over the edge. Exhaustion coupled with unappreciation equals nurses talking with their feet.

Conversations continue.

I saw the MedSurg manager taking care of patients this morning!.”

“Seriously, did she even have Pyxis access? She hasn’t worked bedside in 8 years! How come the charge nurse isn’t taking patients instead?"

“She is! She’s charge and has a full load.”

Anger

The boilerpot situation breeds deep frustration and anger...and anger wants a target. Staff who have worked at their hospital day in and day out, month after month, year after year, are orienting travelers making twice as much pay. Meanwhile, staff nurses’ phones are blowing up with requests begging them to stay later, come in earlier, and work on their days off.

Nurses are angry at managers and Directors who are seen as out of touch and insensitive. Administration blames managers if their staff leave. “We all know employees leave or stay because of their managers.” Ironically administration rarely asks nurses themselves what it would take for them to stay. 

Brenda, an NP who loves ED medicine, is quitting and going to work in a plastics office because she can no longer tolerate the chaos.

When COVID resurged with the Delta Variant, and the ED staff was stocking tents erected in the parking lot in 108 degree weather, she texted her manager to see about getting some flats of chilled bottled water for the staff.  Her manager texted back she was out getting body work done on her car. 

Nurses are angry when work gets shifted to them from other departments. An out-of-ratio ICU RN caring for 3 ICU level patients with one patient alone on 4 different antibiotics went to the Pyxis only to discover that suddenly this morning, she has to mix and label her own antibiotics. She calls Pharmacy and is told, “It’s because we’re short-staffed”.

Nurses are angry at patients who brought this on themselves. Nurses put their lives on the line once for over a year, but many aren’t willing to do it again for people who could have been vaccinated but chose not to.

Lack of Trust

Signs on patient doors say PAPR required for aerosol inducing procedures...what..? We aren’t routinely given PAPRs, just N95s! Is the sign wrong? Or is the practice wrong? Are we at risk? Why can’t we trust the information we’re given?

Nurses are practicing in chaos with conflicting directions and changing guidelines. Discovering that they weren’t protected after all. There’s distrust in government agencies and hospital administrations. 

Leaving Begets Leaving

“I heard 3 nurses turned in their notice on 7SE.”

“Wow. Maybe I’ll quit, too.”

Leaving is contagious. It starts as a trickle and ends up a flood. I’m not at all sure it’s possible to stop it midstream, but could it have been prevented?

What do you think? Why are nurses quitting?

Hi! Nice to meet you! I love helping new nurses in all my various roles. I work in a hospital in Staff Development, and am a blogger and author.

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157 Comment(s)

Emergent, RN

Specializes in ER. Has 28 years experience.

Yep...

deej394, BSN, MSN, RN

Specializes in Progressive care, cardiac surgery, telemetry. Has 7 years experience.

I think you bring up some really good points as to why nurses are quitting. I am one of those nurses who recently "quit" however, I feel as though I abandoned a sinking ship. I recently completed my master's degree in another field, and got a job in that field. So while I left the bedside at the hospital, it was with good reason, and actually unrelated to the delta surge, since I had agreed to the position prior to the surge.

This doesn't mean that I wasn't very happy to leave. The point in this article about getting bottled water for staff working outside in excrutiating heat spoke to me. When we don't give people the resources they need to do their jobs, they aren't going to keep doing them. Many nurses are strong and resilient but that resilience has been tested and a lot of us are breaking. 

While at my previous hospital we did not have tents outside at the time I left, the float pool (which I was a part of) was asked to staff more and more overflow areas with fewer and fewer staff and fewer resources. In one area, there was one phone for 7 staff members. So whenever anyone needed something, they would have to page, then yell for who has the phone, and hold onto it until they got a call back. This was a particular issue when transporting patients and overtly unsafe. The "unit" which was just an open hall, could not be left without a phone, but the nurse transporting a patient also needed a phone in case of emergency. This meant that the unit had to use the desk phone while any transport was occuring.

ICU nurses are regularly tripled and floor nurses are having to take 6 patients at times, with the charge nurses and unit managers in staffing. People can't keep taking the constant calls (literally twice a day--every shift) to work extra when they feel completely unsupported by the hospital and the community.

JBMmom, MSN, NP

Specializes in Long term care; med-surg; critical care. Has 9 years experience.

My unit has experienced the same in the past eight months. The major thing that it's highlighted for me is the disconnect between management and staff. If you ask our manager why there are 13 open positions (out of 40 or so nurses normally on staff), she says "COVID has been really hard on people and some have decided to leave". However, when my colleagues gave their notice NOT ONE of them cited COVID as the reason they were leaving. If anything, the first round was COVID was a sad but exciting time to work in critical care. We had something new and we were on the front of the learning curve for dealing with things we hadn't seen before. We became proficient in techniques like patient proning. We became more knowledgeable about ventilators and respiratory issues because we covered more of that than we ever had before. We were there for our patients and families in difficult times and we did our best to be their support. It was challenging, yes, and draining at times, but many of us were a little excited in a way to use our skills in new ways. 

However, the outpouring of love and respect from the general public did NOT translate into appreciation from management. Our union contract negotiations began in February of 2020 and were dragged out until November. It included a short strike by the union that really split the nurses in their support because many people didn't really agree with the union or management strategies, but were forced to choose a side. We had two nurses leave to go to travel nursing. Then my manager sent out an email about how travel nursing at that time was really hard and we didn't know how good we had it. She said it was coincidental timing that the nurses were leaving when the message was sent, but it was poorly received in general. We've been chronically short staffed, as everyone else, but our manager does nothing to stick up for the unit when we're told we're floating a nurse to cover another unit or they're taking our tech for the night to cover somewhere else because someone there called out sick. There are a few things we have requested that cost literally nothing but would take our assistant manager maybe half an hour to complete (like a calendar of who will be the charge RN daily- we don't have access to future staffing), and we get push back for what appears to be NO reason.  Stupid little stuff has now become big stuff because it feels like we've been on the losing end of everything. I don't mean to come across as a "woe is me" type person, I still enjoy most aspects of my job and since I work nights and rarely deal with management it's still okay. But it's my personal impression of why people are leaving. 

For what it's worth, four of my colleagues went to PACU in the same organization and now they LOVE their jobs. Microenvironment has SO much to do with job satisfaction. And some people shouldn't be in management. 

Nurse Beth, MSN

Specializes in Med Surg, Tele, ICU, Ortho. Has 30 years experience.

2 hours ago, JBMmom said:

However, the outpouring of love and respect from the general public did NOT translate into appreciation from management.

Then my manager sent out an email about how travel nursing at that time was really hard and we didn't know how good we had it.

 Our manager does nothing to stick up for the unit when we're told we're floating a nurse to cover another unit

 Stupid little stuff has now become big stuff because it feels like we've been on the losing end of everything.

I don't mean to come across as a "woe is me" type person, I still enjoy most aspects of my job and since I work nights and rarely deal with management it's still okay. But it's my personal impression of why people are leaving. 

For what it's worth, four of my colleagues went to PACU in the same organization and now they LOVE their jobs. Microenvironment has SO much to do with job satisfaction. And some people shouldn't be in management. 

Your experience just resonates. When I feel appreciated, I will gladly work extra hard. It just seems basic...but it's not, apparently.

LibraNurse27, BSN, RN

Specializes in Community Health, Med/Surg, ICU Stepdown. Has 8 years experience.

https://www.nytimes.com/2021/08/21/health/covid-nursing-shortage-delta.html

The New York Times recently published an article about this as well, and how the forever feared "nursing shortage" is now actually happening, and projected to get worse when a large number of nurses in their 50s and 60s retire soon. The situation in states where covid is surging again sounds horrifying, and patients will definitely die due to short staffing. It is so sad that it has come to this, and I wonder if the situation we are in will finally get people to care about staffing issues and the treatment of nurses in general. 

Nurse Beth, MSN

Specializes in Med Surg, Tele, ICU, Ortho. Has 30 years experience.

4 minutes ago, LibraNurse27 said:

https://www.nytimes.com/2021/08/21/health/covid-nursing-shortage-delta.html

The New York Times recently published an article about this as well, and how the forever feared "nursing shortage" is now actually happening, and projected to get worse when a large number of nurses in their 50s and 60s retire soon. The situation in states where covid is surging again sounds horrifying, and patients will definitely die due to short staffing. It is so sad that it has come to this, and I wonder if the situation we are in will finally get people to care about staffing issues and the treatment of nurses in general. 

Good article, thanks.

It's so frustrating, some hospitals are running on what? 25% traveling staff- and that's just not a long-term solution.  Will it get better? I hope so, but it would take some painful, non-short-sighted decisions. 

anewsns

Specializes in Neurosciences, stepdown, acute rehab, LTC. Has 8 years experience.

I think it is a domino effect. Covid was probably the catalyst, then the staffing, followed by the morale or simply that tense atmosphere and people leave. Honestly Covid didn't have a great deal of effect on my daily work, so any effect was quite indirect,  but the environment was just the  straw that broke the camels back. 

Edited by anewsns

14 nurses on one floor just gave their 2 weeks notice on the same day!  Rumor has it that our hospital is not hiring any regular staff and is planning on only hiring travelers in an attempt to bust our union. We have no code or RRT teams at the moment. Ambulatory floats have been pulled in-patient. They’d pull us too but we are already at least 10 nurses short on the daily. The CNO recently told us that if we don’t like how things are,  “Amazon is hiring”. Our manager massively threw us under the bus then immediately went on vacation leaving us to try to clean up the mess. Her last message to us…”Peace Out”. Since she’s been back all she’s done is hide in her office with the door closed and a “do not disturb” sign on it. Our annual reviews are due…I can only imagine how those are going to turn out, they don’t want to pay us. Morale is the worst I’ve ever seen it in over 30 decades of nursing. The lack of respect from the top down is stunning. I’d run too if I could but I can’t take the massive financial risk. 

anewsns

Specializes in Neurosciences, stepdown, acute rehab, LTC. Has 8 years experience.

4 minutes ago, Wuzzie said:

Morale is the worst I’ve ever seen it in over 30 decades of nursing 

Gandalf, this is the worst mass exodus story I've ever heard. (Jokes aside, it definitely is the worst.) Im so sorry , I hope you can get out of there. 

LibraSunCNM, MSN

Specializes in OB. Has 10 years experience.

1 hour ago, Wuzzie said:

14 nurses on one floor just gave their 2 weeks notice on the same day!  Rumor has it that our hospital is not hiring any regular staff and is planning on only hiring travelers in an attempt to bust our union. We have no code or RRT teams at the moment. Ambulatory floats have been pulled in-patient. They’d pull us too but we are already at least 10 nurses short on the daily. The CNO recently told us that if we don’t like how things are,  “Amazon is hiring”. Our manager massively threw us under the bus then immediately went on vacation leaving us to try to clean up the mess. Her last message to us…”Peace Out”. Since she’s been back all she’s done is hide in her office with the door closed and a “do not disturb” sign on it. Our annual reviews are due…I can only imagine how those are going to turn out, they don’t want to pay us. Morale is the worst I’ve ever seen it in over 30 decades of nursing. The lack of respect from the top down is stunning. I’d run too if I could but I can’t take the massive financial risk. 

Good lord Wuzzie!  I'm so sorry you're dealing with this.  That is insanity.

vintagegal, BSN, RN

Specializes in Geriatrics. Has 2 years experience.

It’s not just nursing. There is an exodus of the work force in general. Everywhere there is a “now hiring” sign. Many people are fed up with the abuse from customers/pts/management. 

I worked previously as a DON in LTC. People were always calling off even pre covid. So I worked, 16 12 hr shifts in a row, with no day off, caring for 40 people entire care from ADLs to meds. I was devastated at how dangerous that was. I begged my company for help, begged my manager for help. I got laughed at. Actually laughed at, and they told me to deal with it because that’s my position. And I was on salary.

And the director of the entire building? She liked to get her nails done, and come to work Tuesday through Thursday 10-4. She didn’t even pick up the phone. “Not her job”. When she was trained to be a PCA…
I was Not even making minimum wage with the hours I was putting in. So yes I left. Had enough of working every holiday, every weekend, every night shift that someone decided they were too hung over to work. 
I made peanuts for a wage while everyone else in higher management was busy cashing in. I begged for travelers. They said no because it was too expensive. 
there is no loyalty with employment anymore. As a worker, you are used and abused to the extent that they can use you. Employers leverage what they can get out of you and then throw you away.