Much is being made of the nursing shortage, but the sad fact of the matter is that much of this shortage is a self-inflicted wound. "30%-50% of all new RN's elect either to change positions or leave nursing completely within the first three years of clinical practice" (MacKusik & Minick, 2010, p. 335). The reasons are many and varied, but a 2010 qualitative study by Carol MacKusik and Ptlene Minick examine these issues and find three major themes, an unfriendly workplace, emotional distress related to patient care and, fatigue and exhaustion (MacKusik & Minick, 2010).
An unfriendly workplace can be one in which the new nurse is simply thrown to the wolves, expected to "toughen up" by more experienced coworkers, women experiencing sexual harassment from male coworkers and physicians, and lack of support from management and/or administration in addressing these issues.
The emotional distress we as nurses experience is, all too often, related to cases of futility of care. This is where, regardless of how many life support systems the patient has attached to them, the result will be the same...the patient will die. The only question being how much suffering they experience as they do so. This occurs at both the beginning of life in neo-natal ICU's to the end one's years in ICU. In either case, physicians may not be entirely honest with patient families, thus giving them false hope regarding the prognosis. The other side of the coin is families, for whatever reason, cling to the hope that their loved one will somehow arise from the bed and leave hale, whole and healthy. This is often due as much to family dynamics involving guilt as it to unrealistic and unreasoning religious views. The toll this takes on the nurses involved in the direct care of these patients is huge.
Fatigue and exhaustion come into play when, for whatever reasons, management and/or administration are more concerned with filling beds than whether or not the staff is available to safely care for these patients. Nurses are asked, then expected, to "flex up" and take more patients it is safe for them to care for, thus putting patient safety and nurses licenses at risk. This creates a fundamental conflict between the core values and terms of licensure for nurses and the values of the organization. Add to that overtime and calls to work on their days off, and the physical and emotional exhaustion simply becomes too much to bear.
So the projected nursing shortage...some 500,000 nurses by 2025 (MacKusik & Minick, 2010)...seems to be as much a result of nurses fleeing the acute care setting as it is with the lack of sufficient new grad nurses to take up the slack.
MacKusik, C. I., & Minick, P. (2010). Why Are Nurses Leaving? Findings From an Initial Qualitative Study on Nursing Attrition. MEDSURG Nursing, 19(6), 335-340.