What is the major reason nurses leave?

angel337, MSN, RN · Oct 19, 2006

i actually like where i work, but some of the main reasons i would leave bedside nursing are:

1. some days its impossible to go to the restroom

2. no lunch or breaks

3. working the holidays (yes yes. i know this comes with the hospital environment, but i still hate it)

patient acuity is high every where and i think it's only going to get worse. it wears on you emotionally and physically.

ZASHAGALKA, RN · Oct 19, 2006

Simply put, nurses are paid below the reservation wage (the level at which too many would have reservations about the job at that wage) because we buy into the concept that we are 'called' and being called has a value of its own.

This has been the case in nursing for decades. And in the past, it was a working model. You don't HAVE to pay full price for the work of someone that sees other rewards besides money. If you doubt this is true, ponder for a moment the moral suspicion that many nurses STILL harbor for nurses 'in it for the money'. Professionals ARE 'in it for the money'.

Now, add to this the restructuring of healthcare in the '80s that changed the focus from 'patient' centered to 'cost' centered care and you end up with nurses so strung out at 'flexed' staffing that they simply don't have the opportunity to fulfill their 'calling'. At that point, the value of being called is no longer a real reward and so, nurses begin to truly look at the bottom line.

And that bottom line, as I said, is BELOW that of a true reservation wage. So, true to form, too many nurses have reservations and walk away.

There is no shortage of nurses; there is a shortage of nurses willing to do the job at the wage being offered.

The ultimate result: Admins will have to either re-align wages to meet true reservation wages, or re-structure work roles and environments to allow for the time to feel 'called' to the work. My bet is that they cannot or will not understand the latter and so, the price of hiring a nurse will continue to go up.

But, that's ok. Being paid a real reservation wage is a key ingredient of being a 'professional'. And with those real wages come respect. The more valuable the commodity, the more respect it deserves.

To answer your question directly: all of the above. They are all inter-related. Wages are not an issue alone, but in tandem with the other issues you suggest, current wages aren't enough to bear the work demand without 'reservation'. As far as the issues related to respect in your question: you don't respect something that isn't fully earned. And since the labor of nurses hasn't been fully 'earned' by paying a true reservation wage, the lack of respect is transparent and palpable. Being forced to pay a real reservation wage will cause a prudent employer to re-examine the issues that cost them that real commodity within the workplace.

For example, it cost 76,000 dollars to bring a critical care nurse up to independent practice in an American ICU. That is the cost to recruit, pay bonuses, and train. At that cost, even a 15% turnover is a far losing proposition. Eventually, it will HAVE to dawn on TPTB that creating environments that retain such nurses is cheaper than endlessly replacing them.

It might take awhile, but that knowledge - read respect - will come to management. That is the value of having to pay full price for a commodity; you also have to respect it. Or more to the point, the bottom line is really the bottom line, or, as they say, money talks.

~faith,

Timothy.

ZASHAGALKA, RN · Oct 22, 2006

Being called has its price. I think nursing is still paying that price.

~faith,

Timothy.

ursulanursula · Oct 24, 2006

If I were to leave nursing right now (which I am not ready to do because I still have "hope" for finding my niche), it would mainly be because of #3. It wouldn't be because of the front line nurses, they are great. It would be because of lack of support & respect from management. I work in Eastern Canada & the basic attitude I have encountered with management is "you are here for us to use, to fill shifts. we don't care about you & will lie to you every chance we have. but you should feel grateful to work for us" No thanks...I'm relocating.

Ruby Vee, BSN · Oct 24, 2006

what do you think is the major reason nurses leave the profession out of these?
1.) nurse to pt ratio without accounting for pt acuity
2.) scheduling of staff
3.) nurses treatment of one another (management's treatment of staff, etc)
4.) pay (or lack thereof )
5.) inability to provide the pt care desired due to administrative requirements.
all responses are valued! thanks!:wink2:

understaffing and underappriciation are a big cause of turnover. and management's unwillingness to manage cliques, bullying behavior and other negative staff-to-staff interactions are another.

indigo girl · Oct 25, 2006

Simply put, nurses are paid below the reservation wage (the level at which too many would have reservations about the job at that wage) because we buy into the concept that we are 'called' and being called has a value of its own.
This has been the case in nursing for decades. And in the past, it was a working model. You don't HAVE to pay full price for the work of someone that sees other rewards besides money. If you doubt this is true, ponder for a moment the moral suspicion that many nurses STILL harbor for nurses 'in it for the money'. Professionals ARE 'in it for the money'.
Now, add to this the restructuring of healthcare in the '80s that changed the focus from 'patient' centered to 'cost' centered care and you end up with nurses so strung out at 'flexed' staffing that they simply don't have the opportunity to fulfill their 'calling'. At that point, the value of being called is no longer a real reward and so, nurses begin to truly look at the bottom line.
And that bottom line, as I said, is BELOW that of a true reservation wage. So, true to form, too many nurses have reservations and walk away.
There is no shortage of nurses; there is a shortage of nurses willing to do the job at the wage being offered.
The ultimate result: Admins will have to either re-align wages to meet true reservation wages, or re-structure work roles and environments to allow for the time to feel 'called' to the work. My bet is that they cannot or will not understand the latter and so, the price of hiring a nurse will continue to go up.
But, that's ok. Being paid a real reservation wage is a key ingredient of being a 'professional'. And with those real wages come respect. The more valuable the commodity, the more respect it deserves.
To answer your question directly: all of the above. They are all inter-related. Wages are not an issue alone, but in tandem with the other issues you suggest, current wages aren't enough to bear the work demand without 'reservation'. As far as the issues related to respect in your question: you don't respect something that isn't fully earned. And since the labor of nurses hasn't been fully 'earned' by paying a true reservation wage, the lack of respect is transparent and palpable. Being forced to pay a real reservation wage will cause a prudent employer to re-examine the issues that cost them that real commodity within the workplace.
For example, it cost 76,000 dollars to bring a critical care nurse up to independent practice in an American ICU. That is the cost to recruit, pay bonuses, and train. At that cost, even a 15% turnover is a far losing proposition. Eventually, it will HAVE to dawn on TPTB that creating environments that retain such nurses is cheaper than endlessly replacing them.
It might take awhile, but that knowledge - read respect - will come to management. That is the value of having to pay full price for a commodity; you also have to respect it. Or more to the point, the bottom line is really the bottom line, or, as they say, money talks.
~faith,
Timothy.

Spot on, Tim.

Midwest4me · Oct 25, 2006

I think #1 (nurse to pt ratio without regard to pt acuity) is the MAJOR reason, closely followed by #2(staff scheduling)!!!! Those would be MY reasons given (if I could afford to leave the profession).

Pompom · Oct 25, 2006

All the above plus the health problems you develop over time like herinated discs.

jade-athyst · Oct 25, 2006

Personally, I am finding myself regretting the four years I spent in nursing school due to #3. I've been hearing the expression "nurses eat their young" for a long time, but didn't know what it really meant until latelly. Number 1 comes in as a close second. I didn't even think 4-6 patients in a CCU was legal, but that's what they expect of us where I work.

ArmyMSN · Oct 25, 2006

1. Dependable staffing levels and nurse-patient ratios

2. Scheduling

3. Pay (I'd work for a lot less pay to work in a better job)

gitterbug · Oct 25, 2006

I agree with most of the previous answers. The one thing I would like to add is the "too high standards of performance" we as nurses are expected to maintain. Doctors make mistakes, serious ones, and somehow are allowed to continue to practice. Nurses are expected to do our jobs, monitor the other workers on the floor and keep an eye on other departments and physicians as well. Nurses have become accountable for a lot of things we just do not have any control over. Like the unit clerk that enters the wrong type of test, the pharmacy sends the wrong dose of med, the CNA does not report a spike in Temp or BP, and a dozen other things I could mention. I am only human, I do try to practice in a competent manner, I can only do so much though. I am sure there are many other nurses who have reached the same conclusion. There simply is too much responsibility and accountability for nurses and not enough for other staff members, including doctors, in today's medical settings.