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? Nurses General Nursing Article

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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. FU6SDbRLo1-zQRU2dKNQXkL5g93fkOWklhqK209A_t15fshoNGW8L_RWuZ3znD38j-6VoPO8EKC7vj__7b5N8BbyWYBXT0YYBSJX8fxz9Zco2in-E2A4wXzZ72E7CPsTr0q1mkGC 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).

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

I think your leaving is a good thing.

AnnoyedNurse said:
Oh be quiet Wuzzie. You're in denial. Please go read the other posts on this site. A nurse asks for advice, and all of you oldies tell her to suck it up or over it or some other rude remarks!

If nurses showed more love to one another, especially new nurses, then nurses wouldn't be leaving the bedside. In my current job, I had some senior nurses including the one precepting me try and attempt to force me to take my lunch on the unit. Of course I refused and they kept making it a challenge for me to take lunch. So I told them, my charge nurse, and my manager, "if these ******* think I'm going to eat at my desk and still clock out for lunch, then I'm walking my *** straight to HR."

Ive met countless nurses who are *******. They hate their lives and they make nasty comments. I put them in their place each and every time, even when I was a new grad. But I was also 25 as a new grad, former army medic and accomplished salesperson, so maybe I was more gutsy. Nurses don't mess with me anymore lol. New grads should learn that they must stand up for themselves.

On on another note, I'm leaving nursing. It sucks and we're underpaid, and there is only a certain about of verbal abuse I can tolerate! I am not everyone's punching bag!

wow, this is one of the best articles i have read so far.. i almost quit last week due to burn out and bullying

Specializes in ICU.

I may be in the minority, but I think it actually helps to be thoroughly prepared for the lateral violence towards new nurses. I just posted in another thread about how I see it all the time on my unit - and how I could think of five people off the top of my head I've seen written up for things everyone else gets away with, and forced out just because the "in crowd" didn't like them. And they were all new grads with the exception of one. If you have the wrong preceptor - someone who's not in the clique - it's going to be harder to get started on my unit because the help is not going to be there when you need it. If you also happen to need to ask a lot of questions because, you know, you're a new nurse and my unit is crazy high acuity - that's it for you.

I'm pretty sure the only reason I didn't get axed right out of orientation myself is I came in with experience and they couldn't find anything to write me up for. I covered my butt extensively, because believe me, they looked. It got better after about a year. After that period, I finally had one of them tell me, "I thought you were annoying as **** when you first started, but I can tolerate you better now" which was funny because she had probably spoken less than 20 words total to me while I was on orientation, but it is what it is.

Not only is it the attitude and exclusion, many of my coworkers like to haze the new hires by giving them the worst assignments on the unit every shift they work. I experienced that myself the first four months out of orientation. It was so bad that the only reason I didn't leave is I kept repeating to myself, "You don't want to look like a job hopper, you need to stay at least a year" over and over again in my head every time I felt like I was being treated unfairly. Now that I'm charge a lot of the shifts I work, I try to rotate the bad assignments and I try not to give them to the new people at all unless every assignment is a bad one. It's hard enough to learn how to do your job on my unit without having the worst assignments on the floor every shift. You need some down time to look up unfamiliar medications and review the protocols when you're new, and there's no time to learn if it's balls to the wall every shift every night.

It's exhausting dealing with other nurses. I'd held five other jobs before going into nursing, and nursing by far has the pettiest people in it. I swear to God I'd take going back to middle school over dealing with some specific coworkers some days.

Honestly I'm trying to leave my current unit because there are so many conflicting policies and then too few on other areas so opinions are so wide. Secondly I can't sleep well any more on 12 hr nights and anywhere that I would want to work is all 12 hr shifts. And the areas with 8 hr positions would be physically hurting my back, I'm 5 ft tall and my back can't take it. So now I'm looking into case management or OR stuff in the out patient environment, I need to have a better work life balance. But I'm hoping that I haven't heard anything from any one last week, I'm hoping that it's just because its the holidays. Here's to my new years resolution-sleeping at night!

Wuzzie, you're right. I did come off abrasive. I'm sorry. On the day I wrote that post, my patient was re-intubated, had a large loose BM during the intubation which was leaking to the floor, and once the intubation was over, each nurse and CNA left my room. It took me another 35 minutes for help. I asked every nurse and nurses aide on the 32-bed ICU (large unit, plenty of nurses). Yesterday, I needed a hand to boost my patient. My "buddy" agreed to help, only if my patients didn't have a BM. She saw that he had a BM (a small one), laid my patient flat, restrained him, left the room while saying, "sorry I'm not on bathroom duty." It then took me another 20 minutes to find someone to help me. It's 32-bed ICU with only one nursing assistant, a Unit with very strict bowel and bladder protocols and a really high reputation for neurosurgery, but yet they don't provide the proper resources to provide proper nursing care. Last night, I quit my job. I refuse to keep my patients in their stool and urine because I don't have sometime to help me turn while I clean them (I've tried on my own, but it hurts like hell, and when the patient is intubated, sedated, and having DT's, it's not the safest.)

I am fully aware that it wasn't "professional" to leave without notice. But I'd rather not work then put my license in danger. Luckily, my per diem job (which is a magnet hospital and provides awesome staffing) agreed to give me as many shifts as I want until I figure out my next step.

AnnoyedNurse said:
Wuzzie, you're right. I did come off abrasive. I'm sorry. On the day I wrote that post, my patient was re-intubated, had a large loose BM during the intubation which was leaking to the floor, and once the intubation was over, each nurse and CNA left my room. It took me another 35 minutes for help. I asked every nurse and nurses aide on the 32-bed ICU (large unit, plenty of nurses). Yesterday, I needed a hand to boost my patient. My "buddy" agreed to help, only if my patients didn't have a BM. She saw that he had a BM (a small one), laid my patient flat, restrained him, left the room while saying, "sorry I'm not on bathroom duty." It then took me another 20 minutes to find someone to help me. It's 32-bed ICU with only one nursing assistant, a Unit with very strict bowel and bladder protocols and a really high reputation for neurosurgery, but yet they don't provide the proper resources to provide proper nursing care. Last night, I quit my job. I refuse to keep my patients in their stool and urine because I don't have sometime to help me turn while I clean them (I've tried on my own, but it hurts like hell, and when the patient is intubated, sedated, and having DT's, it's not the safest.)

I am fully aware that it wasn't "professional" to leave without notice. But I'd rather not work then put my license in danger. Luckily, my per diem job (which is a magnet hospital and provides awesome staffing) agreed to give me as many shifts as I want until I figure out my next step.

Apology very happily accepted. I'm sorry you had such a horrible day and it sounds like your ex-coworkers are serious pieces of work. I don't blame you for feeling like you do. I promise you if I was there I would have totally helped you and without complaint. I really do understand. I have been in your shoes. Having nasty peers is the pits. One thing I'm sure of though is there ARE places where people work together as a team. I've experienced that as well. Don't get me wrong no place is perfect but your unit sounds like pure hell. I do hope you can find your place whether it's in the nursing field or not. And again, thank you for your service. I meant that sincerely the first time I said it too.

Thanks Wuzzie, it was honour to serve. I appreciate your support in my negative experience in my current job. I would like to add that I have an amazing team when I worked Trauma ICU in NJ. I learned a lot and everyone was always helping each other out- the acuity was so high, any type of crack in the team could mean a patient's life so teamwork was a life and death requirement.

I am not sure what the future holds for me, especially in nursing. I know I am good at sales and I love real estate so I may do real estate. However, I am very happy that I have my PD job to lean on until I figure it all out. After explaining it to my manager, he completely understood how I was feeling. Who knows, I might go full time at my per diem job but of course I definitely have some soul searching to do!

Thanks again for letting me rant and for your forgiveness. I guess we can say that nurses can leave nurses for a variety of reasons, but solid teamwork can keep nurses longer- the compassion we give to our patients, if we have to the nurses on our unit regardless of experience, then maybe 30-50% of new nurses would not leave nursing in their first 3-years as nurses.

Specializes in ICU.
AnnoyedNurse said:
My "buddy" agreed to help, only if my patients didn't have a BM. She saw that he had a BM (a small one), laid my patient flat, restrained him, left the room while saying, "sorry I'm not on bathroom duty."

Off topic, but this is the problem with having CNAs in the ICU. Mine is 30 bed, also very high acuity, with zero CNAs. So, all of the nurses HAVE to help each other. Consequently, we have very good teamwork, even amongst people who really dislike each other. We have plenty of politics and lots of cliques, but even the most snobby people know you may be the only help they have one day, so they know better than to screw you over if you ask for help.

Now, my PRN ICU job that I quit recently had CNAs, and some of the nurses would look at you like you had grown three heads if you asked them for help. Having CNAs makes some of the nurses feel like they never have to help you with anything unpleasant because "that's what CNAs are for." :rolleyes: There is no accountability because they don't HAVE to have your help because they can call the CNA.

I will never work anywhere that has CNAs ever again if I can help it. It destroys the teamwork between the nurses.

If these groups of clique-y nurses were brought together and asked why they're not supportive of and/or the cause of losing the new grads/hires, what would they say?

I believe the main reason newer nurses leave is because of the "moral distress" that comes from working in corporate healthcare. Hospitals are being run by rich people trying to squeeze huge CEO pay out of Medicaid and Medicare patients. You can't run a hospital like a Walmart and expect thing to go well. If a Walmart employee gets overworked and shelves don't get stocked, no one dies.

Every time the hospital that I work at has gone through low staffing times, staff have been required to do more than is really safe for the patients. But all of these low staffing times have been their own fault. A few years ago, we had a massive lay-off because we had one summer of low patient census. Things picked right back up again (duh), and suddenly everyone is supposed to handle a full patient census with way less staff. They eventually started mass hiring, but the staffing ratios never actually went back to what they were. Once the big wigs see that nurses can handle stupid patient assignments, they keep it that way. Nothing ever gets any better.

So everyone with experience continues to leave. A 12 hour shift shouldn't feel like a 12 hour Crossfit workout. You should be able to walk without limping when you clock out. You shouldn't have to clean incontinent bed-bound patients by yourself all the time because everyone else is also so busy running around like a chicken with their head cut off that if you waited for someone to be free to help you, the patient would have already lost the first several layers of skin.

The hospital is evidently content to just keep bringing in the new grads. I personally suspect it's because they're cheaper than the experienced nurses anyway. I have worked for one hospital in the little over 2 years since I became a nurse. I started on a progressive care unit and then moved to an ICU (both day shift positions). On both units, I was made a preceptor within 6-8 months of being off orientation. Think about it - with less than a year of experience being an RN, I was teaching new grads how to be nurses. In a cardiac surgical ICU, a new grad gets 8 weeks of orientation on the unit. They're being trained to take CRRT patients and VAD patients before they've been there 6 months total. They're receiving fresh open heart surgery patients within their first few weeks off orientation. I can distinctly remember times of trying desperately to keep a fresh open heart patient alive in the midst of significant hemodynamic instability and looking around for anyone to help, only to realize everyone around me was newer than I was. Add in the fact that in a teaching hospital, the residents don't know much either and it's terrifying.

I've been to ortho docs and physical therapy for issues that I believe are directly related to lifting too much and putting an average of 18-20K steps on my poor tired feet every shift. I dread going in to work most days. I hate that I don't have the time to do what I have started to consider the "fluffy nursing stuff" like patient mobility, patient education or making a human connection with patients or their loved ones. Things that should be standard nursing stuff, not "extras" that I rarely have time or energy for.

I personally have a very high level of self-confidence and am assertive by nature. I'm no wilting flower type. I was flat-out bullied by my preceptor on my first unit. Directly confronting her about, and directly reporting it to my educator and manager accomplished nothing. I have witnessed bullying of other nurses by the few experienced ones that are still around. I've stood up to the bullies, I've comforted the victims. I have brought these things to the attention of management over and over and seen NOTHING done about it. I have seen shift coordinators (who function like assistant managers) do some of the bullying. It keeps happening. I've seen patients suffer because of bullies refusing to help newer nurses. In this female-dominated profession, there is a lot of back-stabbing, bullying, favoritism, and general meanness that reminds me of junior high and high school. Only back then such problems didn't adversely affect the health and well-being of innocent by-standers like they do our patients. It's sickening. And anyone who wants to deny that this happens is delusional.

I went into nursing as a second degree student in my 30s. Going back to that rather assertive personality of mine, I got all the experience I could during my nursing school clinicals. I had the experience of taking full med-surg patient assignments and full ICU patient assignments with my preceptors during school. I wasn't clueless when I walked into this field. I just sold my soul to the devil of corporate healthcare - I took a scholarship with a work requirement because I was broke. Thank god that's over now. I'm a damn good nurse and I've excelled under the ridiculously poor conditions that have comprised my first two years in this profession. I do all the stuff that makes the office-types happy - I've got a bunch of extra letters I can string after my name; I go to conferences; I sit on hospital wide committees and have unit-specific extra responsibilities. None of it actually matters down in the trenches. Now that I have that magical "2 years experience" under my belt, a lot more is available to me and I have a far more options in choosing my employer and my workplace. Never again will I work somewhere without a union. Never again will I work somewhere with high turnover rates. Never again will I work somewhere that hires almost entirely new grads. And just in case anyone is wondering, Magnet designation, Level I everything certification, and top rankings that are plastered all over town on billboards don't necessarily mean anything for nursing work conditions. I believe this is just the state of most of corporate healthcare nowadays. And anyone who sits around wondering why nurses are leaving in droves needs to get out of their ivory tower office and take a typical patient assignment for a shift or two. They're figure out the answer quite easily.

Sarah- best description of why nursing has gone to **** and exactly why nurses are leaving. I'love never work full time in nursing ever again!

This week was the lowest of the low. On Thursday I got a verbal "write-up" because night shift accused me of leaving things unfinished. Even when I later proved that I had finished the things they said I didn't do the write-up stood because admin also believed I was the reason their newest nurse quit during orientation which is total BS (she quit because the commute was too hard for her). Then later that day one of my patient's started to desat and it took me, the DON, and the doctor working with the patient for nearly 2 hours to get her back up to 90% (she was down to 80%). I finally got everything done at 830pm (2 hours late) Thursday night and then came back Friday morning with a splitting headache only to find out that the patient had died at 10 pm Thursday night. Despite that I started my Friday like normal and made it through morning med pass even though I felt like I was going to be sick any minute. I finally had to step outside to cool down and was ill in the parking lot. I told admin and they tried to find someone to cover my shift but couldn't find anyone so tried to coerce me into staying even though I was diaphoretic, nauseous, and had a headache so bad I could hear my pulse in my ears. They finally said I could go home but before I could leave the other day shift nurse told me I had to finish all the charting for my patients and turn off all the IVs I had started earlier. That took another hour. I got home just in time to get sick again and have spent all weekend so far either sleeping or in the bathroom. I have tomorrow off to hopefully feel better but then I have to go to work on Tuesday. I don't dare call off...I've already cost myself over $200 being sick plus my co-worker thinks I was faking the whole thing.