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:
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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)
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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?
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Increasing staffing and limiting nurses' work hours. Flexible work schedules and job sharing help nurses with children stay in the workforce
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Creating a culture of safety
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Providing strong, supportive nursing leadership
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Creating a Just Culture
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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 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).
