Estimates are that up to 30-50% of nurses leave their position or quit nursing altogether in the first year. What drives nurses away?
Updated:
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 :
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.
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.
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.
New nurses either:
Floating to other units is a major stress. Care is not always taken to ensure competency-based assignments, or to support the newbie floater.
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?
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.
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.
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.
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
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).
Reasons Nurses Leave:
1. Most bedside nursing positions are horrible, and the good ones are taken by nurses who will never quit because they are great jobs.
2. The only barrier to better jobs is a measly 40 credit grad degree
3. Why fight the system when you can just change your place within it.
4. Med surg/Tele/ICU jobs will always be a ton of physical work. Few young people want to endure that long term. No administrative measure will change the core of bedside nursing. This is why these jobs have high turnover, even when controlled for everything else.
I love how all these professional bloggers etc. fail to acknowledge that nurses quit entry level bedside positions because there are simply better jobs available. Nursing is a legit 4 year degree now. Who the heck would want to spend the rest of their lives doing heavy labor with that level of education?
"There are times when being friendly isn't in our patient's best interest."
The issue is not one of friendliness vs unfriendliness, rather its a matter of respect. The nurse said she was "loudly humiliated" by the other nurse. There is no justification for disrespecting another nurse, even if you believe they were responsible for "poor patient care" as you mentioned. How does that correct the issue? If you truly believe the outgoing nurse made a mistake, use the opportunity to suggest how she could have handled the situation differently. Even after being a nurse for five years I find myself learning all the time, I would gladly welcome another nurse's suggestion/input. However, I wouldn't appreciate being yelled at for a perceived mistake. We should be kind and compassionate to one another, not only to our patients :)
RegularNurse said:Reasons Nurses Leave:I love how all these professional bloggers etc. fail to acknowledge that nurses quit entry level bedside positions because there are simply better jobs available. Nursing is a legit 4 year degree now. Who the heck would want to spend the rest of their lives doing heavy labor with that level of education?
Personally I would never leave if I got paid well. By "well" I mean anything beyond $40/hr. Right now I'm batting way below that magical number and it's simply not enough considering the rigorous education, physical labor, responsibility (everything falls on the RN...) and mental/emotional toll that the job requires. And my place loves those customer surveys so it doesn't matter what you did for the patient. I love it when family members who never visit are filling out those things and saying how bad we are.
maybe if we weren't treated like crap and given unsafe assignments that risk our license everyday, people wouldn't leave.
Nursing is one of the most ridiculous jobs out there.
I'm rather upset that I wasted all these years and money thinking things might get better.Nothing like going to your job daily and worrying about the situations and short staffing you are subjected to.
LadysSolo said:nuguynurse2b, are you kidding me? I realize it depends on where you live, but as an NP on salary, I average $35.00/hr when I do the math. I have NEVER made $40/hr., and I have a master's degree with 35 years experience (23 as an RN, 12 as an NP.)
You basically answered your own inquiry - it totally depends on where you live. I got hired at a hospital as a new grad that was offering me $34/hr...
LadysSolo said:nuguynurse2b, are you kidding me? I realize it depends on where you live, but as an NP on salary, I average $35.00/hr when I do the math. I have NEVER made $40/hr., and I have a master's degree with 35 years experience (23 as an RN, 12 as an NP.)
Where do you live/work?
Our new hires with less than 2 years of experience, irrelevant at that, with 2 yr degrees start above $40/hr. M-F days. Affordable part of California.
AnnoyedNurse
63 Posts
Honey, I'm so sorry you're dealing with this. That's not the best work environment. I think you need to focus on getting better and do not go to work until you are feeling better. You cannot provide excellent care unless you are 100% healthy and able to do everything your patients and coworkers need.
Personally, I would have a one on one with my director of nursing. Explain to her how I am feeling and tell her I am willing to be a dedicated nurse, to stay thick and thin for the hospital, and I am willing to help support the change. If she is receptive, then great. If not, I'd look elsewhere- there are great nursing work environments despite the horror stories we do hear.
Stay at strong and remember you health and wellbeing should also be an utmost priority to you and also to your employer. If they don't care about you, why you you work for them? There are many employers who love their employees and understand that life happens. You are not trapped nor are you alone.
Best wishes!