Why Do Nurses Quit?

[Nurse Beth]

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. 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).

[~Shrek~]

~Shrek~ said:

Also night shift. I quit my first job because I was working 11pm to 7:30 am. I gained 20 lbs and became extremely depressed, and I never had a history of depression. I was lucky that my family was there to support me, and quit I found another job that was extremely unsafe to the point that I got injured twice and wasn't enrolled in worker's compensation. I posted on here and was told I was spoiled, entitled, living in an ivory tower, etc.

I didn't think I would ever find another Nursing job and I decided to pursue another career. I was lucky that somewhere in there I got my current job because if I had not, I would be in an MBA program or engineering school right now.

Also, I was bullied by a colleague for not having hospital experience. I experienced full on lateral violence for a few months then worked on my own. Every move I made, she would scream at me in front of the patient. Now I am okay but I will never forget the lateral violence experience.

I edited because I accidentally copied and pared a comment I originally wanted to post into the post.

Edit: also I looked through my post history to find the post where I was told I was spoiled etc and I can't find it on this account. I think it was on another account because I may have made a throawaway or deleted it. Most comments on here have been supportive.

[GinnyMi]

i often wonder if the push for BSN has had something to do with new grads being unprepared for the real world? I graduated in 1985 from a Diploma program which, like most, was connected to a hospital. The program was six semesters and we spent 2-3 8 hour days a week in clinicals and had lectures/classroom time the other 2-3. By the time we graduated, we had "worked" in ICU doing everything on our own. At the time, team leading on med surg was the norm and we took our teams of 8-12 pts and had lpns and cnas on our team. The student preceptor was there in the background in case we needed him or her but we were basically on our own. Over the last 30 years, i have had many students follow me. "Clinicals" in icu were observation, not hands on. I noticed most students werent prepared and didnt expect to do the work ( most were thrilled when I would encourage them to try an IV, insert a foley, etc.). I am not saying that there is anything wrong with getting a degree, i just think we need to evaluate the effectiveness of the clinicals they offer now. By the time a nursing student graduates, he or she should know what they are getting into!

[lindahartford]

I agree completely. That is why after 20 years in hospitals, I quit and went into Home Health Nursing. I was able to determine my own patient load (with a few exceptions) and work at my own level of expertise. I could stay with a patient 10 minutes longer if I deemed it neccesary or leave earlier if the patient was becoming more independant. We worked as a tean with good communication and helped each other when possible, ie: a PT might reinforce a dressing for me and I might do an extra set of exercises with a patient. A Home Health Aide and I could coordinate a visit to help each other with some heavy lifting. I also found that Dr's were much more attentive to patient problems when we addressed them. I lasted 30 years on that job.

[lindahartford]

I like your honesty with yourself and with us. Good luck with whatever youdo.

[Alma 3323]

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.

This is what's true for me. Managers being nonsupportive, condescending or just plain disorganized. Managers who demand a solution from the nurse but don't implement any that are offered. Managers that simply believe pts complaints even when they are pt fantasy with witnesses to RNs story. Getting a group reprimand. Who did it? Not me but I get to share in the nastygram.

[Kate-RN BSN]

I graduated nursing school in 2014, and I do feel like it prepared me well, I was handling my own 5 pts during my preceptorship. I also worked as a CNA and a med aid before nursing school. My first job was in LTC...not what I wanted at all felt like I wasn't using my skills and the physical abuse in memory care from the pts, and stress of managing CNAS that would not show up made me leave after just 3 months. (also terrible management, felt like I was in high school).

i then got a job on a med surg floor, I was counting down the months until I had a year there under my belt so I could apply for something more specialized. I knew med surg wasn't what I ultimately wanted but where I live it's that or LTC when you're a new grad...nobody else with hire you. The high stress made me leave, I would wake up at 2 or 3 am unable to sleep due to terrible anxiety. I was not mentally healthy there l. I commend all nurses who work in that environment.

i then got a job in dialysis, which I loved! There are some very early mornings but we were out by about 5 pm everyday... not the case anymore we are now open until about 10 pm having added a 3rd shift of pts. I am pregnant with my first baby and my husband worka evenings so I am unable to stay there due to not having daycare in the evening..the work /life balance there is no longer balanced. With all these new pts makes so much more work in every aspect and we are given no more resources..we have hired more staff but some are terrible and nothing is being done about it, it makes me very sad to leave but it's not the same job as when I first started. Now I am looking for a clinic job with consistent hours.

[Dohardthings]

I don't think that NETY intentionally exists...

See I had a chicken coup with ten bantams (smaller type chickens). 1 Hen decided to get broody and sit on her eggs, and I let her. One day, while I wasn't around, one baby chick hatched, and for whatever reason, his mom left him to fend for himself. When I found him, he was already crushed and dead. Life in the hen house is normal moving and grooving for the chickens. They don't pick on each other and if they bump into one another, no big deal. But chicks are delicate and small and what is normal moving and grooving for them, is just giant feet of death to a chick. That mom was the one thing that could have kept him alive if she had done her job, but she didn't. We need good mentors for new grads. We need to treat our mentors awesome because they go above and beyond. A new nurse is trying to exponentially tackle a huge learning curve in such a short amount of time. Criticism for criticism sake is unhelpful in the first year; guidance and a listening ear is all they need. I think as new grads are given time to grow and get stronger, then handling the hen house with all it's moving and grooving will be just fine.

[Dragonnurse1, ASN, RN]

GinnyMI i agree with you. I graduated in 1993 from an ASN program. Our school had 100% passing rate back then and when I started working I had already had 3 semesters of hands on in clinicals. Just before I had to give up nursing I had a new grad from a BSN program, who had to have her orientation extended 2 times, fall apart when her patient arrived literally. The call was for an unresponsive patient, I was helping her set up and once again walk through what was going to happen. The patient arrived and we could hear him yelling at the medics that they were "killing" him with the O2 mask, that he could ******* breathe on his own (he was still in the elevator while we were listening to this). This was not an "unresponsive patient" and she should have been glad but instead she broke down in tears. Because she was going to have to work him up basically by herself as another patient, a GSW was 2 minutes out and I was going to have to take that one. I was in the bay next door if she had questions but she cried. She had been on orientation for 12 weeks and still was afraid of taking a patient like the one I described. When I graduated I had the required 1 week introduction to the hospital and safety orientation plus an additional class on 12 lead EKG. I had 1 week with a "preceptor", who was the charge nurse, and then I went to nights. My first night, my first overdose was a pyridium overdose and not one nurse with experience would come in to help. The Doc and I were plowing through his books to see what to do. I was pushing methylene blue on my 1st night after a 2 week orientation. I worked 9 yrs, 4 months and 17 days.

When the hospital wanted everyone to go to 12 hour shifts I stayed on my 8's. 12's did not work for me with 4 children at home and the youngest was barely 2. They learned very quickly not to call me to come in early except on certain conditions, the Doc's referred to me as the A team. I had a good school, I had lots of hands on in clinicals including ICU, I was taking care of patients not customers. I was an ASN. Not one of the BSN's made it on nights in the ER while I was there - not one - and we tried to help. Everyone of them were so frightened of hands on and said that their hands on during their clinicals was non-existent. Some of the best nurses were ASN trained that went back for the BSN later because they wanted to be in management. I had no such desire as I enjoyed the direct patient care.

Also we had Patient Care Techs (PCT's) and housekeeping in the ER. We had transporters (unless it was a unit patient) and surgery came and got their patients. The insane desire to get ER stays down to less than an hour was just that insane. Our overall turn around time, even with the holds, was 2.5 hours. Not bad when you are 25 behind when you arrived to start the shift and you were ER of the day for the entire city. RN's NEED support personnel. They need the Unit Clerks to input the orders, get rooms, call for supplies, and get food trays from the Cafeteria when holding a patient for a room. They need housekeeping to clean the rooms and pull the linens. Hospital administration should not be busy buying top of the line SUV's for the department heads nor should they pay themselves and the department heads mid to upper 6 figure salaries while nixing pay raises for the rest of the staff.

I still miss the work but I am glad I do not have to work with the way things are going. I can never return to work due to Latex allergy but I was not ready to quit, I watched the turnover, except for a core group of 5. I became a nurse at the age of 40 but I had been the "family nurse" for much longer, for me and the other 4 in our group nursing was a calling it was not just a job.

[nikegirl09]

This! This is how I feel as well. It drives me crazy.

[nikegirl09]

NocNurs said:

I'm a new RN, but I have been a LPN for almost 20 years, I don't have an unrealistic veiw or expectation but I can say this. The biggest stressor in nursing for me is the recent (last 10 years or so) change in what all health care areas are focusing on: a ridiculous expectation of customer satisfaction. The outcome is very few satisfied customers and nurses who are sick of being pushed into a role of satisfaction and not nursing. Do I want my pt and families comfortable? Yes. Is that really possible when pts and families are in a scary and uncertain situation? Is it OK to send a nurse after sodas for a pts perfectly able bodied visitor? No. But in the eyes of management I should deliver those sodas with a smile. I have to smile and be ok with an insane amount of demands, verbal abuse and questioning of my abilities because Dr. Google has afforded the average person with more then enough education to do my job. The disrespect is insane and health care facilities are not focusing on fixing it in any way. I leave work feeling defeated because 3 out of 10 pts. and their families feel as though the customer is always right. I have to feel guilty that pt. A who is very ill, had to get the very minium of care because pt. B has a more demanding family.

This! This is how I feel as well. It drives me crazy!

[nikegirl09]

Not_A_Hat_Person said:

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.

That's if the new grad is lucky enough to land a hospital job. If they work in a SNF, they may be passing meds to 16, 26, or more residents, with the same lab calls and interruptions.

This was exactly my situation. I struggled/suffered so much as a new nurse. But I sought support, and did not give up. I've had a looooot of bad days, but it has gotten better.

[balletomane, ADN, RN]

On the patient's part, well...they want a 5-star hotel where they just happen to be medically treated.