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).

[Cruzan_RN, ADN]

New nurse here, second career. For me, yes school doesn’t adequately prepare you for the fact that your job is going to have these ever increasing, unrealistic expectations of you. When I left school, I thought that I’d be able to provide the care necessary to promote holistic health. The reality is that, in hospitals (I can’t speak for other places as this is my only experience) short staffing, reduction of ancillary staff, cost cutting, patient satisfaction scores, etc. make it difficult to get an adequate orientation as well as behind able to appropriately do your job as a nurse once you hit the floor. When I spoke to my manager(s) & mentor about why I was struggling, they all attributed it to me being new. However, after speaking to many nurses with 15-30 years of experience, I realized everything I was feeling was not only valid, but was not solely based on me being new. They tell me ”get an advanced degree & get out, nursing is only getting worse. I thought I’d do this forever but now I feel like I can’t leave, get out while you still can”.

I’m not an idiot, yes nursing is new to me, but I also had another career. I have no issues with working hard, or changing environments, I’ve always adapted well. The difference now is that every additional month I am a nurse I feel like facilities are putting my license at risk & patients lives hang in the balance. The consensus I’ve gotten from my discussion with nurses of all experience levels is that we’re expected to do more and more and it leaves less and less time to focus on nursing things.

I shouldn’t be spending so much of my day calling and recalling the pharmacy & chasing meds, having to call and recall doctors to place orders before being told to put the order in myself, searching and calling floors for supplies, answering and screening phone calls for the unit, chasing down food & dietary team members because someone didn’t get the right order, being a maid and personal punching/verbal dumping bag for disgruntled patients & other staff over minor things that they feel I should be doing, and so on, all while keeping up with my nursing tasks that only I as the nurse can do.

To top it off, my generation is becoming more cognizant of personal health & bedside nursing is not healthy mentally or physically. 13-14 hours on you’re feet, barely getting a 30 minute break during that time (forget about 15 minute breaks), holding your pee because the second you try to go to the bathroom call bells start going off and no aide staff is in sight & you don’t want to risk a fall happening, not being able to even have a covered water bottle at your desk to grab sips between running around (hello dehydration), then after your emotionally, mentally, physically draining day, leaving frustrated, irritated, or crying & being so SPENT that you have nothing left to give your family or yourself?!

Honestly, it’s a surprise that anyone does this job anymore to me. I plan on leaving as soon I level up my degree.

[beekee]

17 minutes ago, Cruzan_RN said:

Honestly, it’s a surprise that anyone does this job anymore to me. I plan on leaving as soon I level up my degree.

I’m amazed too. I’ve had a lot of “bad” jobs. Nursing is in its own league.

[Cruzan_RN, ADN]

On 1/2/2017 at 12:51 PM, RegularNurse said:

3. Why fight the system when you can just change your place within it.

Also when you do try to fight or speak up your blackballed.

[Cruzan_RN, ADN]

I’d also like to add that I have no problem getting someone a drink of water or chasing meds, because I do care about my patients. The issue I have with all of this is that with increased patient acuities & complexity, even in 12 hours, certain tasks that could be handled by other staff, pull me away from nursing tasks that cannot be handled by other staff. This compromises the care I’m able to give and patient safety.

Having to deal with CNA’s/PCTs who gripe about how they can do my job better than me and how the nurses are all lazy is also frustrating. You can’t ask for help, even when explaining that you have other more important things to attend to without the aide feeling like you think your above them or your lying to get out of doing work. Speaking as a former CNA, they don’t understand our role & while I have also encountered AMAZING CNAs/PCTs, many of the ones I have encountered provide little assistance or only focus on getting vitals, but don’t toilet patients, bathe patients, answer call bells, turn patients, etc. I do all of these things, but if more often, I had someone who could “assist” me in doing these things at times so I could have more time to chart & focus on my life saving nursing tasks it would be a huge help & help relieve at least some of the stress that comes along with the job.

Nursing resiliency courses and preparation are great, but even with those things nurses are bound to get worn down as, & I think people tend to forget, we are ALSO HUMAN & not magical nurse machines. The environment is what really needs to change if the profession is to retain its professionals, both inexperienced & experienced.

[Snigglefrits]

Why am I, a nurse of ten years, leaving my job in less than two weeks?

Customer satisfaction and mainly the satisfaction tied to damned pain meds. I have heard doctors promise patients “pain won’t be an issue, Ms Smith. You’re not going to feel a thing!” ...after the doc has sawed a sternum in half? Patients don’t even want to experience mild discomfort, because all they’ve heard is there will be a million pain meds at their disposal, any time they want them.

The doctors never seem to explain the administration of said pain meds can hinge upon the patient’s medical status. We try to explain to 101 with the BP of 60/nothing that the 10th dose of dilaudid in 24 hours isn’t safe at this time, but are countered quickly with “But my doctor said I could have it any time I wanted it! I don’t want you to be my nurse any more, you’re no good!”.

Crazy orders I've seen for pain meds? 4mg morphine q 2 hr for laryngitis! (Yes, inpatient admission for laryngitis, no other comorbidities) Or 2000ml NS bolus to raise a CHF and dialysis patient’s pressure enough to withstand 4mg dilaudid.

I didn’t get into nursing to play continuous morphine/narcan roulette with my patients. I don’t want them hurting needlessly, but I sure don’t want to kill them to get a good “satisfaction” score. Seems dead would be a lot less satisfactory.

Add in a few family members like one who said “Take that $1.50 change there and run down to the vending machine for me. The last nurse said y’all don’t have Dr Pepper back there and that’s my favorite.” And no, their loved one wasn’t in dire straights, where they were afraid to leave their side...they literally did not want to miss the lie detector results on Maury!

Enough customer service for me!

[GinnyMi]

I thinks we have beat this topic to death. Why don't we come up with solutions?

Here is an idea! Lets bring back the Diploma programs. They were selective in admissions but a much cheaper way to go. Six semesters, no summers off. Two 8 hour days of lecture, three days of clincals per WEEK! The weeding process is done in school (75 grads out of 150 beginning students). Boards are the same. Ready to work at time of graduation. Plus, the clinicals would help relieve stress for the staff(if done well).

Those that want to or are able to move to higher levels of education. Those that love the bedside can stay where they are with the option to further their education later.

It’s time to look back at the history of nursing and acknowledge that the push for higher education, while worthy, has hurt the nursing profession. I believe the push was meant to increase our “professional” reputation but has that been the case? I think not.

[Melissa Hall Samanka]

Sadly this article is me. Left med surg first year, I left nursing completely. The whole unit was young nurses. It was a terrible experience.

[Jedrnurse, BSN, RN]

1 hour ago, GinnyMi said:

I thinks we have beat this topic to death. Why don't we come up with solutions?

Here is an idea! Lets bring back the Diploma programs. They were selective in admissions but a much cheaper way to go. Six semesters, no summers off. Two 8 hour days of lecture, three days of clincals per WEEK! The weeding process is done in school (75 grads out of 150 beginning students). Boards are the same. Ready to work at time of graduation. Plus, the clinicals would help relieve stress for the staff(if done well).

Those that want to or are able to move to higher levels of education. Those that love the bedside can stay where they are with the option to further their education later.

It’s time to look back at the history of nursing and acknowledge that the push for higher education, while worthy, has hurt the nursing profession. I believe the push was meant to increase our “professional” reputation but has that been the case? I think not.

Having started off working as a CNA under a charge nurse who trained during WW2, I think diploma nurses rock. (I've also worked with incredible LPNs) But how would your proposal change the abysmal conditions that nurses are asked to put up with...?

[stimpie777]

What about the possibility of NO FURTHER ADVANCEMENT....I see that some if not most are RNs. For LPNs there is no advancement..except RN school which is Ridiculous to get into NOW. Plus, I agree that patients and their family have TOO MUCH CONTROL over OUR JOBS. Like not wanting someone because they couldn't work 2 extra hours for a pt you have been with for years... It is unrealistic expectations- not caring for the nurses and if they have medical conditions or illnesses. Like for example, my tearing my meniscus at work and then NONE OF THE MEDICAL BILLS being covered because "it could have happened anywhere" This is part of the issue. We are not robots, we have spouses and children and our own difficulties, but we are being asked to carry the weight of EVERYONE on our shoulders.

[CGB1]

Nursing is the heart and soul of healthcare. I joke that we can survive a day without a doctor, but they'd never survive one without us. While it's a joke the sentiment rings true. That being said, we are often treated as numbers by hospitals. Expendables. One hospital I worked for, in a 56 bed MICU, many of the nurses were new grads. The turnover was so fierce that they had nurses of a year or two precepting new comers. When one quit, they'd hire another. So merciless was the pace of business that those jaded few that stayed the years, and I do mean jaded, were the most incredible, hardcore resourceful people I have met in my career. I left, of course, for better pay, work environment and benefits. Nurses need to unite as professionals and demand work life balance, pay and acceptable nurse patient ratios. And I mean demand, or leave unhealthy work environments that are causing us physical and emotional distress. Nursing is such an incredible profession. We need to recognize ourselves as such. New grads do not have unrealistic expectations. They have a vision of a work environment where they can provide exceptional care and have the need of their patients and their own needs met.

[mfci]

I had a professional career for almost 20 years before I went to nursing school. I'm not a snowflake or a wimp, and I don't take anything personally at work. I learned that a long time ago. I had wanted to be a nurse for at least 15 years. And I left in just over a year.

Some things nursing school had not prepared me for, such as:

• How completely unprofessional way too many nurses, doctors, and other medical "professionals" act. Sometimes it was just like being in high school or even junior high.
• How, despite the emphasis on understanding, promoting, respecting and educating people of all sorts in nursing school, too many nurses expect you to be exactly one type of person and learn in one type of way. Generally, the type of person they are who learns like they do.
• How impossible it is for many new nurses to practice safely (at least for hospital inpatient care) in the amount of time you are given for orientation.
• How abusive the hospital system is to nurses, refusing to spend money to promote safe practice, safe ratios, etc.
• How hypocritical the profession is - promoting evidence based care unless it costs more. And how it clamors to be regarded as professional when such incredibly unprofessional behavior is tolerated.
• How too many nurses are more concerned with doing things their way instead of working as a team towards consistent, safe practice.

I didn't mind working 14-15 hour days on orientation. I was lucky during those shifts that I had a preceptor who spent that kind of time and effort teaching me. I didn't mind working nights, holidays, or weekends. I didn't mind that some of the nurses were so nasty to me, because I figure it's their problem and not mine. I loved taking care of patients, and didn't mind when they were varying degrees of a pain to deal with. Either the nasty ones were stressed or they were behaving poorly for no good reason. I wanted the help the first type and I think the others are just part of the job. Humans are what they are. My job was not to judge them, but to help them as best I possibly could.

The reason I left is because I had a choice. I had a job to go back to which paid more, where I was treated much better, where I had better health benefits (I was shocked at how poor the health benefits as a nurse were in a big regional hospital), where I'd learn more, where abuse wasn't tolerated, etc. I had been sick of my old career when I quit and went to nursing school, but nursing gave me a whole new appreciation of it. I'm back and happier than I had ever been.

I miss nursing. I miss my patients, I miss taking care of people, and I miss the many amazing coworkers that I had. However, I think life is too short to take that kind of abuse (from the hospital and the mean nurses) and I opted out.

My mother-in-law (a nurse) told me, about 15 years before I started school, that there wasn't a shortage of nurses. There was a shortage of nurses willing to work, because they job was so crappy. So, I wasn't even surprised by that. But after a year of it, I'd had enough.

[Quickbeam, BSN, RN]

You aren’t wrong. I am a career change RN, from a professional Criminal Justice career. Nothing prepared me for the really blue collar, clock punching, massive forced OT and floating exhaustion. I loved patient care but missed any shred of professional respect. The benefits as an RN were so much worse than my prior career, I could not believe it.

I found a couple niche roles that allowed me to get a pension and a career using my nursing education. I was lucky to be able to combine nursing with my prior degree. Floor nursing chews you up and spits you out.