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).

[VivaLasViejas, ASN, RN]

All of this serves to remind me that I did the right thing for myself by leaving nursing when I did. It seems that it has only gotten worse over the past six years since I've been out, and it was tough as hell before then. Even though my exit was unplanned, it turned out to be the right time for me to make it, and I regret nothing. Oh, yes, there are times I miss taking care of people, but the more I see and hear of what is going on out there in the nursing world, the more grateful I am that I'm not a part of it.

My youngest son is a newish RN with over ten years' experience in healthcare all told, and he's burned out...he's not even working as a nurse now, even though he's studying for his BSN and still plans to become a CRNA down the road. To be honest, I don't know if he'll go through with it; he's even told me "Mom, sometimes I'd rather be an insurance salesman." That doesn't speak very well of our profession; we are running off many of our young nurses before they have a chance to develop into competent professionals, and we are running off many of our experienced nurses because they can no longer handle the working conditions (and they cost more).

I honestly don't know how y'all do it anymore.

[SisterofMary]

I really appreciate this article because it resonates deeply with my experience as a New Graduate. I started out in a sub-acute/long-term care center for children. It was a "cushy" job in hind-sight. I worked nights and I was eager to get into a hospital and start a job as a "real" R.N. Acute care nurses get all the glory right? I thought I was walking into a nurturing and considerate environment where I would grow my skills under the care and tutelage of my seasoned co-workers.

True or false?

What followed rocked my world. I worked nights on a med-surg unit where the most senior nurse had approximately 3 years of experience and that nurse flew the coop. The senior nurses fled and left us to our own devices. There were few nurses I could count on for support. Giving report to the day nurses was tiring and painful. The P.C.A.'s refused to work. I cried for a whole year. I wanted to very much quit but stuck to it to pay off my student loans of which I had one grand left. The worse was the disillusionment and fatigue. I knew nursing was a tough job, but not that tough. Nobody warned me. Now A year or so in I survived but I never suggest nursing to anyone unless they can get into a magnet hospital or residency program.

[SisterofMary]

On 10/16/2019 at 12:18 PM, Cruzan_RN said:

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.

This.

[JackdLPN]

one of my supervisors went PRN and picked up a job at Village Inn across the street, I was like WOW! holy ***

[floramary, RN]

My opinion only. I believe we have set the nurses up for failure. There was one sentence that referred to nurses who have worked 30 years vs new grads quitting so soon. I will guarentee they were trained totally differently. From the moment new nursing students start training, it appears the orientation is to meet goals to pass your board's. The old training, beside classwork, was immersion in the nursing experience. By graduation you worked a full patient load. The new grads have no idea of the reality awaiting them. Hospitals should be training their own CNA's so a close working partnership can developed between RNs and CNAs. Saving money has got us here. It has to stop

[drlizrn]

One of the real problems is that this web page and many of the participants believe the only area for nursing is acute care - hospital nursing. Yes if I worked in that environment I would not last either. There are so many community health/public health arenas to practice in. Been a nurse 51 years this year 50 in community/public health, and one year as evening charge nurse in 65 bed surgical unit in Boston MA at Brighten Marine Hospital during Vietnam - it was crazy - no wonder people quit.

[LPN Retired, LPN]

TPTB create so many positions and dont want to hire over that number. Then they will work the ones there, to death, calling them in on their days off. I had a supervisor work me about 8 days in a row, but she didn't care as long as I came in and covered. Other nurses calling in sick, couldnt get to work on account,of icy roads or whatever. But they call me cause I lived close, and expected me to come in .

[floramary, RN]

Nurses need the right to say no without the fear of retribution. You've worked your shift, you need to rechg to be the best you can be.

[~Shrek~]

Why I left my nursing jobs.

Job 1, as a new grad, non acute care: They told me I would rotate between nights, evenings, and days. Then they put me permanently on nights. 11pm to 7:30 am, 5 nights a week. I said "**** that (self-censored), I am becoming severely depressed doing this."

Job 2, non acute care: I had a very poor support system and was in charge of like 100 patients. I got stuck with a needle and was not enrolled in worker's comp. My parents asked me to quit, even if it meant not finding another RN job and having to change careers.

Job 3, non acute care: I stayed for years. Excellent work environment. However, I left because even after working there for 4 years, new grads were being offered an entry level job one level up from what I was doing while I interviewed about a dozen times. I was being overlooked for a promotion that was still entry level, and new grad external candidates were being hired instead of me.

Job 4, acute care: Remember that I had not worked acute care in my life, and was a few years out of school: I felt like I was 100% in a nurses eat their young situation. I felt like I was being berated and left on my own without training or support. I felt like I was not getting enough training and that I was unsupported. I broke down during this job, and was dead set on changing careers until I got offered Job 5.

Job 5, non acute care: I will see how this goes. It seems like a very good and satisfying job that I will stay at for years. Hopefully this works out well. ?

[mfci]

21 hours ago, SisterofMary said:

Now A year or so in I survived but I never suggest nursing to anyone unless they can get into a magnet hospital or residency program.

I was in a magnet hospital with a residency program. See my previous comment on why I left nursing.

[Quickbeam, BSN, RN]

I left a profession that limited my geographic mobility (tight residency restrictions) to retool as a nurse. It was a huge eye opener to go from respect, dignity and an office to being dumped on, ridiculed, hazed and generally abused. After a few hospital years I sought out niche roles like community health and case management. That’s been better....but still not the professional respect I received in my former profession 35 years ago.

I’ll retire in 2021. I will not be working as or volunteering as a nurse in retirement. Done.

[SisterofMary]

On 12/28/2016 at 9:24 AM, calivianya said:

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,
So sad how this reality mimiced mine and so many others.