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).

[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.