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).

[Libby1987]

I agree with above statements of unrealistic expectations and schools attracting and accepting ill suited personalities as part of the problem. Also that schools not adequately preparing their graduates. Not only for the workload but also training to deal with difficult personalities, strategies for meeting customer service needs*, professional advocacy, problem solving and coping for the first couple of years.

*I may be wrong but I cannot recall once reading about positive ideas and work arounds to meet, or better, to anticipate, divert, prevent etc some of the customer service demands. All I really read is resentment and just wanting it all to go away.

That is not to dismiss staffing issues but I believe that if our industry produced people better prepared with the above skills, along with strong clinical skills, there'd be less problems with nurses lackimg a better seat at the table.

I also think preparing grads with the above skills may not be best accomplished by nursing instructors, perhaps schools need to bring in a different type of talent to address those aspects of preparedness.

And finally, responsibility owned by pre nursing students to demand and even defer enrollment until better preparedness is provided by nursing programs. As long as thousands continue to bank roll these programs who stop at practicing with max 2 patients by 4th semester and never train and require a demonstrated ability to come close to working conditions, it's going to be more of the same.

[Kate_Peds]

"If I took report and this was the situation you'd bet I would say something very directly to the nurse who was sooooo busy. We could debate this all day long I suppose but I still think it's a poor example of an unfriendly environment."

I think openly and loudly humiliating someone and insinuating that a newer nurse, who is obviously going to be weaker in terms of time management, was "soooo" busy is part of the issue. Newer nurses are slower, they don't know all of the nuances of a unit quite yet, and when they are purposefully humiliated in front of everyone it can do enough damage that they feel targeted and move on to something else.

The post is about why nurses quit, specifically new graduates. The quote was from a new graduate. You can't get any more authentic than that, whether it be your personal experience or not.

[Wuzzie]

Libby1987 said:

As long as thousands continue to bank roll these programs who stop at practicing with max 2 patients by 4th semester and never train and require a demonstrated ability to come close to working conditions, it's going to be more of the same.

True that! When I went to school a long time ago we carried a full patient load by the second semester but then we had a CI who was actually on the floor and only had 5 students.

[Wuzzie]

Kate_Peds said:

"If I took report and this was the situation you'd bet I would say something very directly to the nurse who was sooooo busy. We could debate this all day long I suppose but I still think it's a poor example of an unfriendly environment."

I think openly and loudly humiliating someone and insinuating that a newer nurse, who is obviously going to be weaker in terms of time management, was "soooo" busy is part of the issue. Newer nurses are slower, they don't know all of the nuances of a unit quite yet, and when they are purposefully humiliated in front of everyone it can do enough damage that they feel targeted and move on to something else.

The post is about why nurses quit, specifically new graduates. The quote was from a new graduate. You can't get any more authentic than that, whether it be your personal experience or not.

Sure you can. You can take the drama out of it. We have no idea if she was "loudly" humiliated. I know when I'm called out it sure seems loud to me when in actuality it isn't. When I screw up (which fortunately isn't very often) I feel humiliated but whose fault is that? Her hyperbole makes me question how authentic her report of the interaction was. And when people don't own their mistakes, as she didn't, it makes me suspicious.

And I stand by my position that we need to stop perpetuating this NETY concept and instead focus on how to better prepare new nurses for the rigors of actually being a nurse!

[MrNurse(x2), ADN]

After three decades in nursing, I have seen change that is not for the better. When I began in 1989, I was a graduate nurse for three months before I ever sat for boards. I then waited another three months for board results to be told I could function independently. Effectively a 6 month orientation. I was then exclusive days for 1 year, despite my desire to work nights. The disadvantage to new nurses that come as any other nurse sets up failure. Mistakes when I was new were seen as learning opportunities, now they are strikes against you. The general attitude that employees are expendable prevails and even veteran employees with decades of loyalty are no longer valued. The cost to develop a new nurse is no more than an experienced nurse today because there is no difference in orientation time. That leaves the new grad in a position to fake it until they make it, a very dangerous place for the nurse, patients and coworkers. It really is a scary time to be a new nurse.

[Kate_Peds]

Wuzzie said:

Sure you can. You can take the drama out of it. We have no idea if she was "loudly" humiliated. I know when I'm called out it sure seems loud to me when in actuality it isn't. When I screw up (which fortunately isn't very often) I feel humiliated but whose fault is that? Her hyperbole makes me question how authentic her report of the interaction was. And when people don't own their mistakes, as she didn't, it makes me suspicious.

And I stand by my position that we need to stop perpetuating this NETY concept and instead focus on how to better prepare new nurses for the rigors of actually being a nurse!

I would encourage everyone to remember what it is like to be a new graduate. Hopefully that way the line of communication will remain open. The issue of new grads leaving is not just the topic of a popular gossip session, it's a very real problem.

I think the best way to find out why new graduates are leaving is to communicate with them about their experiences. I commend Nurse Beth for asking those direct questions, and, as unpopular as the terms may be, saying what needs to be said. We can sit around with our eyes shut and our hands over our ears because we don't like a particular phrase, but in the end, if this is what new grads are saying is causing them to move on, we would be foolish to assume that syntax is the cause.

[DeeAngel]

Kate_Peds said:

"If I took report and this was the situation you'd bet I would say something very directly to the nurse who was sooooo busy. We could debate this all day long I suppose but I still think it's a poor example of an unfriendly environment."

I think openly and loudly humiliating someone and insinuating that a newer nurse, who is obviously going to be weaker in terms of time management, was "soooo" busy is part of the issue. Newer nurses are slower, they don't know all of the nuances of a unit quite yet, and when they are purposefully humiliated in front of everyone it can do enough damage that they feel targeted and move on to something else.

The post is about why nurses quit, specifically new graduates. The quote was from a new graduate. You can't get any more authentic than that, whether it be your personal experience or not.

No one said anything about deliberately humiliating anyone in front of others. A quiet private mention of the problem and why it's a problem for the oncoming shift is how new people learn and grow.

[JerseyTomatoMDCrab, BSN]

Being asked to do so much more with so much less.

It all pretty much boils down to that.

[Wuzzie]

Kate_Peds said:

I would encourage everyone to remember what it is like to be a new graduate. Hopefully that way the line of communication will remain open. The issue of new grads leaving is not just the topic of a popular gossip session, it's a very real problem.

Like any of us have forgotten. I remember every painful detail even though it was 30 years ago. Look, I don't disagree with you but this NETY thing is getting out of hand and setting new grads up to fear starting out. They are told they ARE going to be eaten so they start looking for it. Add to that the new generation of nurses we are seeing that cannot handle criticism of any kind, in any format no matter how kindly it is meted out. People are spewing "NETY" if someone doesn't say good morning to them for crying out loud. Do a search here and you will see what I mean. None of us are disagreeing that we should be nice to each other but sadly there are mean people in this world and some of them become nurses. My stance is instead of scaring the crap out of new nurses how about better preparing them to handle the stressors, and yes that includes mean people and being corrected when they screw up (which they will), before they start their first job. I would be happier with the phrase HETO (Humans Eat Their Own) which is much more accurate.

[Julius Seizure]

Wuzzie said:

The patient may have been NPO and without fluids for an entire shift or may have had an intermittent arrhythmia with potential for instability. I could keep going. Not having any scheduled meds is no excuse for poor patient care. She tried once. Did she ask anybody else? Did she ask for help? If I took report and this was the situation you'd bet I would say something very directly to the nurse who was sooooo busy. We could debate this all day long I suppose but I still think it's a poor example of an unfriendly environment. There are times when being friendly isn't in our patient's best interest. The unfriendly part comes when the staff has too much to do and not enough time to do it which leaves them stressed and sometimes short when they answer questions. This is often interpreted by new nurses as mean and disrespectful when in fact the "offender" is simply trying to keep her/his head above water.

While I wouldn't call that nurses experience "bullying", it was not appropriate for the oncoming nurse to question her care so loudly that everyone fell quiet and it was heard by family and/or patients (if that was the case, of course the possibility of exaggerating exists).

I would say, Wuzzie, that you seem to be looking for any and all possibilities to find fault with this off-going nurse. We only have the information in the quote - not the whole story. All of your scenarios are plausible. But it is also plausible that the nurse prioritized correctly and WAS "so body". It's also possible that the patient wasn't NPO, had no IV meds at all, and no cardiac complications to their illness. It is not unheard of for a floor-status patient to not need IV access. She also may have tried more than one. She may have asked other nurses to try, too. We don't know any of that, so we cannot assume. By the way, I don't think that the quote wasn't meant to be a comprehensive police report; it was just a quote about how that nurse felt, and probably not even the entire story as she would have told it.

To your ultimate point, I do agree that if not prioritizing IV access for this patient was inappropriate, then saying something directly to the off-going nurse can be appropriate. And that there is a right and a wrong way to do that. I think that matters. Especially when we are ALL just trying to keep our heads above water.

[Wuzzie]

Julius Seizure said:

While I wouldn't call that nurses experience "bullying", it was not appropriate for the oncoming nurse to question her care so loudly that everyone fell quiet and it was heard by family and/or patients (if that was the case, of course the possibility of exaggerating exists).

I would say, Wuzzie, that you seem to be looking for any and all possibilities to find fault with this off-going nurse. We only have the information in the quote - not the whole story. All of your scenarios are plausible. But it is also plausible that the nurse prioritized correctly and WAS "so body". It's also possible that the patient wasn't NPO, had no IV meds at all, and no cardiac complications to their illness. It is not unheard of for a floor-status patient to not need IV access. She also may have tried more than one. She may have asked other nurses to try, too. We don't know any of that, so we cannot assume. By the way, I don't think that the quote wasn't meant to be a comprehensive police report; it was just a quote about how that nurse felt.

To your ultimate point, I do agree that if not prioritizing IV access for this patient was inappropriate, then saying something directly to the off-going nurse can be appropriate. But there is a right and a wrong way to do that. I think that matters. Especially when we are ALL just trying to keep our heads above water.

No, my ultimate point is that we need to stop telling new nurses that they are going to get eaten (they are now being told this in school) and figure out how to better prepare them for the rigors of nursing which includes but certainly isn't limited to dealing with mean people and receiving criticism which is never easy and often painful. I have stated this over and over but all I'm getting back is myopic responses focusing on my wish for a better example of an "unfriendly environment" than what was provided in the article. I never said that loudly humiliating a person is acceptable nor do I participate in such behavior. I simply offered another point of view of the situation which has now descended into assumptions being made about me. As such I will bow out and let everyone go on with their day.

[Julius Seizure]

Wuzzie said:

No, my ultimate point is that we need to stop telling new nurses that they are going to get eaten (they are now being told this in school) and figure out how to better prepare them for the rigors of nursing.

I agree with this as well.