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).

[SolosGirl]

chiromed0 said:

I think part of the reason "new" nurses quit isn't any different than any other occupation. They just simply have that option b/c they can find work. If the job market is tight-they will stay. Some are just young and don't know the value of patience. Some get scared and hate it so that justifies quitting until they find out they will "hate" every new job for a while then might like it--that's just called "work". Others do what we all do and take the anything until what we really want comes along. Either way there is a high turnover and it even extends to mid-levels and physicians in big cities. Health care saturated markets just see a lot of moving around. Hard to turn down the next employer giving you $10/20/30K or more a year just for quitting one job and starting another. I never understood why they just don't make tiered salary bands for nurses vs just hourly rate...get a contract, give them a high salary and make them stay.

I agree, but there are a lot of other reasons I am leaving after my residency is through. Not Nursing per se, but definitely the department I oriented to, the "hospital life" and the geographical area (see Chiro's response for this one)

NETY is alive and well, and I think everyone here knows it. Whether you PRACTICE it, that's not the issue. I had an exceptionally lengthy orientation, 6 months. After one month, it was clear that my preceptor was in it to get his CNIII and climb the ladder, nothing else. He set me loose and would literally leave the unit without saying a word (I'm ED), getting his co-workers to "watch over" me.

(80+ bed ED here, folks. just putting a little context out there)

When I was asking to get some trauma experience, which is what my preceptor was supposed to be teaching me---I LITERALLY was told (by preceptor) "Well, get in there!"

Oh. THAT'S all I had to do? Just "get in there"?! I know I truly would trust a trauma RN that had that kind of teaching under her belt!

How about a girl who graduated a cohort behind me, who had the CNIV come to her 2 days after she got off of precepting, he sat down, crossed his legs, and slid a piece of paper across the desk to her.

They had "studied" her first self schedule as a brand new "on your own" RN...and determined that she had not opted to take >2 days of OT per week....and on that slip of paper were the dates/shifts (some not her regular shift of 2p-2a) that THEY decided that she should take.

That same CNIV, who told me that I was not permitted to take any classes on my off time---even if they had everything to do with Nursing---because if I had "spare time", I should be using that towards chipping away at the short shifts in the dept.

And that is just an everyday run-down. The pay sucks. That's geographical, and I am doing something about that at 1 year. I don't get lunches or pee breaks (common), but I also don't ever get a single word of guidance.

Know why? Because the "senior RNs" feel that since I will "probably" be gone after a year, like all the others, they aren't investing in me fully.

It's not a marriage, folks. It's a job. Putting your "heart and soul" into training someone? That's nonsense. It's a job. If you are precepting by choice, then it's a job YOU signed up for. Do it. And act as if that person you are precepting may be taking care of your parents or your kids. If you are being tapped to precept against your will? Still do the best you can. Again...that RN may be in a position that they're taking care of YOUR loved ones.

It's a JOB. Not a popularity contest--your personal opinion of any other employee is irrelevant. If their skills are up to par, then you need to keep your "personal" opinions of them to yourself. That's where the "lateral violence" comes in.

One of my cohort made a simple mistake in putting a foley cath in a female pt and inserted the catheter into the wrong orifice. yeah wasn't that just hilarious? especially being the patient, i'll be she thought that was just so funny to have her hoo-haw out there for the senior RN to snicker at the new grad.....and then, not to be outdone by her disgusting behavior at bedside embarrassing the NG, senior RN goes and spreads the story around. Classless and gauche.

Oh, but dark humor! No. It's lateral violence, and it's showing your butt to the patients as well. I wouldn't EVER allow that RN, senior or not...to EVER touch one of my family or friends.

There's just no line with some RNs. Oh, but I'm senior and I'm having a bad day. Well, I'm an NG and I'm having a bad day. We're even. I don't get to act like a classless jerk, neither should you.

Respecting each other in the workplace isn't a function of how LONG you've been there. THAT is what NETY is all about. Senior RNs feeling that they have "earned the right" to act like jerks.

I wasn't told in nursing school that I would get a preceptor that sits on his phone all day while I do his pt load, and when I ask a patho question I get, LITERALLY, a dumb stare and a comment like, "i have no idea. i don't keep those things in my head." To complain to management....preceptor's longtime friends? LOL. Yeah. I'll do that.

Which is why I am of the Robert Downey Jr school of thought..."Listen, smile and agree...then do whatever the **** you were gonna do anyway." Which is learn what I can, read everything....and then bail. Go to someplace where the pay is 3x what I make now (same experience level)...there is a union that protects my rights and my pee breaks....and let the NETY senior nurses sit around and wonder "why oh why" the NGs aren't interested in staying.

[llg, PhD, RN]

Ruby Vee said:

I have actually communicated with new graduates about why they are leaving -- perhaps 10-15 of the 30 or so who leave our ICU ever year never intended to stay in the first place.

I have several years of research data from my hospital that says pretty much the same thing -- and not just for the ICU. Approximately 1/3 of all the RN's in their first week of employment say that they plan to leave the job they are orienting to within 2 years. Realizing that so many of our new hires view their jobs as just "short term," we are questioning the wisdom of providing lengthy orientations and lots of additional education within the first year of employment.

Their department has nothing to do with how we treat them. They are planning to leave before they even start their jobs with us.

[johsonmichelle]

If you work in a ltc , then its very easy to list why nurses quit. Poor pay , sometimes you make less than you would working in a hospital. Very very short staffed which leads high patient ratios. Very poor orientation which may make you less marketable than your counterparts who trained in a more acute setting.

[ThePrincessBride, MSN, RN, NP]

Nope. I got a measly six weeks while some experienced nurses received ten.

I stayed at my first job in med-surg ft for eight months before becoming PRN.No one wants to stay it seems and the most senior nurse on nights has graduated fnp school. After her, the next one has less than two years of acute care experience.

Nurse Beth said:

It is a scary time to be a new nurse-and overwhelming. I'm curious about your observation that new grads have the same amount of orientation as an experienced nurse.

In my community, new grads receive significantly longer orientation than experienced nurses. Is this not the case elsewhere?

[determined25]

Well as bad as it sounds,it is true. I see it all the time. So nothing is wrong with saying it.

[Idaho_nurse]

I honestly think its due to the high expectation of "customer service" that the organizations place on nurses. we are expected to not only do everything within our scope of practice, but essentially play "cruise director" with family and patients alike. get a remote fixed, get a family member something to eat/drink, etc... we spend so much time doing these things that often, good nursing care gets put to the side. I also feel that some "tech" nursing schools are so focused on getting students through the doors that they do not emphasize the important things such as time management skills etc. I also feel that all nurses should be required to work as a CNA for 6 months to a year before applying to a nursing school. The reason? it helps give some nursing experience at the lower levels and in the trenches. the best nurses that I have seen have done their time at the bottom and do not act like wiping a bottom is beneath them. Many new nurses have unrealistic expectations that were given to them by the school the applied for, such as optimal working conditions, hours, etc, and when they are given the worst patients, shifts, etc, they do not know how to handle them. again, I feel the major contributor is the administration of the employer. They keep adding stuff onto the nurse to get done and only seem to focus on that "customer service" survey and not the nurses well being or good nursing skills. Sorry, but I am here to save your life and not serve your family. I have worked in most aspects of nursing, which I feel is to my benefit. I have buttloads of experience everywhere, and not just one dept or location and that comes from changing positions and finding what works for me. I have been at the bottom as a CNA, CMA, ER tech, surgical tech, then nursing in med surg, home health, LTC, acute care, clinic, etc... this is my resume over 20 years. I can afford to be picky and I do not put up with an administration treating their employee's like crap.

New nurses do need to understand what real nursing is, but also learn to say no and be honest when they do not feel like they have received the proper training. Alot of problems can be solved by going to a senior nurse and just talking with them, asking them to mentor and assist them in gaining the skills needed in the real world. the person who stated she was yelled at about not re starting an IV? I wouldnt yell back but I would have explained what happened and why it was not done. not enough emphasis is placed on being a team player in nursing. We all need to work together and having a bad day and yelling at another nurse is just simply NOT acceptable. The nurse manager needs to be the role model and not allow "cliques" to function, nor allow sub par nurses to get away with things while the "good" nurse is practically penalized for doing their job. Retention should be the focus, not just hiring.

My rant for the day. lol.

[NurseDiane]

Nurses are being treated like glorified service workers, because reimbursement is being based on patient surveys---which is ludicrous. Healthcare has turned into a major for-profit industry where the administration collects big, fat salaries & benefits for "keeping costs down" while severely understaffing the nursing departments & operating at an unsafe level of care. The administrators couldn't care less----until something happens & they subsequently receive a summons & complaint. Then, they throw the nurse(s) under the bus & take no responsibility for the problems that caused the harmful event.

Nurses are not paid anywhere near what they should be paid, for the level of responsibility & amount of work that they must do. Their salaries are disgraceful. And it seems that every time, at every hospital from coast to coast, the nurses & administration have to negotiate the nurses' contract, hospital administration wants to cut benefits, balks at a mere 3% raise & nurses have to go on strike to get a decent contract with decent pay & benefits. Why would anyone want to subject themselves to constant abuse----both mentally & physically---to be treated like that?

I do think that nursing students are woefully unprepared to take on their role in the "real world". It is sort of equivalent to law students----to be a lawyer you have to pass the bar exam, but are far from qualified to be a "lawyer". Someone that just passed the bar exam exam couldn't find their way to the court house steps, never mind functioning within its walls. That's why new lawyers work as associates first---writing pleadings/motions, bringing papers to the court clerk, etc., to get to know HOW to function in the "real world" of law. There should be something similar for new nurses---maybe something like working in a CNA role (if the nurse has not been a CNA or LPN before becoming an RN) for a couple of months to see how things work on a unit, then transitioning into their RN role. Today, as compared to 25+ years ago, medical floor patients are MUCH SICKER than they used to be. We didn't used to have vent patients or patients on drips or monitored patients on the floor---now it is routine to have vents & drips & telemetry. Increasing the acuity without increasing staff numbers is very dangerous, especially when new nurses come into play. New nurses are extremely anxious, older nurses are fed up with repeatedly precepting new nurses that don't stay, and the result is pissed off nursing staff & lousy patient care. Nurses are not valued AT ALL today, unlike 25+ years ago. Yes, nurses floated to other units 25+ years ago. Yes, nurses dealt with wrong meal trays, family issues, policing doctors & other non-nursing tasks 25+ years ago. Maybe we felt like it wasn't "beneath us", I don't know. In some respects, I do blame the "entitlement syndrome" of today's millennial generation----they think they are "entitled" to be a supervisor or manager because they have a BSN & passed the boards & don't have to put in their bedside time to learn how to actually BE A NURSE before supervising other clinical bedside nurses. The millennial generation doesn't seem to have to same motivation or work ethic that us "older" nurses have---they'll complain that they didn't have enough time to do something, i.e. start an IV, but if you look at their cell phones they received & sent quite a lot of text messages to their friends about what their weekend plans are or where they are going out on Saturday night. They had plenty of time for all those texts, but not enough time to finish their work. I've had plenty of experiences with younger nurses being chronically late---5 or 10 minutes---and they think nothing of it because "it's only 5/10 minutes". Yet, they are the first ones to start complaining when their relief doesn't show up 15 minutes early. And FORGET IT when I started to dock their pay for all of those 5/10 minute late days---some nurses were docked 2 hours from their paycheck & they had a FIT. And they came stomping down to my office to find out WHY they were 2 hours short---they had no defense when I showed them their time cards with the 5/10 minute late days, and how showing up 5/10 minutes late every day added up to between 60 & 120 minutes. Today's generation has a far more difficult time prioritizing & organizing themselves than we did back when we were new nurses, for some reason. Things are quite different than they were 25+ years ago----I am the first to admit that. Many issues are compounding nurses' disdain for the profession---for both new nurses & experienced nurses. It is not the selfless profession that we all thought is was when we wanted to be nurses. Nurses are expected to bend over backwards for their patients, yet when it comes time for management to bend over backwards for their nurses it is a much different story. I think that is one of the major problems----lack of respect & loyalty toward nurses, and management viewing nurses as glorified service workers who are there to genuflect to patients in order to get great satisfaction surveys so the hospital gets maximum reimbursement. And then when nurses see that the hospital administration gets yearly raises & higher bonuses only for nurses to have to fight like hell for a measly 3% raise, it is insulting. I would NEVER advise anyone to go to school to become a nurse in this day and age. There are too many other jobs out there where knowledge & experience are revered, hard work is rewarded, you are not "mandated" to stay for an additional 4-8 hours after you've already put in a full day, where you are treated like a human being and you are respected for the work that you do.

[Jbgood]

My first nursing job out of school was on a busy post op surgical floor with a high patient load. I can tell you I left one day before my orientation was up, so I was only there for 3 months and it was hell on Earth. My preceptors were horrible, just about everyone who worked on this floor was catty. My first preceptor acted like precepting me was her vacation. I was basically given a patient load, a phone, and told "Here's your patients, come find me if you have any questions." Most of the time I couldn't find her and when I did I would get an eye roll or a snarky comment. I didn't know what the hell I was doing, my zone phone rang constantly and I couldn't answer anyone's questions and the doctors thought I was an idiot and I was yelled at multiple times. All I could say was "I'm sorry, I'm a new nurse in training." Not only was I yelled at by doctors but was snapped at by other nurses and even the receptionist. By the time I got to my second preceptor 3 weeks before the end of my orientation she expected me to know everything. But I spent so much time on my own running around like a chicken with my head cut off I barely had time to learn. Not only was she unforgiving but she also acted like she was on vacation, taking selfies with her phone at the nurses station and such. Just completely unprofessional! I would spend hours on end after my shift just catching up on charting while my preceptors left me and went home. I would see the janitors on the floor and fantasize about switching places with them because scrubbing toilets seemed so much better. There were times on my drive to work that I wished I would be in a fiery car crash rather than make it to the parking lot.

I left that job for a psych position that I've been at for 7 months. Though I will say it's less hectic than working on a busy hospital floor I can't say that there are times it's not as grueling...just in a different way. When you are dealing with manic, drug seeking, borderline, or violent patients who are constantly in your face for 12-16 hours at a time it wears you down. At least at this job I have more support with other coworkers and management. But I still dream of working a nice, peaceful office job and think of how much I wasted my time with a nursing degree when I could have went into a different field making the same, if not more money!

[drlizrn]

Nurses leave for many reasons, I am in my 47the year and never once wanted to quit - what I wanted to do and did do was change what I did in nursing - staff nursing in an acute care agency hospital is NOT the be all and end all - there are so many other functions, and types of nursing it is amazing - we need to stop thinking that hospital staff nursing is the only nursing - have been in community/public/non-profit for 46 of my 47 years, I have the independence and ability to think as an individual and do my own thing - oh yes obtaining advanced degrees MSN and then EdD allowed me to do many more functions. Stop thinking staff duty in acute care is the only area to function in!

[DangerMouse]

I don't know if it was because I came from the military, or because I was in my mid 30's when becoming an RN, but that NETY stuff just did not play. If a nurse/doctor decided to berate me in front of a patient or family we would sure as hell have a come to Jesus conversation in a private or semi-private setting. That kind of behavior is unprofessional, unacceptable, and undermines a nurses credibility with their patient. I would have no problem setting those boundaries on day one.

I think some feel that they have no place to speak up and set boundaries because they are new to the game. It's a shame.

I personally left nursing after doing analysis about what exactly it was going to be like as a nurse. I don't appreciate being set up for failure, and I had no illusion that I wouldn't be a scape goat for not only my mistakes but the mistakes of others. A controlled crash is a controlled crash, whether you are new or a veteran. The probability may change but the safety risk was not acceptable to me. Working in a clinic wouldn't have been challenging so that wasn't an option either. In the end, I chose to utilize my nursing skills and clinical experience in the medical research and development field, and I'll never look back.

Back at the hospital, during full moons, when the planets aligned, I would have a killer team. A doctor that wouldn't do rounds without me present, that asked for and valued my input, incorporating it in his treatment plan accordingly, other RNs who helped out, smooth and effective delegation...was a thing of beauty. That right there leads to great job satisfaction, better patient satisfaction no outcomes, and a higher level of safety.

I would do 30 years of that. Otherwise...meh.

[kisspop]

Ruby Vee said:

I think you're way off base there. I think all of the articles about nurses eating their young, horizontal violence, lateral violence and bullying convince students and new nurses that this is what they're going to find in the workplace. Then, SURPRISE! They go out and find such things in the workplace. Even if they're not there. It's easier to blame your problems getting along with your new coworkers on bullies and NETY than it is to admit, even if only to yourself, that you may be partially (or even mostly) to blame for your difficulty getting along with others.

The fact that people believe they're being picked on, bullied, eaten or subjected to lateral or horizontal violence does not mean that they have been. And there would not be so many people believing in such things if there weren't so many articles out there about it.

And I think you're way off base there.

Which brings us to a stalemate really and brings up the point that we can't account for someone else's experience. Telling someone they're making things up is invalidating their experience and it's ultimately pointless.

In this case though, it seems far more inane to tell nurses that they "think" it happened rather than take it at face value that it did. You're not dealing with a psych patient there with a history of making things up. You're dealing with an educated co-worker who has gone through nursing school as well as the NCLEX, things that do require people to at least have a modicum of resilience. Statistically speaking (Stats is required where I went to school), it's more probable that the nurse's judgment is sound.

I'm curious to know though, for all the people that are tired of the "drama" (of which, bringing up the drama is making drama, so by your own logic, no you're not), what would convince you that this phenomenon actually exists? Does bullying exist to you? What does it look like?

I would like to point out that NETY does contribute to this nurse leaving the unit at least. I'm planning on transferring after 2 yrs because my unit refuses to address the issue. Are you going to tell me I'm making it up? lol

[phaith]

New grads simply don't have the insight to plan for what will happen next in an environment where patients are sick enough and nurse ratios are high enough that care MUST be proactive or things quickly slip out of control. 4 med-surg patients the first year should be the absolute brick wall ratio for new grads, and 2 PCU. After the first year or 18 months, nurses tend to understand the connections of things a bit more. The workplace is simply too busy to rely on an expertise-novice ratio structure anymore.