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).

[sarmedic70]

Totally agree on pretty much all of the points made as to why RNs quit. I lasted for a few years till I had it. I spent 39 years in the military (combined active duty and reserves), became a RN (while serving in the Reserves afforded me to go back to school and obtain my RN), and as a result have been appalled as to how RNs are treated by peers, nurse managers (from unit on up to the DON), and overall management. I never ever would have treated my fellow soldiers in such a way as what I have seen in nursing. There are many factors as to why the way things are still remain the same. We all have seen and experienced it. So you know what I am talking about. I loved my patients and I loved being a RN, but I will not tolerate "status quo" and poor management and caring of nurses who have a difficult job enough as it is from so many levels. This article presented hit the nail on the head as to the immense issues still faced RNs. I try to warn new nursing students as to what they will be faced with. Not to be a "Debbie Downer" or be negative.....but to prepare them for the REALITIES of nursing. This is something that is NOT taught in nursing school. I loved working with nursing students when they were doing their clinical rotation through my specialty area. I would ask them what their goals were, why they want to be RNs, etc. I spent as much quality time with them that I could. I wanted them to see the POSITIVE side of nursing BEFORE they entered into the field. However, the reality check is just what this article shared. Hopefully, one day, things will change. I have talked to several friends who have remained in nursing (due to being close to retirement) and have said things have not changed, but actually have become worse. Makes me very sad to say the least. I still think nursing is a VERY noble PROFESSION but until management changes (from the bottom up), we are going to continue with these continued issues and see many discussions and articles, such as this one.

[sarmedic70]

I left nursing for all the reasons (well most) of what this article shared. I was a RN for quite awhile (nearly 10 years) before I opted to go LOA. Right now I am working in my Criminal Justice degree; however, I don't have the satisfaction as I did as a RN (despite management, excessive demands, no lunches/breaks (and not getting paid for it - of which is illegal), covering another unit if a RN is on break or there is no RN, the list is endless. I do work as a RN in EMS but only part-time limited shifts. So, I have my somewhat involvement in nursing. I am not so sure I want to return back to nursing at this stage of the game. And I am always on the lookout for something else. I spent 39 yrs in the military (combined active duty and reserves - non medical - went to nursing school while a Reservist).I don't foresee things changing nor improving in the medical field for RNs and foresee it only getting worse unless things change drastically from nursing management, overall management to this patient-satisfaction nonsense driving by the "insurance" industry (of course, I want my patients to be satisfied, but it has gone overboard - as some of the others had shared). It is just nuts.

[elite_1, BSN, RN]

Agree! What is working in the community like? And What is EdD if you don't mind, thanks!

[LadysSolo]

EdD is Education Doctorate.

[riggy3, MSN, RN]

A great amount of responsibility to a novice nurse quitting in the first year falls back to the schools. The student expectations today are not realistic, many new graduates expect to begin as the Director of Nursing at Walter Reed never doing bedside care.

Graduate nurses have very little clinical training application. Some states do not even have a required amount clinical instruction hours for generic RN programs.

Interestingly most states with LPN programs have a specified number of clinical hours also advanced nursing programs like an NP, nurse midwife or nurse anesthetist have required amounts of clinical hours specified. The middle starting point RN nursing student programs generally have no specified amount of clinical required by the State Board.

Perhaps State Boards should require generic RN programs to have greater hours of clinical experience. Lacking clinical experience is then a cost issue for schools. Schools are even having difficulty trying to find hospitals who will allow students.

Some states allow the amount of clinical time total flexibility to the school. All clinical can be done on one weekend. This is great for the total on line programs, You too can be an RN . I believe New York and Virginia have programs like this. (Someone can help me here I forget the states)

Grade inflation, along with instructors Failing to Fail students to maintain numbers for school/ university enrollment statistics is common. My thinking was NCLEX would pick out these problems. Turns out the current millennial entitled students go to a few day program to Cram for the Exam. Students pay a fee to be given predictive tests and areas to cram study. These novice students then do indeed pass NCLEX. Taking the cram programs does keep the school statistics rate up. Still does not help prepare the student ability to critically think or provide a Novice Graduate Nurse a realistic expectation for success .

I retired recently due to students who put no effort into learning yet are still passed by the school. The responsibility for the early transition of many nurses falls to the schools and the State Boards. The cost to the schools adds to the issue If the ability to cut cost is as simple as clinical time cutting. This places the training responsibility back on the hospitals increasing the likelihood the hospitals will need to eliminate poor performing lacking interest nurses.

Looking at the common factor to nurse turnover boils down to the dollar.

[FutureNurseInfo]

So, I am at the very beginning stages of becoming a nurse. I am only taking pre-reqs as of now and will be applying to the programs next summer. However, I have been a teacher for 7 years and have quit the profession due to same reasons nurses quit. Some may say "Are you nuts for quitting teaching to work as a nurse when nurses experiences similar, if not, same issues?" Well, I guess I am. However, I still have hope that everything will eventually be fine. Also, having worked as a teacher and gained a valuable experience in the workforce, I will try to avoid many stressors, or at least, deal with them with the minimum amount of anxiety. Lastly, unless one works in some office in a cubicle as the article touches upon, no matter what profession one chooses, he or she will inevitably face a moderate degree of stress sooner or later.

[rlhouck09, BSN, RN]

Actually I still see NETY frequently! In different hospitals and different places. Yes, it does need to go away, so look for it and stop it - I quit my first job because of NETY. It makes me so mad to see the arrogance of nurses who think it's okay to NETY. If ya ever need an example come find me And I'll direct you to some places...

[Quickbeam, BSN, RN]

I have another one. "No vacation approved from 11/15 to 1/15 every year". I was unable to go home for Christmas even one year during my 20 hospital years. Mandated floating and double shifts. No other profession would put up with this.

These are also also the reason I transitioned to case management. I make more money, have professional respect and take a Christmas vacation every year. I loved patient care but got really tired of being treated like a serf.

[kneira]

Fairly new graduate here. Class of dec 2015, started as a resident in february and have been on my own since July so you could say I've been nursing for nearly 6months. I've had some bad days but today takes the cake. My assignment was spread out between hallways with 5 patients including a total with a trach, peg, picc and about 15 pressure ulcers and dressing changes. The entire day I was being given my ass handed to me but I broke down after my encounter with the second condescending doctor for the day. I'm so tired of being treated like I'm incompetent and a nuisance for just trying to advocate for my patients. Worst of all I couldn't even go to a corner and cry or compose myself. I was so knee deep with patients, nuclear med, physicians, family, pharmacy and so on, I had to just keep moving mid break down. Yes some physicians are just plain *******s who need to be put in their place, but nurse to patient ratio is the root of nurse burnouts and poor patient care.

[Doumbia]

Wuzzie, agree with much of what you say, but disagree in that I find it appropriate that the oncoming nurse publicly humiliated the new nurse. What age are we, are we in grade school? I have worked with (many) nurses who get frustrated when we are understaffed (which is freaking ALWAYS to be honest) and it gets overbusy and we are having a hell day. What are the responses of the nurses?- varied. But the most damaging response is when nurses get angry- start slamming charts down and throwing things around, barking at others or publicly humiliating; those things are all inappropriate behaviours in anyone over the age of.. maybe 23. It's also quite frightening for their coworkers, and it adds greatley to the stress level of the entire staff.

Life is a learning process and hopefully eventually people stop that stuff, but I have seen also many nurses in their 40's and 50's STILL doing this stuff. It's almost as if they take pleasure in it as a form of stress relief. And possibly it's also good for management in terms of.. divide and conquer. As long as nurses continue to resort to childish acting out, and bullying abusive behaviour to others, as their stress coping mechanism- NOTHING will ever change. We can all discuss this to death (useful actually in terms of parsing out problems)... but unless nurses eventually stand up to managment, NOTHING NOTHING NOTHING will ever change). In my first nursing job, in the first two weeks, I had a flash of realization that the working conditions in nursing were on a par with the most terrible jobs I had as a young teenager- dead end, no support from management, poor working conditions, etc. Has any of that changed? No. Is it because nursing is a traditionally "female" occupation and women traditionally have had a hard time advocating for themselves? I have to wonder about that. Unless nurses stand up for themselves (and that can make us very unpopular with management)... not sure anything will ever change. Downward spiral for profession, IMHO...

[SaggieRN87, BSN]

To be frank, I wasn't going to comment on this thread. I find that topics about new nurses, especially on this website, produce tirades bashing millennials and highlighting imaginary generational differences. I rather stay and focus on becoming a better nurse. Another thing I would like to comment on is the opinion of some that being a CNA should be a requirement for acceptance into nursing programs. Interestingly, I saw CNAs and other healthcare workers fail classes or out my nursing program completely. While these people had the practical skills to excel in clinicals, they did not possess the "book smarts" to pass the exams. I'm not implying that CNAs aren't book-smart but this is what I've seen. We must never forget that nursing is a science as well as an art. We must possess proficient knowledge base in medical sciences such as anatomy and physiology, pathophysiology, pharmacology, etc. in order to make sound clinical decisions for our patients. I think this piece gets lost in these conversations. However, to answer the question, I believe the following factors contribute to poor new graduate nurse retention:

1. Insufficient orientation

2. Unclear or unrealistic expectations

3. Poor communication and a lack of feedback from management

aka lack of professional development

4. Lateral violence

5. Excessive and redundant documentation

6. Fear of not being able to delivery safe patient care

There are definitely other reasons. However, as a new nurse who quit her first nursing job two months during orientation, these were my biggest issues.

[Doumbia]

SaggieRN87..... excellent, articulate response. Wow!! ?