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).

[bhouse113]

As a new grad in1989, these are the same issues I faced. I left hospital floor nursing as soon as I could.

[Lovemed]

You know, maybe it's an age/maturity thing. I'm 50, I've been a classical singer my whole life, a clergywoman and I've been a chaplain at a large hospital for 8 months. I'm pursuing an RN slowly and doing CNA/PCT state boards soon. At my clinicals I was excited. I love chaos and multi-tasking and challenge. I'm also divorcing with two little boys and I feel so lucky, SO privileged at the thought of being in healthcare and I'm excited in my class studies. I can't wait to be an LPN/RN or PA one day. Some of the RN's scare me where I work I admit it openly but I know that the pressure they feel is serious. Adjust your attitudes and try to keep your job. Be proactive and ask your colleagues if they will start a babysitting co-op with you. Seek another area of nursing or medicine that suits you. Do what you need to do.

[justavolunteer]

I am 'justavolunteer' on a patient unit. I think a new job in any field has the potential to cause a person to feel overwhelmed at first. This is especially true of nursing because the stress level is so high. Also, unsafe staffing levels, unrealistic demands on nurses time, the fixation on survey scores, etc (all of which = the administration doesn't give a %$#@ about the nurses). Sometimes I wonder why anyone wants to be a nurse. i am surrounded by people who appreciate me and I love being a volunteer where I am. However, if the administration was ever hauled into court and accused of caring about the nurses, the case would be tossed out in a heartbeat for lack of evidence.

[Ruby Vee, BSN]

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.

It seems that many young people graduating from college and finding their first jobs these days still live with their parents. They can justify quitting a job because they "hate it" if someone else is paying the rent and putting food on the table. When I started 40 years ago, almost no one still lived with their parents after graduating from college -- I would have (hell, I DID!) eat macaroni and cheese seven days a week and rented a room from strangers before I would have moved back in with my parents. And because I -- and most of my peers -- were paying our own way, we didn't have the option of quitting.

[CathyGubersky]

I have thought for a very long time about when I was most happy working in the hospital as an RN. Sorry this may bore many younger, newer nurses but 8 hour shifts allowed you to work several days per week with many of the same nurses and develop a team mindset that is missing today on nursing units. The stressful job of nursing should not extend longer than an 8 hour shift. As the article said there is no office or place for a nurse to go to decompress, and being expected to be "on" for 12+ hours is not healthy. Also, having CNA's and LPN's as part of the "team" and of course a unit secretary takes a lot of workload off the RN, and allows for true nursing assessment to be done on your patients. An 8 hour shift also still allows family and friend time after work, something that is missing from a 12+ shift. IF someone called off for the next shift working 4 hours longer, and having the next shift nurse come in 4 hours earlier is much more do-able. Having graduated from a diploma nursing school program, based in a hospital, we were provided numerous clinic hours to hone our nursing skills and did not suffer "reality shock" of today's BSN nursing graduates who do not have nearly enough clinical hours in their programs to feel at all skilled when they take on a nursing job. Increase the clinic hours by at least double and that would help. Graduated in 1974 and still working full time, and still paying on my student loans for BS and MS degrees too!

[caliotter3]

Ruby Vee said:

It seems that many young people graduating from college and finding their first jobs these days still live with their parents. They can justify quitting a job because they "hate it" if someone else is paying the rent and putting food on the table. When I started 40 years ago, almost no one still lived with their parents after graduating from college -- I would have (hell, I DID!) eat macaroni and cheese seven days a week and rented a room from strangers before I would have moved back in with my parents. And because I -- and most of my peers -- were paying our own way, we didn't have the option of quitting.

In total agreement. Granddaughter whines and complains that she wants to quit her first job (in retail) because she doesn't "like it". I continue to remind her that no employer was in any hurry to hire her before she happened to get this job and she should keep that in mind. Somehow she thinks that employers will fall all over for her uneducated, unmotivated 'looks'. And she defends to the hilt living with her mother and paying no rent. On occasion she buys groceries but in no way is she making an effort to actually support herself. School is just an interruption to her social life. At her age, I had been on my own for five years already. Times have changed.

[Ruby Vee, BSN]

kisspop said:

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

There are bullies in nursing -- I've seen two in 40 years. But failing to say "good morning" is not bullying, nor is not wanting to share personal histories with the orientee you met yesterday. Negative feedback is not bullying, even if it isn't delivered in your preferred manner. Too much of the complaints of "bullying" we see these days is nothing of the sort. And that devalues the REAL bullying it that is out there, although rare.

The nurse who shoved her orientee across the room and into the furniture because she "wasn't moving fast enough" may have been a bully. If she also scheduled that same orientee to work every Sunday for six months, threatened to fire her every week and nitpicked her charting until the manager called the orientee into the office daily for weeks, it is more likely that the nurse was a bully. If she called the orientee at home on her day off and threatened to fire her if she didn't come to work "right now", stuck her hand down the orienteers boyfriend's pants at the unit Christmas party and then said "I could (bad word) him right now if I wanted to" to the orientee, that might be bullying. If she told the orientee "I'm going to ride you until you quit," that might be bullying. But that sort of thing is rare.

This idea that "bullying is anything that makes me uncomfortable" is a crock we're selling to new nurses who then fail to learn about workplace relationships because they're so sure that everyone around them is a bully. THAT is more harmful to new nurses than letting them learn to deal with negative feedback and workplace relationships.

[Julie Carr]

Nursing is a tough job, you need your family behind you. It is not just passing a few meds, and putting on a little baid aide. Residents take alot of meds wounds are heavy then you have labs, DRs orders, family to contend with , call out's CNA call out you have to do there job also. If you work days you have all of that and usually stay till at least 5PM. 3-11 has admissions. So the older nurses get burned out. I have thought about quiting my self. Then I go in and a patient will say oh I am so glad you are here . It is no longer a 8hr job and you family ha to understand cooking after a day like I described is not a option. Well that's my thoughts.

[kim.kitchen60]

I have been in Nursing since 1989, have my BSN. I can't believe the stuff that is tolerated in nursing in any setting: sloppy looking, long nails, no common sense, feeling that they don't have to do certain things. It is just a whole different setting that it was in the years that I started. Nurses in management have not been precepted or have any idea about leadership, they allow bullying, and just do not really monitor what is going on amongst their staff.. They are just untrained, don't care, and are mean. I had a nurse mgnr that was just awful. In her office she had a poster up of Al Pacino as Scarface: must of been her idol, because she had that attitude. Us older nurses are done, we just couldn't take the redundant paper work and the chaos that continued, poor leadership, and working with a bunch of sharks. I am still in nursing, I tutor students to pass tests and NCLEX, by helping them understand the questions. Im sorry such a noble, wonderful art became so ugly. Kim Kitchen RN BSN

[nutella, MSN, RN]

What I tell high school students who are interested in nursing as a career is that :

If you are comfortable being uncomfortable - nursing is for you!

I do not agree with the idea that the younger generation, that is now coming out of the nursing school, is doing something "wrong" or is all about instant gratification or can't be uncomfortable.

But their behavior is a product of a constantly developing world with parents who seem to be very concerned to expose their kids to anything or , the other extreme, neglect them.

What I do see is that nursing and healthcare in general has changed. Nursing is very different from even 20 years ago. It is all about the "tasks" and completing the endless list of "to do" - which is often too long. This generation is better educated than any generation before us. They do not put up with something "just because" - which is actually something I admire. I am not saying one should quit right away with little problems. But I think that not putting up with too much balony is to the advantage of everybody in the end.

One of the reasons for young people to stay at home or to move back in are the high costs of education.

I think it is totally ok to place a high value on life-work balance and also to consider "happiness" and overall life. I feel that the generation graduating now is perhaps the first one that is not forced to "just suck it up" and who will also determine the "rules".

When I look at how med/surg has become for nurses - between intentionally understaffing (to save money) to forcing nurses to also work for the techs, to dealing with highly emotional patients and families, and the usual stress of working in a hospital it is no surprise that nurses run away. Why shouldn't they???? What else has to happen so that the people who make decisions and who are in control realize that patients only get care that adds value when nurses actually have the time to do so and the time to think and reflect. I do think that the baby boomers who were used to just slaving along in the name of "caring" and who would constantly jump in and "work extra" undermined change that is necessary. For sure it happened in different setting I worked in. Instead of all nurses pulling on one string, some would "work extra" and put pressure on everybody else. HR does not see a need to hire when there are always people jumping to the rescue who thrive in this environment and who get a lot of validation through "being needed".

I now work in a hospital that values nurses and is not punitive. Of course there is a normal turnover and there are also a lot of nurses back in school to become NPs or educators. But to me it seems less turnover as compared to other hospitals.

I like to work with the young generation - my perception is that they are motivated, want to do a good job and care. There needs to be mutual respect. Yes, I have more experience but I also learn from them. A different perspective sometimes, a different opinion.

[SeasonedOne, RN]

Reality check! Over the years we have negatively altered the supportive and progressive model affecting nursing in the following ways:

#1 Student Selection

Schools placing a high priority on "A" students who can memorize materials. In practice, I'll take a "C" student with good people skills and common sense any day of the week. Let's face it, having a higher level to pass the boards tends to be a driving force.

#3 Attempted Killing Off LPN/LVN Programs

With the "better care with all RNs" rhetoric we have decreased options for upward transition from CNA to LPN/LVN to AS-RN to BSN, etc. Over the years many RNs would have been better served as an LPN or an CNA than in a position of responsibility. Not everyone was meant to be an RN. CNAs, LPN/LVNs and AS-RNs really understand the basics of patient care where BSN focus is more admin. The transitional stair-step model of the past helped weed out those not suited for nursing early, rather than going 4 years and then quitting.

#3 Primary Care Model

The less than brilliant idea of changing from the supportive team nursing model to the more isolating primary care model may have looked good on paper but in practice patients are getting poorer care now. It is an expensive choice and had decrease the continuity of care.

#4 Not Starting At Med/Surg

If you don't give nurses a basis for making decisions on the big four: COPD/CHF/DM/Renal diseases, how do you know they can recognize a problem? Developing self confidence by sheer repetition is a good thing. The basics can be scary as heck by themselves and then you throw someone into a critical situation...many run like hell.

#5 Nursing Aptitude

Part of nursing is to weed out those without the aptitude for nursing. It is more than showing up for work and collecting a paycheck or assuming you will be the boss. It is emotional, or should be at the gut level. It is service with a smile, or it should be. It is staying that extra 5 minutes holding a hand even if you aren't getting paid for it or it should be. Nurses have to have inner strength to act calm on the outside even though being scared within. It is being a teacher, a confidant, a cleric to all religious need PRN, or it should be. It is learning to listen to your gut instinct and be willing to act even if you are proven wrong, cause one time you might be right. It is learning to face your fears of not knowing and trying anyway. There are times you will second guess your decisions and hope you made the right one - yes you will be uncomfortable and you should be...for to be overly confident has even more risks. Nursing is not always hearts and flowers. It is sometimes emotionally painful as well as rewarding. Nursing is not for the faint of heart. I would say that many nurses who leave have difficulty acting in one or more of these roles or instances.

#6 Is It A Profession?

When I started on the first day our instructors advised us were were nurses 24/7. We had a standard to uphold while at work and off hours in the community. Dress appropriately, act the part. BE a professional. Today, I'm amazed how nurses want to demand others respect them, when they have little respect for themselves shown by their actions and appearance. Is nursing these days still a profession or just a job?

#7 Life Is Unfair

If you work in this profession long enough you will have an issue with staffing, poor supervisors, overtime, and a hundred other injustices nurses face. In reality, we make a good living, are respected by our community, do good things in service to others, and hopefully when we lay our heads down at night, are happy.

Yes, there are probably some things we as nurses can do to keep people in nursing but the question really is, do we want to? If you are not cut out for our profession, isn't it better to leave and change your path sooner rather than the potential harm of doing it later? And for those with unrealistic expectations, the 'school of hard knocks' is an unrelenting teacher.

[johsonmichelle]

I see some interesting and valid points on this thread but there are some misconceptions . Nursing students have evolved, the new graduating nurses today tends to be older, may have a previous degree and work experience. Cost of living has risen but the not the pay which has caused some people to live longer at home then they should. If a new nurse is still living at home, I highly recommend that he/she save money and work at the job for a while before moving out. I have also seen a lot of people quit who have children and mortgage to pay so its just not those who are living at home. At one of my previous jobs, the older nurses were leaving because they could not cope with the hospital new charting system. At my current job, they have the highest turnover I have even seen in my life. A lot people have told me that they will not work at my facility even if its the last nursing job on earth and thats coming from both new and experienced nurses. We are in desperate need of nurses , they don't get a lot of applicants, the ones they do get, they don't show up to orientation or they quit after a few days of work.