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).

[Neurotic Student]

I am sort of a new grad to nursing and I've contemplated leaving several times. I am seriously considering it. A lot of reasons discussed here are true. Fortunately I haven't really been bullied as others have. I just can't stand the expectations, the stress is overwhelming. I believe myself to be inherently prone to stressing out anyways.

It is considered the nurse's fault for everything. Your aide didn't do this? Why weren't you monitoring your aide? Medication isn't there, gotta go pick it up from pharmacy, and now almost everyone's meds are late. Pt asks for water, oh I can grab it real quick, much quicker than trying to hunt down the aide to tell them. Got the water, now pt wants an extra blanket. Now there's only one aide on the floor and 3 of my pts are urinating almost hourly or Q2 due to the IV fluids running through them but they are fall risks so they'll either use the call light or set off the bed alarm. I do 12 hours shifts but on average they are 13-14 hours. Giving/receiving report is typically >30minutes, unless I only have 3-4 reports to give and it's the same nurse. These are some of the few.

I'd rather take a pay cut for less stress, and I probably will go that route.

[greatgiginthesky]

llg said:

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.

I think much of this issue is due to the prevalent notion of a severe nursing shortage (which was briefly mentioned in this article). I'll be starting nursing school in the coming months and have done a fair amount of research to prep myself for the job market as a new grad. In speaking with other nurses and health care professionals, nearly all told me that this was a great time to enter the nursing field because so many nursing positions need to be filled. While this may be true, most of the positions needing to be filled require an experienced nurse, making it difficult for a new grad to enter the type of nursing he or she would like. Right or wrong, many grads then take any job available to them with no intention of staying to get the 1 or 2 years experience needed to pursue the position they really want. And if a hospital is willing to throw in resume- building educational opportunities within those couple years, then it can turn into a pretty nice deal.

I have no idea how to solve the issue of constant turnover within hospitals, but a good place to start might be loosen up on some of the experience requirements for nursing positions which could lead to more long term hires of new grads.

[RegularNurse]

First, bedside nursing is rarely desirable long term employment.

Nurses quit for better jobs. Whether it is NP, administrative, or non-physical RN jobs, they are just better in every way.

For example, writing blog posts about nursing is a much easier job or supplemental income source than working as a staff nurse. (I do think it is a well written post)

[MaeRN1]

I've been a NICU nurse for almost 20 years. I am reading all of these reasons and nodding my head... Been there, done that.. At this point, my reasons for wanting to quit are quite different than those posted here. If I might be Frank here, I'll tell you what those reasons are. I work with babies, and we consider the family unit our patient, but when it really boils down to it, the babes are my priority... And, after almost 20 years and tons of education, I think I know what's best for these kiddos. I've been accused of being controlling and of thinking these kids are mine... No, never by a parent, but rather by women online who insists that the child is theirs, and that they will direct the care of the babes, as if they, these non-medical parents, know what's better for the child simply because it's their child. So, the nurses, myself included, just kind of hang around and do our assessments, while the parents direct the other care of the child. Forget that the babe is less than 34 weeks, and susceptible to IVH's with improper and too much handling. Forget that the kiddo is Coombs positive with a Bili pushing 16 at less than 24 hours of age and needs supplementation for the first couple of days to drive the Bili down rapidly, but rather, let's start an invasive IV on the kid instead, and then yell at me because I stuck your baby and it cried.. I'm tired of all the suspicion, all the disrespect, and of all the times I am ignored because, somehow, these parents know better... Then, what am I there for?

That's most of it, but there are other reasons I'm looking to do something else besides bedside nursing... I'm just not going to go into it all...

[FloridaBeagle]

llg said:

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

Gotta admit I'm guilty of that. I never really wanted to do hospital nursing, but needed that magical "1+ year(s) of med-surg" experience to get a cushy-office/clinic type job (which I have now in school nursing).

HOWEVER, I could have been convinced not to leave with higher pay and better benefits. Hospitals need to focus more on retention.

[Nurse Beth, MSN]

RegularNurse said:

First, bedside nursing is rarely desirable long term employment.

Nurses quit for better jobs. Whether it is NP, administrative, or non-physical RN jobs, they are just better in every way.

For example, writing blog posts about nursing is a much easier job or supplemental income source than working as a staff nurse. (I do think it is a well written post)

As a nurse writer who writes blog posts, well, I only wish it provided sufficient income and benefits to be considered on par with a job, lol. What I love most about being a nurse writer is not the supplemental income but having a voice and advocating for nursing.

I no longer practice at the bedside. My hat is off to all of you who do-you're all my heroes!

I loved, loved patient contact and clinical (bedside) nursing practice until I injured my back helping a doctor insert a central line. I tried to pull a bed out from the wall to make a space for him between the head of the bed and the wall. The bed was locked, and the jerky movement against an inanimate object resulted in an injury. It probably was a function of repeated stress on my back over years. My fault, bc the bed was locked, but it was a very old model and our hospital had many different beds at the time, all which operated differently. My doctor looked at my MRI and called it "nurse's back".

I work full time in acute care as a Nursing Professional Development (NPD) Specialist aka Med Surg Educator. My units include oncology, corrections, surgical, medical, and Peds. I also do new hire Orientation, policy review, train Preceptors, Shift Leaders, teach Basic Arrhythmia, CNA CE classes, and..any special projects as assigned ?

I have lots of part-time and sequential jobs as a writer. In the past couple of years, I've done contract work for HealthStream, Versant, ANCC, and ANPD, mostly content development as a subject matter expert. I volunteer for AMSN and am doing Lippincott procedure reviews for them right now.

If any of you want to be a published writer, start here at allnurses (shameless plug)! Or go on over to the Innovator's Hub and join in the discussion.

You are so right, bedside nursing is relatively short-lived. I still miss patient contact and providing care.

Where I'm going with all this is, plan for your future. Get your education so you will have options when twelve hour shifts at the bedside are no longer one of them.

In my Ask Nurse Beth column, I regularly receive letters from nurses who are 50+ and looking to leave the bedside, but have only an ADN degree. It is much more difficult for them to find a position than for their colleague with a Bachelor's degree.

[TheCommuter, BSN, RN]

I entered nursing as an LVN. My first licensed nursing position was at a smallish nursing home in February 2006. I received one 8-hour shift worth of orientation before being cut loose to work on my own.

To be fair, my orientation was supposed to have been three days, but the nurse assigned to train me called in sick on two of those days. Since I showed up, I was handed to keys to the medication cart and told to work.

I lasted approximately six weeks at this place before moving on to somewhat greener pastures. I probably would have stuck around if the investment in training me would have been more substantive. Also, a few of the other nurses were blatantly rude, though I realize no one owes me a darned thing (including kindness).

So, yes, I quit my first job. However, nothing about this first job was alluring enough to compel me to remain employed at that facility.

[Not_A_Hat_Person, RN]

I graduated with an ASN just before the 2008 economic crash. All I wanted was a basic med-surg job. No one wanted to hire new grads. Even nursing homes wanted a BSN and 1 year of experience. After 10 months and a cancelled job, I moved 250 miles for a job in assisted living. I never wanted to work in LTC, but we all have to start somewhere, and I figured experience was experience.

The place turned out to be revolving door. Most of the nursing staff had been there less than a year. My 2-week orientation was overseen by my charge nurse who had started 2 weeks earlier. My job consisted of passing meds and being a charge nurse, despite having no nursing or management experience. I learned a lot; some good, some bad.

After I hit the 1-year mark, I started job hunting again. The positions that had required 1 year of experience now wanted 3-5 years of experience, in the specialty you were applying for. I ended up taking a job in what turned out to be Nursing Home Hell. After 3 days of facility orientation and 2-1/2 days on the floor, I was on my own, with 17 residents, most total care, and LNAs who did very little beyond feeding, ambulating, and toileting. Most of my co-workers flat-out refused to help me. I was working the business shift on the hardest unit. I tried to transfer to a different shift or a different unit (they were looking for night shift nurses), but I was refused. I ran screaming after 6 weeks, swearing that I would sell my body on the street before working in another nursing home.

The next month, I found a job in home health. It paid very badly, but it was steady work with supportive management. I learned a lot. I'm now with a different agency, doing the same work. I'm glad I found my niche, even if it doesn't pay well. If I hadn't been hired, I would have left nursing for good. I will only go back to LTC if my family is facing immediate homelessness.

[smartnurse1982]

Not_A_Hat_Person said:

Even nursing homes wanted a BSN and 1 year of experience.

Wait,WHAT?

I think nurses who graduated at that time(I had finished an Lpn to Rn program at that time) just received a bad deal.

I almost choked on my water when you wrote"I will sell my body on the street before I work in another nursing home".

I agree with you,but instead of the streets I would go to Dubai.

[Carabella]

Daisy4RN said:

What are the reasons nurses quit?? All of those stated in the article and then some. Bottom line is that job satisfaction (at least in the hospital setting) has steadily declined as workloads and stress has steadily increased. Bedside nurses are held accountable for EVERYTHING. It used to be that the nurse was responsible for the nursing care. Now everything is the nurses responsibility/problem (ie lab didn't come/blood draw, meds not delivered by pharmacy, PT/OT didn't come, Doctor didn't come, lunch/the right lunch didn't come, no supplies on hand, no working equipment, no CNA, family wants to speak to you again, pain meds every 2 hours, routine meds 5 times on your shift etc etc etc). And don't forget the endless charting. The hospitals cut back while at the same time the patients are requiring more time, either because of (medical) acuity, or because the pt/family is demanding (even though medical issues don't require that much time, but you know, customer service..). Bottom line is that nurses are running around attempting to get everything done but it is always a loosing battle and someone is always complaining because its never enough! Do we really need to ask why nurses are quitting??

So true!

[Carabella]

Kate_Peds said:

I remember being a new grad and experiencing the "floating" that, ultimately, caused me to find a new job. Being new, I had the fewest points, meaning that I was the first pick to float every time. My first week and a half off of orientation I floated to tech on other floors. After that, I was spending probably one shift a week floating to do non-nursing work. Safety sitting, suicide watch, tech work, etc. I remember being back on my home unit after a long string of floating, I had a patient that was not looking so great. I had no clue what I was doing and another nurse came to my aid. I left my shift scared. I felt completely incompetent.

Reflecting back on it, I realized that I was taking a long time to complete very simple nursing tasks, such as priming IV fluids. Things that I was very good at, now I was fumbling through because I had been doing non-nursing work for several weeks. I was truly embarrassed and I was concerned about my own ability to complete the job. I felt bad leaving that job, but in the end, I suffered greatly being so new and being pulled from the bedside to watch monitors. My already novice skills deteriorated very quickly.

There is a lot more paperwork and charting in nursing than ever before. I truly think the learning curve for a new nurse today is higher than it was 15 years ago. I'm not saying that nursing itself is harder, I'm just saying that they've added so much more, while giving so much less in terms of resources. When you're already new and don't have adequate time management skills, it's easy to be swallowed up by the extra clerical duties and waitressing that they expect you to do.

Uggggggh! Floating should be distributed so nurses take turns. It is not right that you were treated like this. When I started in nursing, I got a five week classroom orientation, and then a critical care orientation after that (I started on a cardiac unit). I was then precepted until I was ready. I was comfortable with starting lines, drawing blood, codes, interpreting ABGs, EKGs etc... We had time to talk to our patients and teach them! There were no "scripts"... Clearly we were expected to be compassionate patient advocates. Having said that, it was okay to respectfully stand up for ourselves; and administration had our backs for the most part. I soon felt very comfortable as a critical care nurse! All of my colleagues from those days fondly remember those times. I really liked critical care and ER nursing but things have changed a lot and I now practice in a hospital, but away from the bedside...

[Carabella]

riggy3 said:

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.

New York State has requirements in terms of clinical hours.