Why Are Nurses Leaving The Profession?

Deborah Chiaravalloti - 04/08/19

A recent survey by RNnetwork shows that 49 percent of registered nurses have considered leaving the profession at some point over the past two years. That is not good news. At a time when nurses are reaching retirement age at an increasingly rapid rate, (due to the aging of the Baby Boomer generation) and nursing schools lack the educators needed to turn out sufficient numbers of graduates to fill job openings, the last thing healthcare needs is for nurses to drop out of the workforce. Their reasons for dissatisfaction and burnout are very real. They need to be taken seriously and addressed quickly. It is essential that we keep good nurses in the workforce.

The RNnetwork survey exposed many of the difficult working conditions experienced by RNs. Despite medical devices, electronic medical records, and modern technology, crushing workloads and grueling schedules are causing nurses to burnout. The survey found:

  • 40 percent of nurses believe they have less free time now than compared to two years ago
  • 62 percent of nurses felt regularly burned out in their jobs
  • 44 percent of nurses believed that burnout had affected their work performance

The looming national nursing shortage is contributing to burnout and adversely impacting nurse performance. The Bureau of Labor Statistics has predicted that between 2014 and 2022, there will be a shortage of 1.2 million RNs and its impact was reflected in the survey. When asked about the nursing shortage, respondents said:

  • 91 percent felt their hospital was understaffed
  • 88 percent said the shortage has negatively affected workloads, up from 62 percent just two years previous
  • 62 percent believed the shortage was negatively impacting the quality of care nurses could provide
  • 46 percent feel more overworked than they did two years ago

Some nurses report that they do not feel respected on the job, and that bullying is still alive and well it the profession. A majority, 62 percent, believe that physicians respect them, but that is slightly lower than survey findings two years previous (65 percent). In addition:

  • Only 29 percent of nurses feel respected by administrators, a significant decrease from two years previous (46 percent)
  • 33 percent said they feel fully disrespected by their top leaders

As incredible as it many seem, nurses bully nurses. Nearly 40 percent of nurses reported bullying and harassment in the workplace:

  • 30 percent of bullying and harassment incidents came from other nurses
  • 25 percent from patients
  • 23 percent from physicians
  • 22 percent from administrators

Any percentage of bullying is too much, and there should be zero tolerance for it in every workplace. The survey showed that the incidence rate is decreasing compared to two years ago. The 2016 survey reported, “45 percent of nurses reported bullying by other nurses, 38 percent by physicians and 41 percent by administrators.” (There was no mention of the previous rate of bullying from patients).

Fortunately, more than three-quarters of nurses (79 percent) said they do not experience sexual harassment at work. However, 21 percent said they do.

  • 43 percent from patients
  • 29 percent from physicians
  • 24 percent from other nurses

All of this is taking a toll on the mental health of nurses, which consequently impacts their ability to do their jobs

  • 54 percent of nurses reported their workload has negatively affected their mental health
  • 35 percent said their mental health had negatively affected their work 

Minority Nurse echoed these findings saying, “Many nurses run from the bedside as soon as possible because conditions are so deplorable.” The publication stated four main reasons why nurses are leaving the profession:

  1. New graduate attrition: With their first nursing job, new grads are suddenly on their own. Despite their training, they no longer have mentors at their side and Minority Nurse says they may find themselves “frightened and in despair. Cultural shock is a very real phenomenon.” As a result, they can’t wait to get out of bedside nursing and into another type of nursing role. (see more on this below)
  2. Staffing ratios: Minority nurse says that while staffing ratios are important, they are emblematic of the larger work environment. Not only do hospitals need to reduce the number of patients each nurse is responsible for, they also need to stem “horizontal violence” to keep nurses on the job.
  3. Compassion fatigue and burnout: These lead to depression, anxiety, and can ruin nurses’ lives. It creates an inability to extend oneself emotionally or care about one’s job or life. Administrators need to be aware of these issues and create support for nurses before they reach compassion fatigue and burnout.
  4. Injuries: As patients get larger, transferring them holds increased risk of injury. Lift equipment isn’t always available because it is expensive. As a result, back and other injuries are on the rise.

New nurses struggle to stay on the job

The peer reviewed journal Nursing2019 published a survey of 3,266 new nurses to find out why they were leaving their jobs. The nurses had been licensed for 18 months or less 85 percent worked in hospitals. One-fifth of them (610 nurses) had already left their first nursing job for the following reasons:

  • 42 percent: poor management
  • 37 percent: stressful working conditions
  • 34 percent: desire to experience a different clinical area.

New nurses also reported suffering bullying:

  • 62 percent had suffered verbal abuse

Many of the new nurses left because of the injuries they had suffered, including:

  • 46 percent: bruise or contusion
  • 25 percent: needle-stick injury
  • 21 percent: cut or laceration

Although they had just begun their careers in nursing, 41 percent said they would choose a significantly different career path.

Nurses speak

Surveys and third-party reports about leaving the nursing profession are one thing; hearing it from nurses is quite another. Here are the voices of two nurses who left the profession:

LEE,  a bedside nurse for 38 years:I have seen a lot of changes, and most of them are not for the better. Nursing is becoming more complex every day and the clinical expertise needed to continue to care for increasingly sick patients is unreal.

  1. Salaries have fallen way behind in many areas, as well as staffing ratios
  2. Upper management and corporate hospitals mind set is so far from reality that is ridiculous
  3. The atmosphere in many large hospitals, is much like a drive thru window at a fast food restaurant, push them out as fast as possible
  4. The ever growing "flogging" that many patients endure at the end of life is soul draining
  5. The patient is allowed to say and do whatever he or she wants when it comes to treatment of nurses
  6. Redundant computer charting, a punitive working environment, and lack of managerial support makes for a poor-quality working environment

I would discourage anyone from going into bedside nursing, until they have actually shadowed a bedside nurse in a large hospital for several days. 

Janet Wiege, a new nurse:I left my first and only job as an LTC in skilled nursing after four months. My training period was three weeks long because of their nursing shortage. I had 24 patients to care for while answering the unit phone calls, entering orders, talking to family members and doctors via phone, trying to manage the paperwork, and unit staffing when CNAs didn't show up for work. There wasn't much time left for actual patient bedside care. Twelve hours days turned into fourteen hours. One of my regular scheduled weeks was six days out of seven and the next week was one day, how silly. I had to leave because I felt I wasn’t giving enough time to the patients and worried I would make a mistake due to being rushed all the time. When I put in my resignation I felt like a failure.

Nursing is repeatedly ranked as the most respected profession in the United States. The majority of people revere them and hold them in the highest regard. There’s good reason for that; nurses are on the front lines of healthcare. When we are at our most vulnerable, they are the first people we see. It’s time to ensure that nurses themselves are no longer vulnerable to the ravages of the profession. Let’s find meaningful solutions to these problems and protect nurses who want to devote their working lives to the care and healing of other human beings.