For the last few years there has been a trend seen among the work force of nurses: nurses are quitting their jobs or leaving the profession entirely at a much higher rate than has been seen in decades.
There are several factors that are contributing to this trend, with worsening staff shortages and burnout among nurses being the most reported reasons for nurses leaving their current roles.
This exodus of nurses coupled with an aging population and an expected increase in the need for nurses over the next several years is causing an even larger and more acutely felt nursing shortage.
Certainly, action must be taken now to stop this trend in order to retain current staff and attract new nurses to the field so that the U.S. healthcare system can continue to provide safe and competent care for all.
Why are Nurses Quitting their Jobs or Leaving the Profession?
Burnout and High Stress Work Environments Cause Nurses to Quit Jobs
A recent poll taken by connectRN provided valuable insight into the reasons nurses are quitting their current jobs. The majority of nurses reported that burnout and high stress work environments were the reasons they were leaving.
It’s no secret that the COVID-19 pandemic added a massive strain to the U.S. healthcare system and the devastating and overwhelming effects of this pandemic were directly felt by the nation’s frontline healthcare workers, nurses included.
The pandemic caused a large influx of patients into the hospitals, creating an unprecedented number of patients for each nurse to care for, creating strain on already short-staffed units.
This large influx of patients coupled with the lack of staff, witnessing an increased number of deaths related to COVID-19, and other issues such as lateral violence, caused many nurses to quit their jobs or the profession entirely during this time, creating an even larger nursing shortage.
Even now, after the peak of the pandemic, the nursing shortage is larger than it was prior to it and nurses are still feeling the residual effects.
Hospitals are still severely understaffed, creating high stress work environments for nurses and leading to burnout among them. This puts each nurse at increased risk of leaving their current jobs or the profession of nursing, and also poses a safety risk for patients.
In fact, according to the poll, 90% of nurses reported that they feel that the staff shortages have caused lower quality care to be delivered to patients.
Nurses report feeling guilty for taking their much-needed breaks, for not being able to be in multiple places at once, and for delivering what they see to be suboptimal care.
Violence Towards Nurses by Patients is Causing Nurses to Quit their Jobs
Equally problematic, 65% of nurses also reported being physically or verbally abused by patients within the last year, with frustrations over staffing being a leading reason for the aggression.
This aggression by patients and their family members has historically been ignored by healthcare leadership, often followed only by discussions as to “what could have been done different” by healthcare staff to prevent these occurrences.
Such discussions should take place, certainly, but many nurses feel that it is not enough. They report feeling that leadership does not care about their safety, as little is done to help shield nurses and other healthcare professionals from such acts of violence.
Nurses have been made to feel that this abuse from patients and families is just part of the job and that they are expected to simply deal with it. For many nurses, however, this outlook creates a feeling of complete disrespect for nurses, and they feel utterly unsupported by management.
Discrimination has also been reported by nurses, most of which coming from patients or their families, but also has been reported as coming from management.
Due to these issues, nurses often feel that they are not respected or appreciated for what they do and for working as hard as they do for their patients, units, and organizations. Given the statistics above, it should be no surprise that nurses feel this way.
While some hospitals are attempting to make a move toward better supporting nurses and taking a “zero tolerance” stance on the issue of violence and abuse of healthcare workers, more needs to be done to ensure the safety of all workers.
Low Wages Encourage Nurses to Quit
Nurses are also citing low wages as a reason that they are quitting their current jobs. COVID-19 has once again played a role in this.
Following the massive layoffs that were seen across the nation during the peak of the pandemic there has since been a shortage of workers in nearly every industry.
In many areas of the country the shortages have been so high that wages continue to rise, with many industries now offering higher wages than ever before. Many of these places of employment offer much less stressful jobs than the work that is done in hospitals.
For nurses who are feeling burnout, attacked, and underappreciated, a career change for similar pay might look pretty good. Especially in those areas of the country that do not pay nurses well.
Hospitals have attempted to combat this some by offering sign-on bonuses, but many nurses are weary of having to sign on for the next “X” number of years. They’ve been abused before and aren’t keen on being married to an abusive organization again. Not having to sign contracts offers them the freedom to leave if they need to, whenever they need to.
Hospitals have also done little to raise the hourly wages of nurses. Even through the pandemic and increased nursing shortage, wages for nurses have barely moved at all, while wages for nearly all other industries have increased significantly over the last few years.
Poor Work/Life Balance Driving Nurses to Quit their Jobs
Nurses often work 12-hour shifts in busy hospitals where they run from one hallway to another, administering medications and answering call lights.
They work nights, weekends, and holidays. They miss their kids’ ballgames after school. They arrive home after their shifts exhausted and with nothing left to give their families, emotionally or otherwise.
Their fluctuating schedules also do not allow them to recharge on their days off and at times they are bitter about missing out on so much with those that they love.
Nurses crave a better work/life balance, flexibility in their schedules, and more time off. Some are leaving the profession of nursing entirely due to this issue alone, as a better balance can be found in other professions and job opportunities.
What are the Repercussion of a Continued or Worsened Nursing Shortage?
The repercussions of failing to address these issues could be utterly devastating to the American healthcare system.
Nurses make up a large majority of clinical staff and if nothing is done to address the large number of nurses leaving the profession, the nursing shortage will only continue to grow, causing an even greater strain on every aspect of the healthcare system.
As mentioned previously, a large majority of nurses state that the current staffing shortages that are being experienced by hospitals are already affecting patient care. Nurses feel that when they are short-staffed, they cannot provide optimal care to their patients.
When patients receive suboptimal and potentially “distracted” care, this poses a great patient-safety risk. If nurses are not able to adequately monitor and care for patients the outcomes could become catastrophic.
Changes in patient condition that may warrant an increased level of care, medication administration, and other nursing tasks may not take place in a timely manner and may therefore place the patient at risk for poor health outcomes.
Nurses are already reporting the delivery of suboptimal care and extreme guilt for this in hospitals across the country. If the nursing shortage continues to grow, the nurse-to-patient ratio will continue to climb, and nurses will continue to be overwhelmed by their assigned duties.
This could then throw nurses into a downward spiral, where because of working short staffed, nurses become overwhelmed and burned out. This in turn leads them to quit their jobs, which then places the remaining staff under even more pressure and risk for burn out. This is a trend that is already being seen in hospitals and has the potential to worsen if the nursing disparities are not addressed.
What Can be Done to Address these Issues?
The issues that are being experienced in the American healthcare system are complex and will certainly take time to fully address.
However, action must be taken now in order to address the large number of nurses who are quitting their jobs.
If steps are not taken towards this goal, the nursing shortages will only continue to grow, which will affect patient care and productivity in hospitals across the country
Address the Root Causes of Burnout in Nurses
The most cited reason for nurses leaving their current jobs has been burnout and high stress work environments. While many factors can attribute to this, inadequate staffing on nursing units is the driving force of burnout in nurses, as it causes nurses to become overwhelmed by the number of patients they must care for and expands their responsibilities for these patients.
Nursing management should predetermine what a safe nurse-to-patient ratio is, taking into consideration the level of acuity of patients that are cared for on the unit, resources available to the nurses, and number and level of supporting staff that help make up the care team (nurse’s aides).
This ratio must then be standard and must not be surpassed. If additional patients need care, management should call off duty staff to inquire about their ability to come in to work or the hospital could divert patients to another facility who are able to safely care for them.
Diversion is not ideal for hospitals, but unsafe conditions for patients and workers should not be considered ideal, either.
To prevent diversion in hospitals while maintaining safe care environments for patients, efforts should focus on recruiting additional staff to the units. A few ways to do this are to offer such incentives as higher pay, flexible scheduling, and ample time off.
Nurses have reported these specifically as factors that would help alleviate the feelings of burnout. According to the poll mentioned earlier, these are what nurses themselves have asked for to make them feel more valued by their organization.
Offering these incentives to nurses’ aides would also be beneficial in ensuring adequate supporting staff for nurses, as well, helping to alleviate some of the responsibilities of nurses and could also allow for higher nurse-to-patient ratios if there is adequate support staff to aid nurses in caring for patients.
This is another solution to help alleviate the pressure on nurses during this nursing shortage while still providing safe care environments and without diverting patients.
Another smart solution to addressing staffing issues in hospitals is to create apprenticeships, bridge programs, and training programs within hospitals to fill shortages quickly, where possible.
If hospitals can get nursing students into their organization early and start building a relationship with them, they would stand out as an obvious choice as an employer after the student graduates. This could help them fill the gaps in their units and ensure that safe staffing levels are obtained on each unit.
Protect Nurses Against Violence in the Workplace
Violence and discrimination against nurses and other healthcare workers cannot be permitted by organizations, regardless of where it comes from.
Even a patient should not be allowed to abuse their caregivers and when abuse occurs, management should step in to help alleviate the tension and provide support for nurses. Even allowing multiple nurses to care for a difficult patient instead of one nurse being responsible for all of the care, can help alleviate the feelings of not being valued as a person or professional, as it helps the nurse feel supported by their coworkers and management.
Healthcare is a high stress environment in many cases and this stress cannot always be avoided. But looking for ways to manage it when it does occur and for ways to support frontline staff is paramount in making nurses feel safe and valued in their workplace.
In addition, a leading cause for violence against healthcare workers is related to staffing issues and the perception of patients or their families that they are not receiving adequate care. Employing the tactics cited above to help recruit and attract more nurses and support staff would be an important solution to the problem of violence in healthcare organizations, as well.
Increase Salaries for Nurses
Nurses have reported that their salary does not reflect the level of care they provide, how hard they work on their units, or the value the bring to healthcare organizations.
Nurses are specially educated and trained professionals who fill a unique niche within healthcare systems.
They deliver direct care to patients, act as care manager for each patient, communicate with every member of the healthcare team to ensure quality care, aid in performing various diagnostic tests and therapeutic treatments, engage in technical skills such as foley insertions, and monitor patients for changes in condition to prevent deterioration of the patient.
Nurses deserve to be compensated for their level of knowledge and skills, and for filling this specialized and highly needed niche within the healthcare system.
Many nurses could make comparable salaries working in other industries that are much less stressful and this reality should be acknowledged and addressed to prevent nurses from leaving the profession to work elsewhere.
Improve Work/Life Balance of Nurses
Nurses have also cited their grueling work schedules to be a source of dissatisfaction in their work. They are asking for more flexibility in their schedules and more time off in order to feel fully recharged when they return to work.
Some healthcare organizations have sought to address this concern by employing such strategies as self-scheduling, where nurses help to schedule themselves, thus giving them more choices in when they work.
This must, of course, be approved by management to ensure that adequate staffing is had each day but more opportunities for nurses to choose their hours would be extremely helpful in addressing this issue.
Other hospitals have offered nurses the ability to choose the length of their shifts. Some nurses find working 12-hour shifts, which can easily bleed into 13 hours due to the need to provide a hand off report to the oncoming shift, is too exhausting for them both physically and mentally.
Some organizations are offering nurses a choice between 8-, 10-, or 12-hour shifts. In this way, nurses are given more power over their own schedules and can choose a schedule that works for them and their families.
Ensuring a schedule that nurses can commit to long-term is a very forward-thinking solution. If nurses can’t see themselves working a certain schedule long-term, they are more likely to leave the organization in pursuit of a schedule that works better for them.
Providing that schedule at the hospital helps to keep the nurses there and also attracts new staff who are also looking for increased flexibility and thus a better work/life balance.
A Call to Action
Nurses are invaluable assets to the American healthcare system, and they fill a very specific niche that cannot be filled by others. They deliver the bulk of patient care and work tirelessly to ensure quality care for their patients.
They have specialized knowledge and skills that cannot be understated. Organizations need nurses to function, and steps must be taken immediately to address the root causes of why nurses are quitting their jobs or leaving their profession.
The future of healthcare depends on it.
Resources:
- ConnectRn. Industry Insight 2022.
