10 Reasons Why Nurses Want to Leave Hospitals
The Robert Wood Johnson Foundation reports that one in five nurses leave their first nursing job within one year of hire.
That’s a sobering statistic given that it takes a minimum of two years to get the necessary education, plus passing a national licensing exam and getting licensed (which requires a fee) within the state of residence.
Why would a nurse be so quick to leave?
Although there are many other employment opportunities for nurses these days, most still work in hospitals, according to the US Bureau of Labor Statistics (BLS).
Still, nurses may want to leave the hospital environment, and managers often wonder why.
Nurses want to leave hospitals for a number of reasons.
A certain amount of turnover can actually be a good thing, as new employees can bring new ideas, skills and perspectives to an organization.
Excessive turnover, however, is costly, can be demoralizing to staff and is time-consuming from the point of dealing with the termination process, hiring new nurses and training them.
The reasons nurses want to leave a hospital range from working conditions to pay to relationships to personal issues.
People tend to get resentful when they don’t feel they can call their lives their own.
Mandatory overtime is one of those tough situations that can cause problems.
The hospital has a responsibility to make sure patients are safe and in some states the organization must also meet regulatory guidelines for staffing.
Many nurses don’t mind helping out in a crisis situation, but when mandatory overtime becomes the norm, they get tired and cranky.
They’re between a rock and hard place, however, as nurses who refuse to work mandatory overtime can and have been disciplined by the organization they work for.
Each state handles mandatory overtime regulations differently, but there is no state in which the practice is completely prohibited.
In some organizations, mandatory overtime is a way to avoid the additional costs of hiring new staff.
In the long run, however, this practice is counterproductive because it drives up turnover, which also has significant costs.
Like mandatory overtime, floating is another situation where it’s tough to make everyone happy.
Patients need care – does it make better sense to ask a nurse to help out or to leave one department overstaffed and another understaffed?
Learning something new can be exciting, but being required to step out of your area of expertise is scary, especially if you feel it puts patients at risk.
Nurses forced to float – as opposed to those who volunteer or who are hired specifically to float wherever they are needed – are often downright scared because they don’t feel they know what they should to keep their patients safe.
This can be particularly true for a new graduate or for a nurse who has only worked in one unit for a long period of time.
Floating can be even more stressful if the staff in the unit to which the nurse floats are not supportive, or worse yet, if they criticize the floating nurse for his or her efforts.
At one time, nurses were expected to perform housekeeping and other non-nursing tasks – today these highly skilled professionals should be better utilized.
Nursing is a profession in which it can look like the task is the job.
Not so – the nurse who is turning a bed-ridden patient is also assessing skin color, muscle strength and range of motion, as well as whether the patient is alert enough to follow instructions.
Cognitive skills, along with critical thinking, are often the most important aspects of a nurse’s job.
However, once the assessment has been completed, someone else could handling the routine of turning the patient for the rest of the shift.
Bog that nurse down so he or she can’t think, by forcing on tasks someone with fewer skills can handle and the nurse gets frustrated.
The nurse may also be so distracted that patients suffer because there are too many non-nursing tasks to do.
Bullying and Abuse
Sadly, there are still people in health care who think it’s OK to bully and abuse the people with whom they work.
Nurses often report verbal abuse at the hands of physicians and in some cases, have had objects thrown at them.
Experienced nurses may bully students and managers may bully staff.
These toxic working environments create high turnover conditions, as no one is going to stay in such a situation if they have an opportunity to leave.
The hospital culture can lend itself to this problem for several reasons.
First, health care still tends to be hierarchical, with doctors on top of the heap.
Second, doctors are often seen as making money for the hospital, while nurses are an expense.
For a hospital administrator, allowing a physician who is a big moneymaker to behave badly may seem like a lesser evil than high nursing turnover.
A nurse’s relationship with his or her manager is vitally important in preventing unhealthy turnover.
The manager is especially critical for the new graduate, who needs support and education to learn how to be a fully functional nurse.
When staff find the manager to be cold or distant, they stop taking problems to the manager (which shuts off a valuable source of information, allows the problems to get worse and creates other problems).
A manager who doesn’t seem to understand or care about the nurses’ concerns, or who can’t communicate empathy, creates barriers that can seem insurmountable.
For many nurses, the only solution is to leave the hospital.
Nursing is a profession in which you have many opportunities to learn new skills or to become specialized in a variety of areas – you can have a dozen different “careers” and still be a nurse.
Within the hospital, upward mobility can be limited, as management positions may be the primary option.
Others specialize in areas not found in some hospitals, like endoscopy or cardiac rehab, or become entrepreneurs in various health care fields.
Although nurses are well-paid compared to the average American worker, many would like or need to earn more.
Sometimes that means moving in the geographical sense, as pay is often tied to locality.
Government positions typically pay more for RNs than hospitals do, according to the BLS, and may draw nurses who are otherwise happy in the profession.
Related positions can also be a draw; being a pharmaceutical rep, for example, allows the nurse to draw on his or her education in the field while making considerably more money.
High pay within the hospital is often tied either to management positions or to shift work – many organizations pay a differential for less popular shifts like nights.
Working nights has some definite disadvantages, though, so a nurse who has the opportunity to make more money elsewhere on a day shift is likely to jump ship.
Staffing and Workload
Nursing is often a very physically challenging job.
Changes in reimbursement mean that most patients who are hospitalized are quite sick – people who need a lower level of care go home sooner or are treated in outpatient centers.
The high acuity means people need extra care, while lower reimbursement means it’s hard to pay for that care.
Hospitals handle this issue by staffing for the minimum in many cases.
If a nurse calls in sick, there may be no replacement.
The other issue is staff mix – how many RNs/LPNs/CNAs are assigned to a unit to care for a given number of patients.
If there are too few RNs, it means those RNs who are working have extra responsibility in supervising licensed staff and have the additional workload of tasks only an RN can perform.
When units are chronically understaffed or the staff mix has too few RNs, nurses may vote with their feet by leaving the hospital.
Hospitals are 24/7 operations – they have to be.
That means someone has to work the night shift.
In some organizations, the least experienced nurses wind up on nights – a stressful situation for the novice nurse that can be potentially dangerous for patients.
Some organizations consider it is most fair to allow senior nurses their choice of shifts, while others handle the fairness issue with rotating shifts, which is extremely hard on the nurse’s health and can lead to severe sleep deprivation.
Working nights when you also have family responsibilities can be very difficult, not to mention that the rest of the world runs on a different schedule.
Family time and social activities may have to take a back seat; sometimes even sleep takes a back seat.
Nurses who work in hospitals also work many weekends and holidays, which cuts into their personal lives.
That can make an outpatient surgery center or doctor’s office very attractive, not because the work is different, but because of the daytime hours with weekends and holidays off.
Other work settings may also offer eight instead of 12-hour shifts, which may be easier to work around family members’ schedules, child care or other commitments.
Older nurses may also find it physically harder to work 12-hour shifts, which are most common in the hospital environment..
Novice to Expert
All new graduates need some seasoning to become expert nurses.
While hospitals are a good place to get that seasoning, they are often a nurse’s first job.
Once he or she has a little experience under the belt, it’s common to look around and think, “OK, what else is out there?”
Some nurses move on to a challenge within the organization – move, for example, from a medical/surgical department to critical care or emergency.
Others look outside the hospital to something like home care.
This is one kind of turnover that is a very natural progression of the process from novice to expert, and a certain amount of this kind of turnover should be expected.
Of course, nurses leave the hospital for other reasons.
The family may be relocating because the nurse’s spouse has taken a new job, or to be closer to an aging parent.
After a few years, the nurse may decide this was not a good career choice (it can be hard to know whether the shoe fits until you’ve worn it for a while).
Nurses do grow older and retire, while others may be forced to leave the profession for health reasons.
Some nurses develop “compassion fatigue” and burn out, a not uncommon occurrence in service professions.
Nursing turnover and the reasons it occurs are complex issues; there is no one-size-fits-all solution and each nurse makes a decision for his or her individual situation.
However, for the organization that wants to minimize nursing turnover, there are some important take-home messages: treat people well, with respect and kindness; make sure managers are competent, empathetic and really care about their staff; listen to staff concerns; offer fair pay and good benefits; do everything you can to mitigate the disadvantages of shift work and staffing difficulties.
These strategies can go a long way to keep nurses from leaving hospitals.
Written By 3rd Independent Party