In healthcare, the costs associated with nurse turnover have been well documented, with reported averages ranging anywhere from $36,000 to $57,000 and beyond depending on specialty and experience. While dollar figures are a tangible way for hospitals to understand the effect of losing nurses, the overall impact extends across whole facilities and deep into departments, including the nurses who remain on the unit. Reasons that these nurses leave have also been well documented; however, not everything can be analyzed by statistics, dollar signs, or anecdotes from Managers and CNOs. In my first six years as a bedside nurse, I worked at five different facilities across four different specialties. Here are the main reasons nurses leave their jobs from the perspective of a nurse on the front lines.
First, a preface: The conversation around nurse burnout and retention needs to be reframed. This is not just about preventing nurses from leaving. Rather, the goal should be to create a workplace environment that makes nurses actually want to stay, which is different from just not wanting to leave. More than semantics, this forces department leaders to be proactive and forward-thinking in the way they manage their worksite.
The Obvious Ones:
- Relocating: Life happens, and there's not a lot you can do about that.
- Ratios: Even though states set mandatory maximum staffing ratios, let’s get real: Sometimes nurses are given more than that. Acknowledging that this happens is the first step (because it does). You’ll find a strong correlation between departments that do a good job of sticking to these ratios and satisfied, retained nurses.
- Management: This is consistent across many industries, but good Managers lead to happy employees. Finding a style that works for your department type and set of employees will benefit the department in the short and long term.
- Doctors: No one wants to say it, but if a hospital is full of doctors who treat their nurses terribly, nurses will leave.
The Communal Ones:
- Community: Fostering a healthy, engaged community of nurses and nursing staff creates a bond that leads to better teamwork, healthier patients, and happier nurses. It is, unsurprisingly, difficult to do well. We recently wrote about one department that identified colleague supportiveness as the most significant factor impacting nurse stress and satisfaction, and some tips for improving team engagement and collaboration.
- Bullying: The reverse of a positive community, bullying is a disease that can sneak into departments. This has received a lot of attention online, and my own experience supports the idea that it’s a major problem. As a new nurse on an IMCU, I experienced a heavy dose of bullying. I literally had anxiety about going to work, not because I couldn’t deal with the patients, but because I couldn’t deal with some of the nurses. That job did not last long.
- Report: This is a very specific issue, but sometimes the culture surrounding report is pretty terrible: Some nurses taking 15 minutes before they’re ready for report, asking for entirely too much detail, making you feel bad about leaving a task for them after a crazy night, and so on. When you’re leaving a shift 30 minutes to an hour late because of report, it cuts into your personal time, sleep, and enjoyment of your job (and life!).
- The Little Things: Recognizing nurses for their good work makes a difference, whether it’s positive comments from coworkers or patients or nice gestures. There are some people who don’t think they need recognition, but the truth is we all do. Some hospitals even go a little further, occasionally giving gifts, dinners, turkeys, and more to their nurses for the work they do. When you’re getting off of a difficult shift on the front lines of healthcare, it’s the little things that can make a big difference.
- Having a Voice: How is it that a CNO doesn’t know that their nurses are caring for more patients than they should? Many nurses don’t feel comfortable speaking up, which means that departmental problems remain bottled up and nurses become demoralized. And more than just providing them with a safe avenue to speak up, nurses need their voices actively solicited regarding many of the decisions that directly affect them. If not directly heard, they should at least be properly informed ahead of time, keeping them engaged and involved.
The Operational Ones:
- Advancement: Providing nurses with the ability to advance their career includes more than just allowing them to get their BSN or DNP. Night shift nurses unable to move to day shift will apply to a different hospital. Setting up a system that migrates nurses into roles and shifts that meet their needs will help retention. And at a macro level, we desperately need nurses’ perspectives and experience in more leadership roles such as on healthcare policy-making groups and hospital leadership boards. Most departments and facilities have a long way to go to better prepare and position nurses for these opportunities, but we must start moving toward this.
- Preferred Schedule: There are few things in a nurse’s life more frustrating than having an erratic work schedule that destroys your personal life. Working with nurses to give them a sensible schedule will help overall nurse satisfaction and retention. When your career requires you to work half of all holidays and weekends with a sporadic weekday schedule, being able to plan further than 45 days out can go a long way to a nurse.
- Alarm Fatigue: When bed alarms are used too liberally, nurses can burn out fast. One night, I decided to count how many times a bed alarm went off in my department. 42. FORTY-TWO! And every time one goes off you’re expected to run to the alarm, only to find that for the 41st time it was just a 90 pound elderly woman shifting in bed. Alarm fatigue can also apply to telemonitors, nurse phones, and even personal phones. When you’re being called and texted every day to come in and work (sometimes for shifts you’re already working because your management is just mass texting) you begin to tune it out. This fatigue can accumulate and overwhelm staff, not to mention reduce their responsiveness, which can negatively affect managers and schedulers.
- Workplace Investments: When I worked in the older wing of a hospital, with older beds and dirty carpet in the hallways, I had a patient ask me, “Am I being sent here because I don’t have insurance?” If a patient feels like this after a three-day stint, how can we expect nurses to stay three years or more? When a nurse feels that pinch, it’s demoralizing. Investing in the facility may seem costly, but losing nurses to a newer hospital is expensive too.
Nurses give their hearts for their jobs, sacrificing a lot for the health of the patient. As hospitals search for more ways to increase nurse retention, they need to think about how they can better care for the caregiver. Creating a positive culture with sustained investment in the workers will have a reciprocal effect, leading to better patient outcomes, a greener bottom line, and more retained nurses.
Zach Smith is a BSN-RN and current VP of Nursing for NurseGrid. Zach helped create the NurseGrid Mobile app, the preferred way to manage a schedule for over 250,000 nurses. Zach is currently helping hospital departments across the country roll out NurseGrid Manager, a departmental technology to help nurse managers fill open shifts, send messages, manage credentials, and more.