Why nurses leave and what hospitals can do to incentivize staying

Remember the “Great Resignation” of the COVID era? Close to 100,000 nurses walked away from their hospital jobs in 2021 alone. Many if not most were 35 or younger, meaning they had the best years of their careers ahead of them. 

The national nurse workforce has largely bounced back, but some geographic areas and care settings continue to grapple with shortages. In fact, HHS’s Health Resources and Services Administration foresees the problem continuing until at least 2036. 

HRSA’s projection is based on a review of data from the latest edition of its National Sample Survey of Registered Nurses. 

New academic research analyzing data from the same source—the latest completed edition being the 2022 survey—drills down into nurses’ self-reported “turnover behaviors.” 

The study is running in the June issue of Health Affairs Scholar. 

In introducing their findings, corresponding author Amy Witkoski Stimpfel, PhD, RN, and colleagues note that, as policymakers and health systems confront widespread staffing shortages, “an understanding of nurse turnover during the pandemic and the motivations of actual turnover in nurses is critical to help provide actionable evidence to inform retention strategies and improve workforce planning and sustainability.”

Here are six key takeaways from the new study. 

1. Nurses who are dissatisfied with their job are more than 2.5 times more likely than their not-dissatisfied peers to leave their primary position. 

This finding is consistent with existing literature, the authors note, adding that nurses who self-report burnout are also at high odds of leaving.

2. Nurses with education-related factors—including current school enrollment and holding of graduate degrees—are more likely to leave than those with a Bachelor’s degree. 

School enrollment is a leading indicator of a “planned transition,” Witkoski Stimpfel and co-researchers report, noting that an advanced degree “reflects upward career and financial mobility.”

3. Participation in collective bargaining is associated with a lower likelihood of turnover. 

A recent scoping review found mixed results on the impact of union membership on nurses’ job satisfaction and retention, the authors point out, “but suggested that the processes by which unions function may help illuminate needs and concerns of frontline staff to leadership.” 

4. The pandemic has been viewed as a catalyst for nurses’ surge in union participation, with rates above the national average of private-sector workers. 

Historic strikes and contract negotiations across the country over the past few years have been focused on improvements in not only pay but also nurse-to-patient ratios, protection against workplace violence and guaranteed work breaks, the authors write. 

“Unionized workplaces may reflect organizational environments with stronger labor protections or improved working conditions,” they add, “aligning with our central finding associating job dissatisfaction as the strongest predictor of turnover.”

5. Actionable strategies for organizations seeking to reduce turnover should involve improving nurses’ job satisfaction.

Such initiatives should include efforts to reduce burnout and improve employment opportunities to promote better work–life balance, Witkoski Stimpfel and co-authors suggest. “Unlike resource-intensive options that take considerable time to implement, such as credentialing programs, our data suggest more immediate policy levers to reduce turnover,” they state.  

They name as examples “adopting flexible scheduling policies—for example, self-scheduling or nontraditional shift lengths—which may appeal to nurses balancing work and other obligations such as child or elder care or school.”

6. Another actionable strategy is reviewing and potentially increasing RN salaries. 

Witkoski Stimpfel et al. cite prior research showing that RN wages had the smallest growth from 2012 to 2023 compared with other health professionals. 

“While RN salaries often are the largest cost center in hospitals’ budgets,” they write, “the value of increasing wages to offset financial losses due to RN turnover needs to be considered.”

In coverage by the news operation at New York University, Witkoski Stimpfel’s home base, the nurse-researcher underscores the singularity of the study. 

“Most workforce studies ask workers about their intentions to leave their jobs,” she says. “The National Sample Survey of Registered Nurses asks nurses if they actually left their job—so it’s not just intentions, it’s the behavior that actually happened.” 

The study is posted in full for free.