BY BENJAMIN J. FOSTER, MBA, CDP
In December 2022, roughly 95% of the healthcare organizations Nurseify supports reported their highest annual nurse turnover and all-employee turnover rates in the last 10 years (Source: Client RN turnover and all employee turnover data). The Great Resignation is real in healthcare, and unfortunately, the healthcare industry is experiencing a Great Exodus when it comes to the nursing workforce. In Q1-2023, we surveyed 100 nurses who made the decision to leave the healthcare industry altogether. To gain additional insights, we conducted follow-up focus groups and one-on-one interviews with 30 nurses who completed the survey.
Survey respondents self-identified their generation and race/ethnicity. Of the 100 nurses who took the survey, 28% of the respondents are Baby Boomers (57 – 76 years old), 24% are Gen Xers (43 – 56 years old), 24% are Millennials (27 – 42 years old) and 24% are Gen Zers (26 or younger). The median nurse tenure is nine years. From a race/ethnicity perspective, 40% of the respondents identify as white or Caucasian, 36% Black or African American, 12% Hispanic or Latinx, 8% Asian American, and 4% biracial or multiracial. Eighty percent of the survey respondents worked in acute care settings; 20% worked in non-acute care settings. Survey respondents represented 22 different states. Although the primary drivers for leaving the healthcare industry vary across the diverse survey respondents, the underlying reasons that sparked the nurses to consider leaving the industry are surprisingly similar. In this article, we will explore the top reasons why nurses are exiting the healthcare industry.
What three words best describe how you have felt over the last 90 days?
The first question in the survey was, “What three (3) words best describe how you have felt over the last 90 days?” The Top 3 words were: EXHAUSTED (65 responses), OVERWHELMED (57 responses) and DISAPPOINTED (41 responses). The COVID pandemic caused significant pressure on an already strained healthcare system. The healthcare industry was experiencing record levels of burnout prior to the pandemic, so we are now experiencing generational exhaustion and fatigue. In follow-up focus groups and interviews, nurses explain that vacancy rates continue to skyrocket, causing the nurses who are staying to take on higher workloads and additional overtime. The nurse case managers who participated in the focus groups explained that they transitioned to the bedside at different points throughout the pandemic, and in some cases, they still have not returned to their pre-COVID roles and responsibilities. Despite brief periods of relief, the continued stress brought on by the pandemic and race to get back to business as normal are causing immeasurable damage to the nursing workforce.
The only positive-sentimental word that appeared in the Top 10 responses was HOPEFUL (22 responses). During the follow-up focus group, three nurses noted that they were a few of the 22 survey respondents who listed HOPEFUL as one of their three words. They went on to explain that the reason why they were HOPEFUL was because they made the decision to pursue one of their lifelong passions full-time. Unfortunately, the nurses who are pursuing their passions will all eventually leave the healthcare industry altogether.
What prompted you to seek employment outside the healthcare industry?
Survey respondents were given nine options to select from and were asked to select their Top 3 reasons. Three points were given to the #1 response, two points to the #2 response, and one point to the #3 response for a total of 600 points [=(100 x 3 points) + (100 x 2 points) + (100 x 1 point)]. The reasons are as follows:
- Career advancement / promotion
- Compensation / benefits
- Entrepreneurial interest
- Family circumstances
- Lack of recognition
- Relationship with your supervisor
- Working conditions
- Workplace culture
- Other – Please explain.
The Top 3 responses identified by the survey respondents were:
- Working conditions (28%/168 points)
- Career advancement / promotion (20%/120 points)
- Workplace culture (19%/114 points)
The stories and anecdotes shared during the follow-up focus groups and one-on-one interviews shed light on why working conditions were identified as the #1 reason that prompted nurses to seek employment outside the healthcare industry. Twenty-one of the 30 nurses (70%) who participated in a follow-up focus group or one-on-one interview explained that they had been subject to or witnessed nurse abuse in the workplace. Twelve of the 30 nurses (40%) were physically assaulted in the workplace and filed a police report on a patient or family member in the last 12 months.
The American Nurses Association conducted a separate study that found “one in four nurses are abused in the workplace. Overall, the likelihood of healthcare workers being exposed to violence is higher than prison guards or police officers” (Source: American Nurses Association #EndNurseAbuse Resource Guide. 2016). In 2021 and 2022, 68% of the organizations that included a statement in employee engagement surveys on the facility taking steps to protect employees’ physical safety at work saw a year-over-year drop in scores (Source: Client employee engagement survey results).
In addition to working in an unsafe environment, nurses explained that carrying high patient loads was another factor on why they selected working conditions as the top reason that drove them to seek employment outside the healthcare industry. Bedside nurses explained that their patient loads have been higher than their facility’s “recommended” patient-to-nurse ratios for the last 12 months, with several critical care nurses explaining that they were asked to consistently care for three or more patients and medical/surgical/telemetry nurses explaining that they were regularly assigned seven patients to care for during their shifts. Lastly, nurses explained that they believed their facility was intentionally understaffing their units in an attempt to cut costs by eliminating shift differentials and removing travel nurses.
Key Takeaway: Unsafe work environments and high patient loads create working conditions that lead some nurses to leave the healthcare industry altogether.
Career Advancement / Promotion
With a median tenure of nine years, most nurses who participated in the survey exceeded the 10,000-hour requirement to become nursing subject matter experts. Although nurses acquired significant clinical experience, several nurses believed their careers had stalled. They explained the pandemic postponed some of their career aspirations because they either did not have time to pursue their career aspirations or did not have the energy to do anything else outside of their day jobs. They also noted that they are making a commitment to aggressively pursue their career aspirations in 2023 and are reserving the time and energy to act.
Nurses have numerous career paths within the healthcare industry, so we explored reasons why nurses selected career advancement/promotion as a reason to seek employment outside the healthcare industry. One-third of the nurses who participated in the follow-up focus groups and one-on-one interviews explained that they plan to pursue a career in academics and are either pursuing adjunct faculty roles or are transitioning to be a full time student. They believe their clinical experience will support their career advancement in an academic setting better than within the healthcare industry. Twenty percent of the nurses are leaving healthcare to work in technical sales roles within the pharmaceutical, medical device and/or technology industries. On average, nurses transitioning into sales roles explained that they will have the opportunity to earn 25% more than they make in their current role and have the flexibility to work from home.
On a positive note, all the nurses who participated in a follow-up focus group or one-on-one survey and selected career advancement/promotion as a reason to leave the industry stated that they would consider transitioning back to the healthcare industry at some point in the future if the right opportunity presented itself. They explained that their next career opportunity will diversify their experience and give them an opportunity to recover from a very taxing period in healthcare.
Key Takeaway: Academic roles and sales roles are the top two opportunities for nurses who identified career advancement/promotion as a reason to leave healthcare; nurses view those roles as opportunities to get a respite from healthcare and earn more money in some cases.
Workplace culture has and will always be a top reason why people leave any industry, and the nurses who completed the survey reinforce the importance of investing in workplace culture and leadership development. Supervisor/manager support and lack of teamwork/collaboration are the two primary drivers why nurses selected workplace culture as the reason for leaving the industry. Nurses explained that poor leadership, nurse bullying, nurse incivility (#NursesEatTheirYoung) and lack of collaboration/teamwork have plagued the healthcare industry for decades. Nurses do not believe the industry will change in the near term, so they are opting to leave the industry altogether.
Survey respondents provided feedback on their most recent manager, department and organization. For each question, the respondent identified how much they agree with a series of statements from Strongly Agree to Strongly Disagree. The bottom four statements are presented below (% Favorable = % Strongly Agree + % Agree).
- My supervisor/manager demonstrates fair and equal treatment (17% favorable)
- My supervisor/manager advocates for all employees in the department (19% favorable)
- My supervisor/manager listens to suggestions and ideas (20% favorable)
- My supervisor/manager resolves complaints and problems (24% favorable)
Employee Net Promotor Score (eNPS): On a scale of 1-Low to 10-High, would you recommend your current organization to a friend or family member as a good place to work?
Only 22% of survey respondents gave a 9 or 10 score, while 64% of respondents gave a score between 1 and 6, which equates to an eNPS of -44 = 22% (9’s & 10’s) – 64% (1’s – 6’s) = -42. Negative eNPS scores reflect toxic workplace cultures, and, unfortunately, the nurses who completed the survey have firsthand experience of toxic workplace cultures.
Key Takeaway: Poor leadership and toxic workplace cultures are not only driving turnover within a healthcare organization; they are also driving nurses away from the healthcare industry altogether.
We can learn a lot from nurses who are deciding to leave the healthcare industry. Gaining a better understanding of why they are leaving the industry can help healthcare leaders develop strategies to retain those that have not decided to leave. We must all band together to (1) create a safe workplace environment for our clinical workforce, (2) acknowledge the exhaustion our healthcare workforce is experiencing and provide opportunities for the workforce to rest and pursue non-traditional paths and (3) invest in our healthcare leaders to become better leaders. Lastly, we encourage all healthcare leaders to take another look at the feedback they are already collecting from their employees and identify the areas where they are at risk of losing employees from the industry altogether.
Benjamin J. Foster, MBA, CDP, is the CEO/Founder of Nurseify, Inc. He also is a member of the CMSA editorial board. You can reach Benjamin via email at [email protected].
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