Should I Stay or Should I Go?

• Nearly 4.3 million nurses are employed in the United States and over half of those work in a hospital or hospital system. In a 2021 survey of 1000 registered nurses, one third were contemplating exiting bedside nursing. 
• Many research studies have been conducted in the pursuit of discovering why nurses are fleeing the profession.  These studies have uncovered numerous influences on the decision to stay or to go. 
• Hospitals must quickly address nurse retention rates to keep the healthcare system afloat. 

Effective healthcare today is dependent upon its most abundant resource – nurses.  Nearly 4.3 million nurses are employed in the United States and over half of those work in a hospital or hospital system.  Healthcare is not blind to the reality of rising costs and is tasked with identifying new methods to control these expenditures.   

Nursing’s influence on high quality, cost conscience care must be viewed as a very real contributor when contemplating how to meet the challenges facing healthcare today.  Unfortunately, many nurses and other healthcare team members report strong feelings of being disrespected, disregarded, and belittled.  At the end of the day, these nurses experience conflict and internal turmoil resulting in a negative impact on patient care.   

With healthcare reimbursement ever more dependent upon patient outcomes, administration must take a long and in-depth dive into why nurses are leaving the bedside and how to get them to stay. Healthcare facilites, no more than ever, need to shift their focus to nurse retention.

Many research studies have been conducted in the pursuit of discovering why nurses are fleeing the profession.  These studies have uncovered numerous influences on the decision to stay or to go.  Undoubtedly, work environment, job satisfaction, compensation, and other personal and professional considerations must be calculated to arrive at a definitive answer, but in truth it is different from nurse to nurse.  Decisions to stay or go must be viewed through a lens of personal satisfaction and professional context, but this view requires balance.   

While days, midshift, or nightshift may present unique challenges to nurses with children at home, empty nesters may be unaffected. However older, more experienced nurses may demand higher compensation by transitioning into a leadership role.   

Nurse Retention

Retention of staff is likely the principal issue facing healthcare and healthcare systems today.  In a 2021 survey of 1000 registered nurses, one third were contemplating exiting bedside nursing.  A mere six months later, two thirds of the six thousand critical care nurses surveyed anticipated resigning from bedside care.   

An increasing number of patients face serious risks as nursing turnover rates continue to soar.  The cost of turnover can be more than $40,000 per vacancy and healthcare systems are incurring $3-6 million dollars in losses annually.  These losses include the cost of new recruitment, interviewing, and training new hires.  This process is time consuming, and that cost is passed on to the individual departments in terms of lost productivity.

These recurring short-staffed circumstances can cause poor morale amongst other employees resulting in a domino effect as more nurses opt out of the bedside position.  When turnover rates are especially high, word of mouth gets out and many talented potential employees may decide against throwing their hat in the ring.  These conditions may leave management to bring in travel nurses at an average cost of $83/hour – significantly more than a staff nurse earns, which causes increased negativity among staff.   

Lack of nurse retention and high turnover rates have become a nationwide challenge.  Perhaps the main reasons these rates are high and continue to soar is a red-hot job market, burnout, and mandated COVID vaccinations.   

There will always be demand for healthcare, hence nurses will always be a sought-after commodity.  The well documented nursing shortage of the last decade is only expected to expand as Baby Boomers move into retirement. 

The Bureau of Labor Statistics forecasts nearly 300,000 new nursing positions before 2030.  With an aging population and an increase in chronic health issues, job opportunities will continue to multiply.  Employers must be aware of these conditions and have contingency plans in place that might include increased pay, bonuses (recruitment & retention), and value-added benefit packages. 

Burnout

Burnout has grown exponentially since the onset of the pandemic and shows little chance of slowing soon.  Nurses generally work 12-hour shifts under demanding conditions including chronic illness, potentially deadly viruses, short staffed, and receive little respect or regard.  These factors can make for an incredibly stressful environment.   

Additionally, nurses under these conditions are often required to work longer shifts or extra days, can be floated to care areas they are unfamiliar with which require skills they do not possess or are uncomfortable performing.  The pandemic forced many hospitals into hiring freezes and patients deferred regular care.  These pauses in recruitment coupled with deferred healthcare by patients culminated in overcrowding, previously unseen saturation levels, and a dramatically overstretched nursing staff.  

Finally, there is no shortage of controversy when discussing COVID mandates.  Most U.S. hospitals require COVID vaccinations of all employees in the same way they mandate flu vaccine and annual TB screening.  Many facilities were unwavering in granting waivers of exemptions, forcing some nurses from the bedside.   

One survey found more than 11% of nurses were reluctant to comply with the mandates and more than 5% flat refused.  Many healthcare facilities dismissed nurses concerns over the vaccine including the speed of the vaccine’s development, lack of safety and efficacy studies for the vaccine, and apprehensions regarding side effects.   

Some are calling the mass exodus of healthcare workers since the onset of COVID the “Great Resignation”.  The Pew Research Center reports one of every five healthcare worker stepped away from their employer from 2020-2021.  With demand for healthcare skyrocketing and labor force dwindling, the U.S. healthcare system may be facing collapse.  Not surprisingly, disrespect was cited by 57% of respondents as the driving force that propelled them from the bedside.   

These healthcare providers may have stepped away from the bedside, but not necessarily healthcare altogether.  Many are opting for alternative clinical situations such as outpatient facilities trusting in lower stress environments, shorter hours, and no weekends.  Others are choosing non-clinical positions in consulting and corporations believing these will offer enhanced working conditions and improved general well-being and still others are selecting adjunct healthcare fields parlaying their experience and knowledge base into pharmaceuticals, education, and insurance domains.

Strategies to Increase Nurse Retention

Building successful teams in healthcare can often hinge on nurse retention.  This has never been truer than during healthcare’s comeback from the pandemic.  Tried and true nurses bring incredible value to the table and are exceptionally positioned to help hospitals attain their organizational goals.   

Onboarding

Onboarding new talent is a costly alternative and therefore managing the current workforce is a much more cost-effective option.  Hospital administration and system leaders should strive to take a proactive approach to nurse retention. 

One way to achieve this goal is introducing new technologies capable of completing the humdrum, tedious, and time-consuming tasks of nursing thus freeing nurses to dedicate their time and expertise to direct patient care.  Reducing sick calls by permitting some online training and competencies to be completed at home while increasing paid time off allotments should be considered on the pathway to improving retention rates.   

Patient Acuity

Finally, leaders should utilize data driven solutions to address patient acuity levels and develop new methods of assignment construction to recognize nurses on the verge of burnout leading to departure.  

Work Culture

Cultivating a more personalized employer-employee relationship is another manner that hospitals and networks could employ to keep their valued, time-tested nurses.  Leaders invested in their staff’s goals shows the level of respect that nurses are seeking.  Nurses want to be more than an employee number on a payroll sheet.  They want to feel valued and respected by the organization in which they give their skill and dedication.  Leaders should support and encourage autonomy whenever possible and always include their staff as valued stakeholders in discussions as they are usually the recipients of agreed upon resolutions.   

A positive culture is also a critical factor in retention in hospitals and healthcare networks.  Creating an inclusive, positive workspace where nurses are comfortable exchanging challenges faced at the bedside and ideas for improvement far outweighs a hierarchical leadership structure that is inflexible and often non-responsive.  This type of environment puts nurses on the defensive and enforces a punitive setting where fear becomes the driving force. When leaders see errors through the lens of opportunity, it is more likely to bring about improved patient safety and enriched patient care. 

Healthcare has all been held hostage to strict CMS guidelines for some time. This alone may impact nursing retention so hospitals and healthcare networks must pivot quickly to address the mass migration of nursing from the bedside.  Reimbursement hinges on patient outcomes and overall experience and nursing is a key factor in this must-win scenario. 

The Bottom Line

Taking a personal inventory and acknowledging one’s strengths, weakness, aspirations, and goals is fundamental to making the decision to stay or go.  Afterall it may not be the profession one needs to leave, but simply the current job or employer.  Nursing is a wonderful career because of the latitude it allows, and the may tangents one can explore. 

Only nurses can make the individualized choice to stay, to go, or maybe seek a change in the profession that meets your unique talents, skills, and expertise.  Talk to friends, family, and colleagues about your dilemma, but then listen to your inner self.  Only you can know what is best for you! 

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