Top Factors in Nurses Ending Health Care Employment Between 2018 and 2021

Muir, K. Jane; Porat-Dahlerbruch, Joshua; Nikpour, Jacqueline; Leep-Lazar, Kathryn; Lasater, Karen B.

doi:10.1001/jamanetworkopen.2024.4121

Cited by 5 publications

(5 citation statements)

References 44 publications

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“…Friese and colleagues found that the risk factors for nurses’ intention to leave their employer were heavy workloads and concerns with management and leadership; and the most important factor in leaving the profession was burnout. These findings align with another recent study on the top reasons nurses cited for leaving their employer: insufficient staffing and burnout. These 2 independently conducted studies provide corroborating evidence that a major factor influencing nurses’ intentions to depart and their actual decision to do so is understaffing.…”

supporting

confidence: 91%

“…That is why serious policy action that targets the retention problem at the source is needed—now. The latest evidence from Friese and colleagues adds further confirmation to what others have found, which is that nurses are not fleeing their profession, they are fleeing their employer. If policymakers do their jobs to ensure the public gets safe, high-quality care in every hospital across the country, they should start listening to nurses and acting on the evidence: safe nurse staffing policies will save lives and keep nurses at the bedside.…”

mentioning

confidence: 53%

“…Recruiting and training more nurses will not retain them at the bedside if staffing conditions are poor. Instead, hospitals should implement evidence-based approaches to resolve their retention issues, including listening to their own nurses who say they are experiencing burnout and leaving because of chronic understaffing . Absent hospitals’ responsiveness to nurses, legislators need to step in to ensure hospitals are sufficiently staffed with enough nurses to care for the public.…”

mentioning

confidence: 99%

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Addressing the Nurse Retention Crisis—Leveraging Policies Supported by Evidence

Lasater

2024

JAMA Netw Open

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supporting

confidence: 91%

mentioning

confidence: 53%

mentioning

confidence: 99%

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Addressing the Nurse Retention Crisis—Leveraging Policies Supported by Evidence

Lasater

2024

JAMA Netw Open

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“…Michigan nurses reported high emotional exhaustion or burnout scores, understaffed patient care areas, occurrence of abusive or violent workplace events in the past 12 months, and job dissatisfaction. In a study of nurses from New York and Illinois who left their employers between 2018 and 2021, planned retirement, burnout, and insufficient staffing were the most frequently cited reasons for departure . This analysis also identified a worrisome pattern, which was reported in a prior study, of high rates of job dissatisfaction and intention to leave their position among nurses aged 34 years or younger.…”

Section: Discussionmentioning

confidence: 53%

Changes in Registered Nurse Employment Plans and Workplace Assessments

Friese,

Medvec,

Marriott

et al. 2024

JAMA Netw Open

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ImportanceThe US registered nurse (RN) workforce is in flux, with high rates of burnout, intention to leave, and vacancies. Rapid, repeated assessments of the nursing workforce can help hospital executives and policymakers enact effective recruitment and retention strategies.ObjectiveTo identify changes in practicing RNs’ employment plans and workplace assessments between the 2022 and 2023 surveys.Design, Setting, and ParticipantsThis survey study compared data collected from the Michigan Nurses’ Study at 2 time points: February 22 to March 1, 2022, and May 17 to June 1, 2023. Practicing RNs with an active, unrestricted license in Michigan and a valid individual email address were included.Main Outcome and MeasuresThe primary outcome was nurses’ intention to leave their current position within 1 year. In the 2023 survey, nurses who planned to leave were queried on their next career step and the primary reason for their planned departure. Workplace assessments included questions about abusive or violent workplace events, emotional exhaustion, job satisfaction, the practice environment’s delivery of high-quality care, and the clinical setting’s safety rating. Regression analysis was used to examine workplace assessments and personal factors associated with planned departures.ResultsThis study obtained data on 9150 nurses (6495 females [71.0%]) and 7059 nurses (5134 females [72.7%]) responding to the 2022 (response rate, 8.3%) and 2023 (response rate, 7.4%) surveys, respectively. In the 2023 survey, 32.0% (2259) of nurses planned to leave their position, compared with 39.1% (3576) in the 2022 survey. Of these nurses, 957 (41.8%) planned to leave their current employer but remain in nursing, with workloads as the most frequently cited reason (29.4% [672]). Compared with the 2022 cohort, nurses in the 2023 sample reported less workplace abuse or violence (4591 [50.2%] vs 3063 [43.4%]; P &lt; .001), fewer understaffed shifts (4407 [48.2%] vs 2898 [41.0%]; P &lt; .001), and less frequent use of mandatory overtime (1709 [18.7%] vs 824 [11.7%]; P &lt; .001). Factors associated with increased likelihood for planned departures included workplace abuse or violence (odds ratio [OR], 1.39; 95% CI, 1.05-1.82) and higher emotional exhaustion scores (OR, 3.05; 95% CI, 2.38-3.91). Favorable practice environments (OR, 0.37; 95% CI, 0.22-0.62) and excellent clinical setting safety ratings (OR, 0.28; 95% CI, 0.14-0.56) were associated with lower likelihood of planned departure.Conclusions and RelevanceResults of this study showed that nurses reported improved workplace conditions in the 2023 vs the 2022 survey; however, planned departure rates, abusive or violent events, and unsafe conditions remained high, and understaffing remained a primary concern for most nurses. Health system leaders and policymakers should prioritize initiatives that support nurse retention and reduce potential workforce instability.

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“…Recent evidence from nurses who left health care between 2018 and 2021 demonstrates that the leading factors contributing to employment departures were not pandemic specific: planned retirement, burnout, and insufficient staffing. 39 Nurses in our study were prompted to provide an open-text response if they probably or definitely did not recommend their workplace to other clinicians. Thus, we do not know the counterfactual to what motivates nurses to recommend their place of employment.…”

Section: Discussionmentioning

confidence: 99%

Emergency Nurses’ Reasons for Not Recommending Their Hospital to Clinicians as a Good Place to Work

Muir,

Merchant,

Lasater

et al. 2024

JAMA Netw Open

Self Cite

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ImportanceHalf of emergency nurses report high burnout and intend to leave their job in the next year. Whether emergency nurses would recommend their workplace to other clinicians may be an important indicator of a hospital’s ability to recruit clinicians.ObjectiveTo examine why emergency nurses do not recommend their hospital to other clinicians as a good place to work.Design, Setting, and ParticipantsThis qualitative study used directed content analysis of open-text responses (n = 142) from the RN4CAST-NY/IL survey of registered nurses licensed in New York and Illinois between April 13 and June 22, 2021. Inductive and deductive analytic approaches guided study theme development informed by the Social Ecological Model. The collected data were analyzed from April to June 2023.Main Outcomes and MeasuresNurses who answered “probably not” or “definitely not” to the survey question, “Would you recommend your place of employment as a good place to work?” were prompted to provide a rationale in an open-text response.ResultsIn this qualitative study of 142 emergency nurses (mean [SD] age, 43.5 [12.5] years; 113 [79.6%] female; mean [SD] experience, 14.0 [12.2] years), 94 (66.2%) were licensed to work in New York and the other 48 (33.8%) in Illinois. Five themes and associated subthemes emerged from the data. Themes conveyed understaffing of nurses and ancillary support (theme 1: unlimited patients with limited support); inadequate responsiveness from unit management to work environment safety concerns (theme 2: unanswered calls for help); perceptions that nurses’ licenses were in jeopardy given unsafe working conditions and compromised care quality (theme 3: license always on the line); workplace violence on a patient-to-nurse, clinician-to-nurse, and systems level (theme 4: multidimensional workplace violence); and nurse reports of being undervalued by hospital management and unfulfilled at work in delivering suboptimal care to patients in unsafe working conditions (theme 5: undervalued and unfulfilled).Conclusions and RelevanceThis study found that emergency department nurses did not recommend their workplace to other clinicians as a good place to work because of poor nurse and ancillary staffing, nonresponsive hospital leadership, unsafe working conditions, workplace violence, and a lack of feeling valued. These findings inform aspects of the work environment that employers can address to improve nurse recruitment and retention.

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Top Factors in Nurses Ending Health Care Employment Between 2018 and 2021

Cited by 5 publications

References 44 publications

Addressing the Nurse Retention Crisis—Leveraging Policies Supported by Evidence

Addressing the Nurse Retention Crisis—Leveraging Policies Supported by Evidence

Changes in Registered Nurse Employment Plans and Workplace Assessments

Emergency Nurses’ Reasons for Not Recommending Their Hospital to Clinicians as a Good Place to Work

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