Why Are Nurses Leaving? Findings from an Initial Qualitative Study on Nursing Attrition

According to workforce projections of nurses working in the United States, there is likely to be a shortage of registered nurses that may exceed 500,000 by 2025. The shortage is becoming a problem, and yet there are few studies on nurses who are no longer in practice. A study by MacKusick and Minick (2010) in the article titled Why Are Nurses Leaving? Findings from an Initial Qualitative Study on Nursing Attrition seeks to understand the reasons that influence the decision of a nurse to leave the practice. In this study phenomenological study design was used to disclose the complex events that influence the registered nurses to leave the practice. This report, therefore, seeks to do a literature review on the reasons that prompt nurses to leave the practice.

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To begin with, one of the reasons for leaving the practice is the unfriendly workplace. From the study, the nurses described an unfriendly environment as one where they were ignored, belittled, sexual harassment, gender abuse by coworkers and lack of support when they were new in the practice (MacKusick and Minick, 2010). Most nurses also described their experiences at the workplace as disappointing, citing that they were ignored, and they felt like they were an inconvenience. This, in turn, made them feel isolated and alone. Incidences of gender abuse in the workplace stood out. At least every participant cited an incidence where they were abused in the workplace. According to the nurses, these behaviors were the norm, and few workers in the units where the RNs worked were not empowered enough to stop the cycle of abuse.

From the study, the participants also described sexual harassment as a problem, and they said that this hostile behavior was mostly experienced from the physicians. In all cases of sexual harassment, the nurses said that there was some of the acceptance of the behavior by the hospital administrators. This acceptance was devastating to the RNs than the harassment they received. The overwhelming lack of support according to the nurses is what prompted them to leave the practice.

The second reason as to why nurses are leaving the practice is the emotional distress that is related to patient care. The emotional distress ranges from lack of collaboration between staff and physicians, and lack of respect for family and patient wishes. All these factors cause emotional distress among the registered nurses. For example, getting family members out of the room when a patient is receiving check up, and treatment can be tedious because most are not willing to give that space. The death of patients can also cause emotional distress among the nurses. There are those that go home crying, and feeling guilty by questioning their professional roles. In other cases, distress can also be caused when advancing technologies are not used correctly. For example, in the study by MacKusick and Minick (2010) nurses believed that prolonging life using life machines lengthened the suffering. According to most nurses, they cited that this was not the kind of practice they wanted to be involved in. Although they mentioned this as a cause of emotional distress, none was able to indicate a problem to the ethical problem. To counter this emotional distress, some nurses consider leaving the practice, calling in sick and changing careers by searching for other positions in the clinics they work for.

Exhaustion and fatigue are another reason that is likely to make registered nurses leave the practice. This occurs mostly when nurses are recalled to work during their off days in times of emergencies. In such cases, the nurses are deprived of their rest, which is also emotionally draining. The results of this fatigue are absenteeism, and some end up resigning from their jobs. According to a study MacKusick and Minick (2010), the nurses complained of being tired, such that they felt like they could not go on. There are those that resigned, and in others, the rate of absenteeism increased. Others mentioned that they feared to pick up calls for fear of being recalled to work during their off days. Burnouts and stress have been found to be significant reasons that correlate with nurses leaving their practice. In a survey done in the UK, 42% of the nurses interviewed reported that burnout was one of the reasons for quitting their practice (Strachota et al., 2003). In the course of training, nurses are required to put the needs of others before their own. This entails spending most of their time with sick people, deal with those with extreme emotional and physical needs, as well as dealing with those that are dying. This, in turn, strains them emotionally, and coupled with other inherent stress factors in the clinical environment, the nurses become vulnerable to high levels of burnouts.

All the above reasons are related or tied to job dissatisfaction. The job dissatisfaction factors often lead to burnouts and stress. Lack of control in the workplace is another reason that influences the nurses leaving the practice. Lack of control entails not being involved in decision making, and not being able to work the way a person thinks is the correct way. Some of these factors are influenced by inflexibility in the administrative policies. Lack of a flexible administration policy can reduce a clinical independence among the nurses. When nurses feel that their autonomy is compromised, this is likely to influence their intentions of leaving the practice.

Reward and fairness are also a key motivating factor for any employee regardless of their profession. When a nurses individual contribution in the workplace is not acknowledged, it can lead to stress. Lack of opportunities for advancement of career is also another de-motivating factor. Studies find these factors correlated to nurses leaving their practice. Lastly, there is always dissatisfaction when there are no promotions. Some human resource managers will improve an individuals pay which always has limited success except if the pay is accompanied by better opportunities. Inequality in salary and workload are some of the actions that can lead to job dissatisfaction, and hence leave.

Demographic variables are also another reason a nurse is likely to leave their practice. The turnover rates for newly registered nurses are high in the first year of practice. The rates can remain high, and in some cases, they can rise in subsequent years. A study done in 2000 found out that 34% of new nurses who had just graduated were not registered to practice (Strachota et al., 2003). Some of the newly qualified nurses enter the workplace fully motivated and with high expectations regarding their jobs. However, the reality of the job changes when the expectations diverge especially when the working environment is not supportive.

This can lead to disappointment and frustration, and if these issues are not addressed, stress builds up, and this may lead to burnout stage if left untreated. In most cases, it is unlikely that newly registered nurses are not always empowered sufficiently with work stressors. They are also not empowered to create better working conditions for their work. Some scholars view the increased rate of burnout as a function of survival for the fittest. In most cases, burnout occurs within the first years of an individuals career, and this frustrates many nurses that they end leaving their practice and those that remain in the profession as seen as survivors.

In summary, nurses leaving the practice have several implications from organizational costs to personal costs. If the above issues are not addressed by the government and other stakeholders, the problem is likely to escalate. A nurses contribution to healthcare is very important. The stakeholders need to know that recognizing when the RNs are frustrated, distressed or socially isolated can help retain the nurses in the future. Mentoring programs can also support the nurses during the transition from nursing school to the workplace. This can greatly help assist in the retention of nurses. Developing cultures that promote diversity and provide support for nurses is one among many ways that will motivate RNs to continue with the practice. Some other important remedies are treating the nurses well, with kindness and respect, managers should be empathetic and listen to the nurses concerns, offer good benefits and fair pay, and ensure that they mitigate the drawbacks of staffing difficulties and shift work.

References

MacKusick, C. I., & Minick, P. (2010). Why Are Nurses Leaving? Findings from an Initial Qualitative Study on Nursing Attrition. Medsurg Nursing: Official Journal of the Academy of Medical-Surgical Nurses, 19, 6, 335-346.

Strachota E, Normandin P, OBrien N, Clary M, Krukow B. (2003). Reasons registered nurses leave or change employment status. Journal of Nursing Administration 33 (2), 111117.