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Why Nurses Quit

Carrie Vaughan, for HealthLeaders Media, September 19, 2008

We've all heard the reports. The U.S. healthcare system will need more than one million new registered nurses by 2020. Thousands of nursing school applicants are turned away each year because there isn't enough nursing faculty, clinical sites, and classroom space. The shortage of registered nurses in the United States could reach as high as 500,000 by 2025. More than one-third of baby boomer nurses (age 45 to 60) plan to retire or change their career in the next one to three years.

It's no wonder CEOs are taking an active role in nursing recruitment and retention efforts. Given these forecasts the competition for nurses is going to get even more intense, and it is going to take more than sign-on bonuses and financial rewards to attract new nurse recruits to your facility. (See Show Them More Than $ in the September issue of HealthLeaders magazine.) Nurses want to work for an employer of choice—a Magnet facility, one of the best places to work, or a healthcare organization that offers them:

  • Empowerment: A collaborative environment where nurses are respected and involved in decision-making processes. For example, they want to have a say in their patient's care and the technologies purchased. 

  • Flexible scheduling: To help them balance their professional and personal lives.

  • Mentoring programs: To help new nurses transition into the workplace environment. 

  • Continuing education opportunities: To help them further their career and realize opportunities within the organization. 

  • Technology: To reduce the amount of time that they spend on paperwork, so that they can spend more time at the bedside. 

  • Concierge services: To help them achieve work/life balance. 

  • Fair compensation: They may not care only about financial perks, but they still want fair compensation for their efforts

These strategies can make your organization more appealing to nurses. But no amount of nurse-friendly programs can undo the damage of a frontline nurse manager who is controlling, unfriendly, or abusive to fellow employees. People quit jobs solely because they don't like their direct supervisor—regardless of the benefits, job perks, and growth potential offered by the facility. In essence, these frontline managers are all chief retention officers. Some nurses are more proactive and may ask to move to a different department or report bad behavior to senior leaders, but many nurses will simply hand in their notice and move on.

Ideally, bad bosses just need additional training in conflict resolution management, leadership styles, or on how to build a positive work environment. (I'm assuming of course that they received at least some training when promoted or hired to the position, which is not always the case.) But some frontline nurse managers just don't have the skills, personality traits, or desire to be an effective leader and no amount of training or support will change that. Those are the managers who are driving away staff, lowering productivity, and hurting morale. They need to be removed from supervisory positions—and fast.

Before you start firing nurse managers, however, take a look at their workload, the demands on their time, and the workplace environment. These factors may be contributing to their ineffectiveness as a leader. But if, at the end of the day, the manager in question continues to receive negative feedback from subordinates and fellow coworkers despite the additional support provided, it is probably time to find a new role for this individual or cut them from the team.

None of these programs and strategies will completely eliminate nursing turnover. But they can lower turnover rates and improve employee satisfaction, which can help establish your hospital as a place that nurses want to work at. So when a vacancy does arise, you'll have a dozen qualified applicants—or at least one or two—on hand to fill the position.


Carrie Vaughan is leadership editor with HealthLeaders magazine. She can be reached at cvaughan@healthleadersmedia.com.


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