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Analysis

'Strong Cautionary Tales From Practicing Nurses' Revealed in Nationwide Survey

By Jennifer Thew RN  
   February 21, 2020

Forty-four percent of nurses say they often feel like quitting their jobs. Here's what nurse leaders need to know to change that. 

It's not easy being a nurse. And that's not just an anecdotal observation. Recent results from The AMN 2019 Survey of Registered Nurses highlight the pressures and challenges RNs face daily. These challenges include the effects of working second jobs, the experiences of bullying and workplace violence, and concerns about how their jobs affect their health. Because of these and other stressors, 44% of the RN respondents say they often feel like quitting.

Here are some of the survey's findings from the almost 20,000 nationwide sample of RNs:

Second jobs
 

  • More than one-in-five (22%) nurses hold more than one job as a nurse
     
  • Nearly one-in-five nurses (18%) working more than one job say it negatively impacts the quality of their work
     
  • 37% of nurses working more than one job say it negatively affects their quality of life
     
  • One quarter say that working more than one job negatively influences their post-shift driving ability due to drowsy driving


Exposure to workplace violence
 

  • 41% of nurses say they have been victims of bullying, incivility, or other forms of workplace violence
     
  • 27% of nurses say they have witnessed workplace violence
     
  • 10% say their organization addressed the situation extremely well or very well
     
  • 63% say their organization did not address the situation well at all


Career vs. job satisfaction
 

  • 81% of nurses say they are satisfied with their career choice, with “extremely satisfied” as the largest category
     
  • 65% say they are satisfied with their jobs, with “somewhat satisfied” as the largest category
     
  • 75% say they are satisfied with the quality of care they are able to provide to patients
     
  • 66% worry that their job is affecting their health
     
  • 44% say they often feel like resigning from their jobs


Factors in job turnover
 

  • 39% of nurses say flexibility and work-life balance are the most important factors that influence their intent to remain at their current organizations
     
  • 31% say compensation and benefits are the biggest influences on their intent to remain at their current organizations
     
  • 27% say it is unlikely they will be working at their current job in one year
     

Diversity and job satisfaction
 

  • 60% of nurses say their organizations support diversity in the workplace extremely well or very well
     
  • Of those nurses who say their organizations support diversity extremely well, 43% are also extremely satisfied with their jobs, compared to only 5% of those whose organizations do not support diversity well at all
     
  • Of nurses who say their organizations do not support diversity well at all, 45% strongly agree that they often feel like resigning from their position, compared to 11% of those whose organizations do extremely well at supporting diversity
     
  • Of nurses who say their organizations support diversity extremely well, 59% say they are extremely likely to be working in their jobs one year from now, compared to only 18% of those whose organizations do not support diversity well at all
     

Support for professional development
 

  • 43% of nurses say their organization does extremely well or very well in supporting professional development; 29% say their organization does slightly well or not well at all
     
  • Nurses working for organizations that do extremely well at supporting their professional development are significantly more likely to be satisfied with their career, job, and ability to provide quality care, and they are more likely to remain at their current job


Retirement
 

  • 20% of nurses say they are planning to retire in the next five years
     
  • 86% of baby boomer nurses say they are planning to retire in the next five years
     
  • Of baby boomers planning to retire, 39% say they will retire in one year or less
     
  • Of all nurses who say they are not planning to retire, 10% say they will leave direct patient care in the next year

These results may make it seem like there is a dire situation in nursing, but it doesn't have to be so, says Cole Edmonson, DNP, RN, FACHE, NEA-BC, FAONL, FAAN, chief clinical officer at AMN Healthcare, headquartered in San Diego.

"These are strong cautionary tales from practicing nurses that are telling us exactly what they want, what they're experiencing, and what will keep them at the bedside and in healthcare," he says of the results. "We need to be listening to what nurses have to say. We need to understand what it means, and we need to be solutioning with nurses and other providers and leadership to solve these challenges in healthcare."

In a recent interview with HealthLeaders, Edmonson discusses the survey's findings and key insights for nurse leaders. The transcript has been edited for clarity and brevity.

HealthLeaders: What are the biggest takeaways from this report for nurse leaders?

Cole Edmonson: There are several key takeaways for nurse leaders in the C- suite as well as those at the bedside. One, is that nurses are extremely satisfied with their choice of careers, but only about two- thirds are satisfied with their job. Then that drives us to start to think about how nursing jobs are structured and what's driving that dissatisfaction and what's driving satisfaction.

Second—I think this is well documented—the experiences that nurses are having with workplace violence and the opportunity for us to better address those as healthcare organizations and as leaders to make sure they're addressed effectively. This survey was also the first time we asked how important diversity and inclusion was to a nurse with intent to stay at [his or her] job. The surprising finding that [diversity and inclusion] was one of the highest correlated elements of what nurses wanted in their job with the intent to stay. This was also the first time we saw nurses say that flexibility and work-life balance are one of the top drivers [for intent to stay], even above competitive pay.

HL: Based on the survey results, where do you think nurse leaders should focus their energy?

Edmonson: There's three key areas where I would tell leaders to focus. The first one is addressing and providing for the flexibility in life-work balance. You might notice I put life before work because I think that's a shift in trend as well. The second one is making sure that you have professional development opportunities for nurses in your organization beyond the traditional tuition reimbursement and scholarships and continuing education.

The third is making sure that as leaders in healthcare, we are effectively addressing workplace violence issues, not only from the prevention and mitigation, but the event and the recovery after that event. Because we know these events change people for their entire lives.

HL: Are there specific solutions that have caught your eye as you meet with nurses across the country?

Edmonson: I'm seeing a lot of opportunities where people are literally leaning in to address some of the challenges that we uncovered in the survey. Some of those are related to particularly the graying and the greening of the nursing workforce. 86% of the baby boomers in the survey said they were going to retire in the next five years.

We don't have a solution that's going to keep up with that level of retirement unless we make some changes. So, where I see people leaning in is more academic practice models: Truly partnering between academia and practice to create different types of programs, a reemergence of dedicated education units and tighter partnerships between academic and practice where they're choosing strategic partners in academia based on their workforce needs.

With the graying of the nursing workforce, part of what I'm seeing is formal emeritus programs that are giving nurses, who are at the latter stages of their careers, more opportunity to stay engaged in mentoring and onboarding and transferring that knowledge to that next generation of nurses.

Going back to [nurses being satisfied with their jobs] … what we're seeing there is sometimes 20% or greater of the nurses' time is spent "hunting and gathering." Now we have studies that are showing that up to 50% of a nurse's time is spent on the EHR documentation. So even in a best-case scenario, 50% of a nurse's time is spent on those two activities, hunting and gathering and EHR documentation. This is a huge cognitive load for nurses in terms of how they're structuring their work, prioritizing their work, and getting time and presence with patients.

[An] interesting solution I've seen as I've traveled across the U.S. engaging with different strategic partners is nurse scribes. They are providing nurses with either virtual or actual scribes as a partner in care. I also had the opportunity to help develop a test of the first mobile nurse assistive robot in the U.S. That [solution] was about taking those lower-value, routine tasks of the nurse and having the robot [do them] on unit as part of the care team in order to provide time for the caregiver to have presence with the patient.

HL: We've talked about career versus job satisfaction and job turnover. What are the factors that
rose to the top in the survey?

Edmonson: When we did our correlation of the data, we found five top factors, the first being flexibility and life-work balance. I think the second is organizations providing professional development, the third is a diverse and inclusive organization, the fourth is having effective leaders and systems to help prevent workplace violence, and then the fifth is around staffing adequacy.

All those, to me, really point out the fact that we have to think about how people have joy at work and start leaning in to that concept of how do we make sure people are feeling great about the care they're providing, the work that they're doing, and how to help them continue to feel great about their profession. I think we don't often emphasize enough the amount of joy that people get from being caregivers and in the healthcare system.

Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.


KEY TAKEAWAYS

Diversity and inclusion are important to nurse satisfaction.

A significant number of nurses work second jobs.


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