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4 Reasons You Are Losing Nurses

Analysis  |  By Jennifer Thew RN  
   February 15, 2019

A new Press Ganey report sheds light on a study that was designed to identify trends of why nurses leave or stay in their positions.

"Millennial nurses are so different than other generations of nurses." If you're a nurse leader you've probably heard sentiments like this before, or perhaps even said this. I certainly hear it quite often during my interactions with nurse executives.

But what is meant by "different"? Based on my discussions with a wide array of nurse leaders, here's a few points that are frequently raised.

  • Millennials want work-life balance. For baby boomers, work was their life.
  • Younger nurses don't stay in their jobs long. Baby boomers often spent their entire careers on one unit.
  • Younger nurses are already planning to go on for advanced degrees.

Sure, sometimes it sounds like the typical "Oh, kids these days" talk that has been going on since the beginning of time. But if you dig deeper, nurse leaders are expressing concerns about these differences for good reason.

Nurse turnover is costly.

"The average cost of turnover for a bedside nurse is anywhere from $38,000 to $61,000," says Christy Dempsey, RN, MSN, CNOR, CENP, FAAN, chief nursing officer at Press Ganey. "When you think about that from a per hospital cost, that's between $4.4 million and $7 million per year."

It also jeopardizes patient care.

"We also know there's a strong association between high nurse turnover and problems with safety, quality, and experience," Dempsey says. "We know from previous research that staffing is an issue across the country and when turnover is high, staffing is impacted and the nurses who stay on the unit or in the department are under increased stress, further impacting the work environment. It's just a vicious cycle of turnover and despair."

So, what can nurse leaders do to retain nurses?

"It requires that we understand the drivers of satisfaction and joy across the nursing lifecycle because we're not all motivated by the same thing" Dempsey explains.

The 2018 Press Ganey Nursing Special Report: Optimizing the Nursing Workforce: Key Drivers of Intent to Stay for Newly Licensed and Experienced Nurses shares trends of why nurses leave or stay in their positions. Here are four of the findings.  

1. Work Environment Matters

"Dissatisfaction with the work environment was the most commonly cited reason for leaving," Dempsey says. "The strongest positive predictors of intent to stay in your job is satisfaction and enjoying work."

According to the analysis, 42% of the 250,000 nurses surveyed said the work environment was the main reason they planned to leave their job within the next year.

Work environment was slightly less important to younger nurses than older nurses. Of respondents under 30 years old, 39.7% said they intended to leave their jobs within the next year due to the work environment compared to 45.4% of nurses aged 40 to 49.

2. Younger Nurses at Highest Risk for Turnover

Newly licensed nurses and those who have been in practice for two-to-four years are at highest risk for attrition. In the next year, 24.5% of NLRNs and just over 27% of the two- to four-year     
experience cohort reported they planned to change jobs.

"It was interesting that nurses under 30 were more likely to say they were going to leave their unit, but they were going to stay in the hospital or they were going to leave patient care, but they were going to stay in nursing over the next three years," Dempsey says.


3. Recognition vs. Leadership

"The predictors of intent to stay for nurses who had been practicing less than two years were things like praise, recognition, nurse manager support, certification, and joy in work," says Dempsey. "For those who've been practicing for more than 20 years, [intent to stay] was about leadership, influence over their schedule, and quality of care."

Additionally, the study found "career development, work group cohesion, RN-to-RN consults, and missed care were less influential on intent to stay among the new nurses than on the experienced ones."


4. At Risk Units

Nurses in adult step down and med/surg units were more likely to say they were going to leave within one to three years.

"These are difficult and demanding units, with sick patients and less staffing than a critical care unit," Dempsey points out. "We need to make sure there is strong managerial support for those units, efficient processes, and that we keep those nurses at the bedside."

Advice for Nurse Leaders

The report suggests leaders make the following areas strategic priorities to develop and retain a multigenerational nursing workforce:

  • Quality of care/joy in work
  • Manager support
  • Staff tenure skill mix
  • Workforce cohesion
  • Staffing and scheduling

And Dempsey's take:

"I think you need to make sure you are recruiting nurses, not just for their clinical ability, but also for their fit within your organization, and make sure that we [hire someone] who's not only clinically competent but who also espouses the organization's values. We [also need to hold] people accountable for safe, high-quality care. We're not just saying, 'Thou shalt.' They're saying, 'I will.'  We [need to] create that positive work environment, and that we're supporting and fostering professional and career goals for nurses. We [need to] make sure we have a good skill mix between newly licensed and tenured nurses so that we have the ability to mentor and welcome new nurses. We [need to] encourage, reward, and recognize [nurses] at all levels, and have safe and appropriate staffing that's not just based on volume but also based on acuity and the nursing skill mix. And, we [need to] offer flexibility so that we can optimize work-life balance, job satisfaction, and, ultimately, joy in work."

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


Dissatisfaction with the work environment is the most commonly cited reason that nurses plan to leave their job in the next year.

Nurse turnover can cost organizations between $4.4 million and $7 million per year.

Drivers of nurses' intent to stay in their jobs vary among age groups and tenure.

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