Survey: 39% of hospital nurses want to quit

Most cited staffing issues, not pay, as main concern

By Mark Sanchez

While Michigan hospitals had problems retaining nurses even before the COVID-19 pandemic, the situation grew much worse in the first two years of the public health crisis.

That’s according to newly published survey data showing that from just prior to the pandemic to March 2022, the rate at which nurses planned to leave the profession rose sharply across Michigan.

“Nurses are telling us loudly and clearly that they do not believe they are staffed appropriately,” said Christopher Friese, a professor of nursing, health management and policy at the University of Michigan and lead author of a peer-reviewed article on the findings that was published in April in the academic journal Medical Care.

In the survey conducted in February and March last year, researchers at the University of Michigan found that 39 percent of responding nurses said they planned to leave the profession within a year. That’s up from prior findings of about 20 percent in a survey a colleague conducted in December 2019 and January 2020, Friese said.

The percentage of planned departures is the highest rate Friese has ever seen in large surveys during his 25 years of nursing. A typical rate is about 10 percent, Friese said.

The survey, which garnered responses from 9,150 nurses, suggests that hospitals can make headway against an acute nurse staffing shortage by focusing more on retention, even as they work to bring more people into the nursing profession, Friese said.

Friese advocates that health care executives need to “commit to improve staffing levels over time, and that’s going to be expensive and it’s going to be difficult, but right now I don’t see them addressing that issue. I see them trying to plug a hole, as opposed to build for the future.” If hospitals only boost the talent pool, nurses are still “going to leave at the same rate or faster,” unless retention issues get addressed as well, he said.

“They need to recognize that retaining their current nurses needs to be the priority, otherwise this is going to be a vicious spiral,” Friese said. “The urgent work in front of health care executives is really actively listening to their staff and acting on their concerns, and I don’t see enough of that happening across the state and the nation.”

Among the 1,224 nurses University of Michigan surveyed who recently left a job, 70 percent cited concerns about adequate staffing levels. Nearly three-quarters of nurses said they were less likely to leave if they had a favorable work environment.

University of Michigan plans to conduct a follow-up survey this spring or summer, Friese said.

One finding that surprised

Friese: The percentage of planned departures was the highest for younger nurses. Among licensed nurses who answered the survey, 59 percent who were age 25 or younger, and 53 percent between 25 and 35 years old, said they intended to leave their positions within a year.

The high percentages of younger nurses planning to leave the profession is particularly worrisome, Friese said.

“That’s our future health care workforce,” he said. “If they recently graduated, we would expect them to stay in the nursing workforce for two decades or so. If they’re likely to leave their first position in such a short period of time, that’s really going to make it hard for health systems to staff up.

“Hospitals and health systems spend a ton of money on recruiting (and) on orientation of new employers, and so they’re going to lose that investment very quickly if these rates continue among our newer nurses.”

Staffing concerns mount

The Michigan Health & Hospital Association has estimated that the nursing shortage has resulted in hospitals staffing 1,700 fewer beds today than in 2020. The shortage also has generated longer ER wait times and greater difficulty transferring patients between care providers. The staffing shortage led Trinity Health Muskegon in February to temporarily close a 30bed unit used for post-operative patient recovery.

Among nurses who planned to leave, their most cited reason was inadequate staffing levels at hospitals, which is an issue that predates the pandemic, Friese said. Nurses also cited burnout and violence in the workplace as their top reasons for wanting to leave the profession.

“Few nurses cite COVID as the primary cause for their planned or actual departure,” researchers wrote in the Medical Care paper. “To maintain an adequate nursing workforce in the United States, health systems should enact urgent efforts to reduce overtime use, strengthen work environments, implement anti-violence protocols, and ensure adequate staffing to meet patient care needs.”

Concerns over inadequate staffing levels have been a common theme in nursing surveys for more than a decade. Many nurses feel that “they have been running too lean and (there are) too few nurses to care for the patients that are assigned to them,” Friese said. “So, that’s not a new finding. I think it’s taken on increased urgency as we’ve gone through the pandemic.”

Nurses who told University of Michigan that low staffing levels were the most worrisome part of their job were the most likely to leave, Friese said.

Pay and benefits were the least-cited reason for nurses wanting to leave the profession, Friese said. In recent contract settlements for unionized nurses at health systems in Michigan, “the sticking point wasn’t salary and benefits in any that I’m aware of. It was commitment to staffing,” he said.

Call for collaboration

Friese suggests that hospitals need to address nurse retention the same way that the health care industry elevated patient safety and quality following a landmark 1999 report by the Institute of Medicine that estimated 44,000 to 98,000 people in the U.S. die each year as a result of preventable medical errors.

Friese advocated that hospitals need to set aside competitive tendencies and collaborate to share best practices for retaining nursing on staff, similar to how they have worked on safety and quality initiatives. As an example, he cites identifying a best practice to reduce administrative work for nurses so they can focus more on patient care and perhaps raise their job satisfaction.

“We need a similar effort if we want nursing in Michigan to be the best it can be for Michiganders. Let’s identify who’s doing well in this regard and learn from them, rather than everybody doing their own thing,” he said. “I don’t think now’s the time to use this for competition, but, in fact, collaboration. (Let’s) learn from each other so that Michigan is a nurse-friendly state and Michigan is a good place for nurses to work, as opposed to competing over the same pool of people and a smaller pool of people. That’s not a winning strategy.”

Friese and others who conducted the survey wrote in Medical Care that their findings “suggest there is no time to waste” in addressing the problem. If not properly addressed, “it is likely that disruptions to the health care workforce will worsen, which will induce a spiral of additional resignations and threaten the delivery of essential care,” they wrote in the Medical Care article.

“Leaders need the moral courage to enact evidence-based strategies to stanch the hemorrhage of registered nurses and enable the U.S. health care system to deliver the care that patients expect and deserve,” researchers concluded.