**Due to the nature of this article, some of the interviewees will only be referred to by first name for their protection**
Nursing may be considered the most ethical and honest profession in America, but that honor and recognition doesn’t always translate into a happy, fulfilling career.
In fact, a 2014 study published in Policy Politics and Nursing Practice reported that 1 in 5 newly registered nurses end up quitting their jobs in the first year. The odds jump to 1 in 3 nurses by year two of a nurse’s career.
For people who are on the outside looking in, it might seem a bit strange that a career so high in demand, offering flexibility and plenty of opportunities for growth is filled with this many disgruntled workers looking to jump ship.
So this naturally begs the question, why?
Feeling Unsupported, Unsafe, and Burned Out
We posed a few questions to the nurses on our CEUfast Facebook page and also interviewed a few nurses and nurse leaders to get further insight into what pushes a nurse to walk away.
A number of nurses who entered the field with a love for helping people and making a difference, now feel the risks involved in the current state of nursing far outweigh the rewards.
Inexperienced nurse management, a lack of support, no breaks and no respect from upper management were among the most common complaints we received, but one of the biggest issues hands down was poor nurse-to-patient ratios.
“I have been a nurse since 2008...I am seriously considering a different career altogether,” Michele said.
“So many young nurses [are] cutting corners to get done in a shift, putting their patients at risk. Many managers are too inexperienced to help; this puts people in danger. Not to mention, the insane amounts of multi-tasking expected of us on the floor.... this is not why I became a nurse.”
Kaye, a nurse for nearly 11 years agrees. She finds that working as a nurse has only gotten more challenging.
“I work much harder now than I ever have because of the downstaffing happening for hospitals to save money on paying staff...I rarely get a full 30 minute uninterrupted break,” Kaye said.
“I have worked with a lot of nurses who have left nursing to become school teachers and nurse practitioners. But not all of us nurses can do that so some are stuck like me just praying everyday.”
Drema, an LPN who has worked in Virginia as a nurse for the past 28 years, agrees with many of these sentiments.
She is the only nurse in an assisted living facility, along with two cnas and a medtech, who are expected to handle 45 residents.
“There are many nights I wonder if I will have a license by morning. Nursing is a very dangerous occupation, more so today than in the past,” Drema said.
“I felt the changes in patient care that were supposed to make things better are making it worse. The computerized charting has been good in some ways and bad in others. I feel that we spend more time relying on it and less time with patient care. The staffing ratios made it worse because the management felt that the "improved" charting with computers we could handle more patients.”
Unfortunately, these nurses experiences aren’t isolated events; they’re echoing a much louder cry being heard from nurses across the nation.
Many feel the weight of managing an unrealistic number of patients with little to no support. They’re forced to rush through tasks, making it easy for things to fall through the cracks, which can (and has) had deadly consequences for patients.
What’s worse is many feel that their concerns fall on deaf ears. In some cases, nurses fear that voicing these concerns could send them to the unemployment line, which is precisely what happened to Linda Boly in Portland, Oregon.
Boly, an RN, was fired after a 34 career in 2013 after complaining to management about cost-cutting measures that were jeopardizing patient care.
Boly took her case to court, where a judge awarded her $3 million, but this obviously is not the case for every nurse.
These issues not only impact nurses and the quality of care for patients, it affects something rather important to healthcare facilities as a whole: money.
Costs associated with nurse turnover can be as much as $6.4 million at large acute care hospital with over 600 beds, according to research gathered by The RN Work Project. The average cost to replace an RN who leaves the bedside can cites the average cost to replace an RN who leaves the bedside ranges from $10,098 to $88,000 per nurse.
The higher turnover rates are also associated with the increased use of physical restraints, patient falls and pressure ulcers---issues that could be alleviated or reduced with better nurse to patient ratios.
The Proof is in the Pudding
States that have made nurse-patient ratios laws have experienced real, measurable improvements.
Since California enforced a one nurse per five patient ratio in 2004, a University of Pennsylvania study led by Linda Aiken, RN surveyed more than 20,000 nurses and learned:
The study also compared nurses in California to nurses in New Jersey or Pennsylvania, where ratio standards aren’t mandated. The research found that if New Jersey had a1:5 ratio in their surgical units , there would be 14 percent fewer patient deaths, and there would be 11 percent fewer deaths in Pennsylvania hospitals if they did they same.
California nurses are also less likely to miss changes in patient conditions due to their decreased workload, compared to their much busier New Jersey and Pennsylvania counterparts.
This leads to better job satisfaction, as California nurses are more likely to stay at the bedside and less likely to suffer from the burnout New Jersey and Pennsylvania nurses do.
That research speaks volumes.
So What’s Being Done?
For years, healthcare advocates, nurse unions and nurse organizations like the American Nurses Association (ANA) and National Nurses United (NNU) have led several efforts to create solutions for these issues.
For example, the NNU currently has two national safe patient ratio bills--one in the senate and one the house, requiring specific nurse to ratio mandates, while the ANA supports a legislative model that allows nurses to make their own staffing plans based on each unit’s needs.
Many smaller organizations and individuals alike are also working on a local level to push for state laws that enforce better ratios.
Now more than ever, nurses are speaking up and joining the action to fight for these changes.
Nurses are taking to platforms like Show Me Your Stethoscope (SMYS) to share, discuss and plan for the future of nursing.
The SMYS movement started off as a Facebook group of nurses responding to less than favorable comments made on The View about a Miss America pageant who was also a nurse.
However, the Facebook page grew rapidly and with 681,000 members and counting, it has become a powerful forum where nurses share experiences, discuss hot-button issues and give perspectives on how to revolutionize their industry.
Jalil Johnson, BSN, MS, RN, ANP-BC, PhD(C) is the national director of the SMYS group.
Johnson started out as a CNA in 2000 and diligently worked his way up his way up to becoming a nurse practitioner specialist practicing in Springfield, Mass.
He wants SMYS to be a place where nurses can strive toward improvements in the field without tearing each other down over differing opinions on how to get things accomplished.
“There are many different ways for nurses to divide themselves. Some believe that unionizing is the only way, some believe that there are other ways to get through this problem. At SMYS, we are unifiers, we know that there are many ways to get our concerns addressed and we’re inviting everyone to join the conversation, everyone’s welcome to the table,” he said.
One particular movement working in concert with SMYS is NursesTakeDC. Created by Deena Sowa McCollum, BSN, RN of Hondo, Texas,#NursesTakeDC is an organized rally that will gather at the nation’s capitol on May 12 to raise awareness about patient safety, staffing levels and promote safety legislation.
About 300 people are expected to show up for the Nurses Take D.C. rally, but regardless of the number, McCollum says the event is already a success.
”For me, quantity isn't a driver! At the final hour, there will be more dialog occurring about patient safety than there was 6 months ago. To me-that is success,” she said.
McCollum believes there’s a true lack of support for nurses that needs to be fixed.
“They [nurse organizations, leaders] have an obligation to nurses. They could and should be doing more to get to the root cause of burnout, nurses leaving the profession, nurses with substance abuse, nurses commuting suicide, etc. I assure you all of these are related to working conditions,” she said.
“I want safe staffing ratios. Period!”
McCollum’s sentiments are an extension of what Johnson believes many nurses are feeling and expressing through SMYS.
“What we’ve found is that nurses are quite fed up….they’re wanting safe staffing and better patient ratios. But that has been a slow grind.”
He says people have been working on safe staffing ratios for a long time and making some headway, but he believes there are politicians that may try to prevent this from happening and he also believes that some of the blame is unfairly placed.
“I think that the people that are managers and administrators are in a tough situation, they have staff that want and deserve better patient ratios, they have patients that deserve better care, and they also have hospitals that need the bottom line goal met. So it’s a difficult position for an administrator to be in. Most people who manage nurses are nurses, they’re not the bad guy. It’s not about anyone being the bad guy. It’s about progressing forward,” he said.
However, Johnson also has advice for those in leadership roles.
“We have jobs we have to do and can get a little lost it that. But if you are a hospital admin, the best way to advocate for your staff is to be that voice for your staff. As you speak to your supervisor, you have to staff and provide the highest level of patient care. Adhere to the science, be that voice to your staff let nurses know that they’re heard and they’re valuable.”