Here’s Why Nurses Are Exiting Healthcare

While planned retirement topped the list of reasons for nurses leaving healthcare, failures by employers also played a role, according to a cross-sectional study that analyzed survey data.

Among nearly 7,900 nurses who left the healthcare field in Illinois and New York from 2018 to 2021, 39% attributed their decision to a planned retirement, with others citing:

• Burnout or emotional exhaustion (26%)
• Insufficient staffing (21%)
• Family obligations (18%)
• Concerns related to COVID-19 (17%)
• Unsafe working conditions (13%)

Of the 4,906 nurses who retired — as opposed to being unemployed or working in non-healthcare industries — 41% ended their employment in healthcare due to reasons other than planned retirement, including burnout or emotional exhaustion (22%) and insufficient staffing (18%), reported K. Jane Muir, PhD, RN, of the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing in Philadelphia, and co-authors in JAMA Network Open.

Reasons for leaving also varied by age. Among nurses ages 61 and older, planned retirement (53%) was the most cited factor contributing to leaving the field. For those ages 30 and younger, burnout or emotional exhaustion (43%) and insufficient staffing (40%) were “considerably more salient,” the authors wrote. However, this might reflect survival bias — older nurses tend to report less burnout — or other confounding factors such as employment setting, they added.

While the survey was conducted during the pandemic, COVID-19 wasn’t the top factor for leaving.

“I think there’s a narrative that nurses no longer want to work in certain settings because of the pandemic. Our research really debunks this,” Muir told MedPage Today.

She said she also did not expect to see that only 59% of the nurses surveyed who retired had planned to retire, which means the other 41% had “an unplanned or premature exit from healthcare.”

Muir pointed out that many nurses said they would have worked longer had their jobs provided safer staffing levels.

“Nurse staffing is a modifiable feature … it’s something that hospitals can choose to invest in, and they must invest in it, if they want to have better outcomes for patients and reduce some of the high turnover and departures that they’re seeing in their institutions,” Muir said, noting that California implemented staffing ratios in 2004.

In 2023, Oregon’s governor also signed staffing ratios into law. Washington nurses attempted to pass such a policy, and a staffing ratios bill in Pennsylvania has passed in the state’s House of Representatives.

Some nurses said they would have stayed if flexible scheduling were offered, while older nurses said they couldn’t handle the “physical toll” of the job, but would not have left their units if an educator role had been offered to them, Muir said. “I think this speaks to the lack of creativity and the need to modernize healthcare working conditions.”

The authors noted that the age distribution of nurses who left healthcare but were employed in other fields closely tracks with the distribution of nurses employed in healthcare, suggesting this “already existing supply of nurses could be attracted back into healthcare employment.”

In an accompanying editorial, Olga Yakusheva, PhD, of the University of Michigan in Ann Arbor, and Katie Boston-Leary, PhD, RN, of the American Nurses Association (ANA), noted that the ANA, alongside other national healthcare organizations that make up the 2022 Nurse Staffing Task Force, released recommendations for hospitals on investing in nurse staffing, supportive work environments, and competitive wages.

“Yet hospitals have been reluctant to implement the recommendations, instead advocating for increasing the supply of new nursing school graduates and immigrant nurses,” Yakusheva and Boston-Leary wrote.

“A consistent influx of new nurses is undoubtedly needed to grow the nursing workforce, yet without correcting the issues nurses face at the bedside and improving retention, it may not provide a long-term solution,” they added, making the argument for alternative payment models in healthcare.

This cross-sectional study analyzed survey data collected from actively licensed registered nurses in New York and Illinois from April 13 to June 22, 2021. They included 7,887 nurses who recently ended healthcare employment after a mean of 30.8 years of experience. Mean age was 60.1, 93% were women, 78% were white, 9% were Asian, and 8% were Black.

Of the respondents, 694 were employed outside healthcare, 2,287 were not currently employed, and 4,906 were retired.

The survey was sent by email to 100% of registered nurses in both states. The survey directed respondents to “select all that apply” from a list of possible factors for leaving the healthcare field.

While the survey included multiple-choice options, an open-text option allowed write-in responses. Finding that three-quarters of write-in responses aligned with existing factors, the authors re-coded those responses.

One limitation to the study was that the authors had only a rough estimate of when nurses left healthcare and were unable to confirm whether they left before or during the pandemic. In addition, they only surveyed nurses with active licenses and therefore the study excluded data on nurses who recently left healthcare employment and were no longer actively licensed.

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