Nurse Survey Signals Improvements, Though Retention Still a Problem

The proportion of RNs planning to leave their position fell from 2022 to 2023, though planned departure rates, abusive or violent events, and unsafe conditions remained high, according to a survey of nurses in Michigan.

Among over 9,000 nurses surveyed in 2022, 39.1% planned to leave their position versus 32% of over 7,000 nurses surveyed in 2023, reported Christopher R. Friese, PhD, RN, AOCN, of the University of Michigan School of Nursing in Ann Arbor, and co-authors in JAMA Network Open.

Of these nurses, 41.8% intended to leave their current employer but remain in nursing, with workload as the most commonly cited reason (29.4%). Prior research has shown that chronic understaffing predated the COVID-19 pandemic.

Factors associated with increased likelihood for leaving included workplace abuse or violence (OR 1.39, 95% CI 1.05-1.82) and higher emotional exhaustion scores (OR 3.05, 95% CI 2.38-3.91), while favorable practice environments (OR 0.37, 95% CI 0.22-0.62) and excellent clinical setting safety ratings (OR 0.28, 95% CI 0.14-0.56) were linked to a lower likelihood of leaving.

Respondents to the 2023 survey reported less workplace abuse or violence compared with the 2022 survey respondents (43.4% vs 50.2%, P<0.001), fewer understaffed shifts (41% vs 48.2%, P<0.001), and less frequent use of mandatory overtime (11.7% vs 18.7%, P<0.001).

“It’s a good news, bad news situation,” Friese told MedPage Today. “On most of the measures that we tracked between 2022 and 2023, things improved.”

The 2023 survey also showed that fewer nurses wanted to pursue travel nursing (7% vs 18.1% in the 2022 survey), fewer nurses planned to reduce their clinical hours (18% vs 27.9%), and fewer nurses reported that their practice environment was unfavorable (11.2% vs 16.9%).

“But a third [of nurses] still are looking to leave their position,” Friese pointed out. “That’s exceedingly high [and] has to be among the higher rates that we’ve seen historically in nursing over many decades.”

Of note, there was little change in the share of nurses who reported that they were either dissatisfied or extremely dissatisfied with their current position across the 2022 and 2023 cohorts (26.5% and 28.2%).

Friese and colleagues also pointed to a “worrisome pattern” of high rates of job dissatisfaction and intention to leave among nurses ages 34 and younger.

“These are the folks who have potentially decades of time left to practice nursing,” and losing them early is a particularly “bad sign” that hasn’t been accounted for in some economic modeling, Friese said. “So, we have to think about strategies that allow nurses to care for the appropriate number of patients for their clinical setting, and that, our data says, is not the norm in 2023.”

Last August, the Health Resources and Services Administration announced a $100 million package that would help LPNs complete RN programs, among other initiatives.

The package is “helpful but not sufficient,” because it focuses only on the supply side of the equation, Friese noted. “You can’t recruit your way out of a retention problem.”

In an accompanying editorial, Karen B. Lasater, PhD, RN, of the Center for Health Outcomes and Policy Research at the University of Pennsylvania in Philadelphia, wrote that “efforts to train and recruit more nurses are akin to fueling a car with a leaking gas tank. Turnover rates in hospitals are averaging over 20%. Recruiting and training more nurses will not retain them at the bedside if staffing conditions are poor.”

“Instead, hospitals should implement evidence-based approaches to resolve their retention issues, including listening to their own nurses who say they are experiencing burnout and leaving because of chronic understaffing,” she added. “Absent hospitals’ responsiveness to nurses, legislators need to step in to ensure hospitals are sufficiently staffed with enough nurses to care for the public.”

Friese noted that “the projections are pretty clear. We have enough people who hold an RN license and are within an age range to practice nursing in the country. We just have a lot of nurses who are choosing not to work under these conditions.”

While it is “not cheap,” he said that he is puzzled by hospitals that say they don’t have the funds to invest in retaining nurses, while pouring money into recruitment. At the federal and state level, legislative proposals aim to establish “a minimum floor for staffing,” some of which incentivize or require hospitals to change staffing practices, he pointed out.

For this study, Friese and colleagues compared data collected from the Michigan Nurses’ Study at two time points: February 22 to March 1, 2022, and May 17 to June 1, 2023. Practicing RNs with an active, unrestricted license in Michigan and a valid individual email address were included.

They obtained data on 9,150 nurses who responded to the 2022 survey and 7,059 nurses who responded to the 2023 survey. Response rates were 8.3% and 7.4%, respectively.

Across the two groups of survey respondents, 21-23% were ages 55-64, 19-20% were 45-54, 17-18% were 35-44, and 13-15% were 34 and younger. The majority were women (71-73%) and white (69-70%).

One limitation to the study was that the sample sizes may not reflect the RN population, particularly nonresponders satisfied with their positions. In addition, the authors did not have confirmation that the nurses who reported an intention to leave actually left.

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