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- The number of nurses in the workforce dropped by nearly 100,000 in 2021.
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- Reasons for nurses’ leaving the profession include burnout, pre- and post-pandemic impacts, and the nursing shortage.
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- Nurses are advocating for safer work environments and better compensation.
A steady growth in the number of registered nurses (RNs) since the 1970s stagnated in the 1990s and took a nosedive in 2021 when the total number of nurses dropped by 100,000 in one year.
High workloads and unprecedented burnout levels during the COVID-19 pandemic, coupled with a declining number of nursing support staff, contributed to the high number of nurses leaving the profession, according to a 2023 National Council of State Boards of Nursing report.
Reasons Nurses Are Likely to Leave the Profession
A 2023 Survey of Registered Nurses by AMN Healthcare called the mass exodus of nurses in 2021 during the pandemic as “The Great Resignation.”
AMN received 18,226 completed surveys between January 5-18, 2023, from staff, travel, and per diem nurses. From the cohort, 94% were working, 75% were working full-time, and 69% worked in hospitals.
The survey offers insight into why nurses are leaving the profession to retire early or for another occupation. These reasons include:
Employer-Related Issues
The survey revealed that a majority of nurses considered leaving hospital employment. Just 15% of those working in hospitals said they would have the same job in one year and 36% said they would be looking for a new position.
When asked if they would continue to work in their current place of employment, 40% said yes. This represents a 5% point drop since 2021, in the middle of the pandemic, indicating the stressors of the pandemic were not the only reasons nurses considered leaving their current employer.
Career Dissatisfaction
For nearly one decade, career satisfaction had fluctuated between 80%-85%, but in 2023, it dropped to 71%. The survey responses indicated that the likelihood nurses would encourage others to become a nurse also dropped 14 percentage points since 2021.
While caring for COVID-19 patients in 2021, 75% of nurses were satisfied with the quality of care they provided. This satisfaction rate dropped 11 percentage points to 64% in 2023.
Mental Health and Emotional Well-Being
The survey also asked nurses about their mental and emotional well-being. The responses indicated that nurses had had dramatically greater concerns since 2021. The number of nurses who experience “a lot” or a “great deal” of stress rose 16 percentage points.
The Nursing Shortage
When asked about the future challenges of the nursing shortage, 9 out of 10 nurses responded that they believed the shortage was worse in 2023 than five years ago. About 80% of nurses expected it to get “much worse” or “somewhat worse” in the next five years.
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Nurses Are Advocating for Better Working Conditions
Nurses are strong patient advocates. Since the pandemic, they have mobilized to advocate more publicly for better working conditions. Nurses are on the frontline of healthcare and see the consequences of high patient-to-nurse ratios, including poor patient outcomes.
Nurses must operate in a safe, satisfying, and empowering environment to improve patients’ health and healthcare. The American Nurses Association created the Nurse’s Bill of Rights, which cites seven principles they believe every nurse has the right to.
While not legally binding, the document gives nurses a template to advocate for rights in the workplace, including:
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- Practice in a safe environment in accordance with professional standards and legally authorized scopes of practice
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- Fair compensation and a safe work environment for themselves and their patients.
Speaking out in the workplace can be intimidating. Yet, advocating for a safe working environment and adequate compensation is essential for nurses to become empowered and make changes in the workplace.
Since the start of the pandemic, nurses across the country have chosen public venues to advocate for a better working environment and fair pay.
One example is the New York nurses’ strike in January 2023, during which approximately 7,000 nurses in the Bronx and Harlem went on strike.
After three days, the hospital reached a tentative contract agreement with the nurses, and they returned to work. The New York nurses’ strike followed a strike of nearly 15,000 Minnesota nurses who took to the street after months of negotiations failed to produce an agreement for better working conditions and lower patient-to-staff ratios.
Nurses from 16 hospitals went on strike, making it the largest in U.S. history. According to the Minnesota Nurses Association, over 500 nurses working at Children’s Minnesota Hospital – Saint Paul left because of stressful working conditions — over 3,500 reports had been filed concerning safe staffing in the past two years.
The goal of the strike was to bring hospital employers back to the negotiating table, hoping to reach an agreement for safer working conditions. A tentative agreement was announced by December, including an historic 18% pay increase over three years.
Although Veterans Administration (VA) hospitals are notoriously short-staffed and their healthcare workers are exposed to workplace violence, the most that nurses working for the VA can do is protest. That’s because VA nurses do not have full collective bargaining rights, meaning their employer has no obligation to listen to their grievances.
States Have Been Working to Provide Better Working Conditions
As nurses begin strongly advocating for their rights, states have also been working to provide better working conditions by addressing the nursing shortage to lower nurse-to-patient ratios.
For example, Idaho, Arizona, and Utah have used federal COVID-19 relief funds to increase hospital staffing. The US Department of Labor also announced an $80 million nursing grant program to increase diversity and nursing training programs to expand the pipeline.
Experts believe the most severe shortage of RNs will occur in California, Texas, New Jersey, and South Carolina. Some states plan to invest in nursing education to grow the program’s limited capacity for students.
For example, Arizona passed House Bill 2691, allocating $15 million toward nursing education. Washington introduced similar legislation to distribute $38 million to create expanded nursing programs throughout the state.
Increasing workplace diversity and addressing the need for more nurse educators can also help reduce the nursing shortage over time. The reality is that while the shortage significantly impacts nurses’ decision to leave the profession, the strategies to address the shortage will take time to implement.
In the meantime, nurses can advocate for and take advantage of support mechanisms offered by employers. Nursing is a rewarding career, but it is also challenging. Nurses spend their time at work, and often out of work, caring for others. To maintain their mental and physical health, nurses must also choose to take care of themselves.