Survey Says: Nurses Are Likely To Leave The Profession

The registered nurse workforce grew steadily from the 1970s, stalled in the 1990s, and then dropped by nearly 100,000 in a single year in 2021. High workloads, record burnout during the COVID-19 pandemic, and a shrinking pool of support staff drove the exodus, according to a 2023 National Council of State Boards of Nursing report.

Why Nurses Are Leaving

The 2023 Survey of Registered Nurses by AMN Healthcare labeled the 2021 departures "The Great Resignation." AMN collected 18,226 completed responses between January 5 and 18, 2023, from staff, travel, and per diem nurses. Of that group, 94% were working, 75% full time, and 69% in hospitals. Four themes explain why so many are heading for the exit.

Employer issues. Most nurses had considered leaving hospital employment. Just 15% of hospital nurses expected to hold the same job in a year, and 36% planned to look for a new position. Only 40% said they would stay with their current employer, a 5-point drop from 2021, which means pandemic stress was not the only thing pushing nurses out.

Career dissatisfaction. Career satisfaction held between 80% and 85% for nearly a decade, then fell to 71% in 2023. The share of nurses who would encourage others to enter nursing dropped 14 points from 2021. Satisfaction with the quality of care they could provide fell 11 points, from 75% in 2021 to 64% in 2023.

Mental health. Concern about their own well-being climbed sharply. The number of nurses reporting "a lot" or "a great deal" of stress rose 16 points since 2021.

The nursing shortage. Nine in 10 nurses said the shortage was worse in 2023 than five years earlier, and about 80% expected it to get worse over the next five years.

Nurses Are Advocating for Better Conditions

Nurses see firsthand what high patient-to-nurse ratios do to outcomes, and since the pandemic they have organized more publicly for safer workplaces and fair pay. The American Nurses Association Nurse's Bill of Rights lays out seven principles, including the right to practice safely within a legal scope and the right to fair compensation. It carries no legal weight, but it gives nurses a template for advocacy.

That advocacy has moved into the streets. In January 2023, about 7,000 nurses in the Bronx and Harlem went on strike and won a tentative contract after three days. That action followed a walkout by nearly 15,000 Minnesota nurses across 16 hospitals, the largest private-sector nurses' strike in U.S. history. The Minnesota Nurses Association reported that more than 500 nurses had left Children's Minnesota in Saint Paul over working conditions and that more than 3,500 safe-staffing reports had been filed in two years. By December the Minnesota nurses reached a tentative deal with an 18% raise over three years. Nurses at Veterans Administration hospitals have less leverage, because they lack full collective bargaining rights and can do little beyond protest.

States Are Trying to Close the Gap

States have started addressing the shortage to bring ratios down. Idaho, Arizona, and Utah tapped federal COVID-19 relief to boost hospital staffing, and the U.S. Department of Labor announced an $80 million grant program to expand and diversify nursing training. Experts expect the worst RN shortages in California, Texas, New Jersey, and South Carolina.

Several states are investing in education to grow capacity. Arizona's House Bill 2691 put $15 million toward nursing education, and Washington introduced similar legislation directing $38 million to expand programs. Adding nurse educators and widening the pipeline can ease the shortage, but these fixes take years to show results.

In the meantime, nurses can use the support their employers offer and advocate for more. Nursing is rewarding and hard, and nurses who spend their days caring for others have to make room to care for themselves.

Sources: AMN Healthcare 2023 Survey of Registered Nurses; Auerbach, David, et al. (2022), A Worrisome Drop in the Number of Young Nurses; Martin, Brendan, et al. (2023), Examining the Impact of the COVID-19 Pandemic on Burnout and Stress Among U.S. Nurses.