Nurses cite employer failures as their top reason for leaving

A new study from the University of Pennsylvania School of Nursing's Center for Health Outcomes and Policy Research (CHOPR)—published in JAMA Network Open—showed that, aside from retirements, poor working conditions are the leading reasons nurses leave health care employment. These study findings come at a time when hospital executives cite staffing problems as their most pressing concern.

"Prior studies evaluate nurses' intentions to leave their job. Our study is one of the few evaluating why nurses actually left health care employment entirely," said lead author K. Jane Muir, Ph.D., RN, a CHOPR Postdoctoral Research Fellow, Associate Fellow of the Leonard Davis Institute for Health Economics, and a National Clinician Scholar at the University of Pennsylvania. The study surveyed 7,887 registered nurses in New York and Illinois who left health care employment between 2018 and 2021.

Across a variety of health care settings including hospitals, long-term care facilities, and ambulatory care, planned retirement was the most cited reason nurses are leaving health care employment. Closely behind retirements, insufficient staffing, burnout, and poor work-life balance topped the list. Among retired nurses in the study, only 59% stated their retirement was planned, suggesting nearly half of nurse retirements are premature exits due to poor working conditions.

"Nurses are not principally leaving for personal reasons, like going back to school or because they lack resilience. They are working in chronically poorly staffed conditions which is an ongoing problem that predates the pandemic," said senior author Karen Lasater, Ph.D., RN, Associate Professor, the Jessie M. Scott Term Chair in Nursing and Health Policy, and Senior Fellow of the Leonard Davis Institute for Health Economics.

Study authors say that health care employers could also retain more nurses through solutions that enhance nurses' work-life balance. This includes greater flexibility in work hours such as shorter shift-length options, higher pay-differentials for weekend/holiday shifts, and on-site dependent care.

"Nurses are retiring early and leaving employment in the health care sector because of longstanding failures of their employers to improve working conditions that are bad for nurses and unsafe for patients. Until hospitals meaningfully improve the issues driving nurses to leave, everyone loses," said Muir.