Mental health, lack of workplace support are leading factors driving nurses from jobs: Study

Coworker and employer support are strong predictors of nurses planning to stay in their jobs, while symptoms of depression are linked to nurses planning to leave, according to a study conducted at the height of the COVID-19 pandemic by researchers at the NYU Rory Meyers College of Nursing.

The research, published in the Online Journal of Issues in Nursing, examines both pandemic-related factors and the overall work environment for nurses and can help organizational leaders improve their support for and retention of their nursing workforce.

"Coming out of the pandemic, the mental health of health care workers has been top of mind," said Amy Witkoski Stimpfel, assistant professor at NYU Rory Meyers College of Nursing and the study's senior author. "Our findings suggest that focusing on organizational support and mental health can improve nurses' well-being and increase the chances that they will stay in their jobs."

The intense working conditions during the COVID-19 pandemic exacerbated stress and burnout among nurses. Many left their jobs, stretching a workforce struggling with shortages even thinner. Inadequate nurse staffing and turnover are linked with a range of negative outcomes, including worse quality of care for patients, poor health for fellow nurses, and increased costs for health systems.

Witkoski Stimpfel and her co-author, NYU Meyers doctoral student Kathryn Leep-Lazar, wanted to understand what characteristics of a nurse's job, work environment, and mental health predict whether they intend to stay in their role. The researchers surveyed 629 U.S. nurses across 36 states during the summer of 2020—when many parts of the country were experiencing surges of COVID-19 cases and hospitalizations.

Witkoski Stimpfel and Leep-Lazar gathered information about the nurses' workplaces, including the type of setting, schedule, patients per nurse, and length of shift, as well as COVID-specific factors, such as whether nurses were caring for COVID patients and had adequate personal protective equipment (PPE). They also collected demographic information and measures of anxiety, sleep issues, and depression, comparing all of these factors with nurses' intent to stay in their jobs one year from now.

The researchers found that the strongest factor predicting whether nurses intended to remain in their roles was having support systems at work. Nurses who felt supported by their colleagues were nearly twice as likely to want to stay in their jobs compared with those who didn't feel as supported, while nurses who felt supported by their organization were 2.4 times more likely to say they would stay. Workplace support was an even stronger predictor of nurses' intentions to stay in their jobs than COVID-specific factors, including pandemic preparedness, PPE shortages, and whether nurses were directly caring for COVID-19 patients.

In contrast, symptoms of depression were associated with nurses planning to leave their jobs within the year. Nurses with mild symptoms of depression were 50% less likely to say they plan to stay in their jobs compared to those with minimal symptoms, while nurses with moderate or severe symptoms of depression were 73% less likely.

"We know that there is significant overlap between depression and occupational burnout, with both capturing feelings of fatigue and a lack of energy. It's possible that many of the nurses reporting depressive symptoms were in fact experiencing exhaustion and burnout from elevated workloads and long hours during the pandemic," added Witkoski Stimpfel.

"Considering that 60% of the nurses we surveyed reported some level of depression, organizational leaders need to be paying attention to the mental health of this critical workforce," said Leep-Lazar, the study's first author.

The researchers encourage employers to examine their mental health resources—such as employee assistance programs and therapy covered by employer-sponsored benefits—available to nurses. In addition to providing support for individual nurses, the researchers urge organizations to create healthy work environments that foster support among staff and have policies and practices that protect nurses against depression, burnout, and other poor mental health outcomes.

"The good news is that the factors we identified—workplace support and mental health—can be addressed through targeted efforts, some of which may already be in place," said Witkoski Stimpfel.