Workplace woes: More nurses consider changing careers due to frustrations over work environment

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This week National Nurses Week is being observed across America, with businesses and restaurants offering discounts or free items to show their gratitude.

But too many nurses feel as if they aren’t getting the appreciation they deserve inside hospitals and health systems, nursing leaders say.

More nurses have been asking for hospital leaders to hear their concerns, and while more attention has been focused on the workplace in health care, many nurses are still troubled and worn down by their work environment, says Jennifer Mensik Kennedy, president of the American Nurses Association (ANA).

“There is definitely a broad frustration across hospitals and clinics, ambulatory centers and home health,” Mensik Kennedy told Medical Economics’s sister publication Chief Healthcare Executive®. “And this is not getting better.”

Many bedside nurses say they are thinking about career changes, according to a survey of more than 5,700 nurses released in late March by the American Nurses Foundation in partnership with McKinsey & Company.

Nearly one in three nurses (30%) said they were at least somewhat likely to leave their positions in the next six months. That number rises significantly among nurses with less than five years of experience in their careers, with almost half (45%) of early-tenured nurses saying they are thinking of leaving their jobs.

The difficult work environment is the leading factor driving nurses out of bedside positions, Mensik Kennedy says. Nurses are juggling too many patients and are encountering more and more violence and aggressive situations, she notes.

“The big one is, of course, the work environment, which violence is an absolute portion of that,” she says. “It’s having all the work hours and having too many patients to take care of in that limited time, and also the compensation, and they all go hand in hand.”

‘Workload is unmanageable’

For younger nurses, the work environment is daunting because they’re not getting time to grow into the job, and too many aren’t getting mentoring from seasoned nurses. The American Nurses Foundation survey showed that most experienced nurses (72%) said they enjoyed working with newer nurses, but only 60% said they had enough time to coach and guide their less experienced colleagues.

“The workload is just unmanageable,” Mensik Kennedy says. “The workload is such that nurses have to prioritize and ration care, to the point where there's not any slack in their day to be able to stop and help actually mentor,” she explains. “And so the new grads and those younger nurses feel and see the extent to which the more experienced nurses are working and just don't have the time to help and help mentor them.”

Hospitals and health systems need to build time in their scheduling for younger nurses to have mentoring time built into patient care, she says.

Too many nurses with just a few months of experience “are expected to take the same workload as an experienced nurse,” Mensik Kennedy says. “So no one's got time to stop and think and that's where we get people who are like …. ‘I don't need to do this.’ And they leave.”

The ANA recommends that health care organizations develop residency programs for nurses, and advises nursing school graduates to seek jobs at employers with those programs. Residency programs benefit both younger nurses and health care organizations, she says. “We see significantly better rates of retention for those new graduates if they've been through an accredited residency program,” Mensik Kennedy says.

Many nurses also feel frustrated with rigid schedules, especially as many hospitals employ 12-hour schedules, Mensik Kennedy says. Such scheduling makes it difficult for nurses with young children to stay in hospitals. About half (46%) of nurses with less than five years on the job said they would like to see self-scheduling as an option, but nurses at all stages of their careers expressed interest in that choice, according to the American Nurses Foundation survey.

The schedules also become taxing for older nurses who may want to stay at the bedside but don’t feel they are up to 12-hour shifts later in their careers. Almost half of nurses (46%) said they would delay retirement if they could have more flexibility in scheduling, the American Nurses Foundation said. The survey found 45% of retired nurses would consider going back to work with more flexible schedules.

Mensik Kennedy notes that some hospitals have more flexible scheduling options in the operating room and the emergency department, and says hospitals should look at offering more options in other areas as well.

‘I would listen’

When asked about advice she would offer hospital leaders, Mensik Kennedy says, “I would listen.”

“What we hear is nurses don't feel listened to,” she says. “The nurses have the answers. They don't want the world but they'll tell you what they need.”

In some cases, hospitals and health systems may need to invest more in hiring more nurses and offering better compensation, Mensik Kennedy says. And she acknowledges hospitals don’t have unlimited resources.

“The hospital may not be able to do everything, but pick a couple of items to really focus on, … and to make change,” she says. “And that’ll go a long way.”

She also stresses the importance of having nurses in leadership positions of hospitals and health systems, including seats on boards of directors. Nurses hold about 1% of seats on hospital boards, according to a study published in February 2023 by the Journal of General Internal Medicine.

“Shared governance with shared leadership is a great opportunity to listen to nurses and have nurses participate in their control of their practice,” Mensik Kennedy says. “And by doing that, you know, organizations will go a long way in improving the work environment.”

She points out that hospitals need to listen to their nurses to talk about ways to make the workplace safer, as more healthcare workers are facing violence and threats.

“I would encourage organizations to figure out what they can do to make the organization safer today,” Mensik Kennedy says.