Nurse-reported career changes improve, yet ‘serious problems persist’

ByJennifer R. Southall

Fact checked byMindy Valcarcel, MS

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Key takeaways:

Workload is the top reason nurses left their career in both 2022 and 2023.
Nurses said favorable practice environments and excellent clinical setting safety ratings led to a lower likelihood of leaving.

The number of U.S. registered nurses, including mostly women, who planned to leave their careers lowered significantly in 2023 compared with 2022, according to updated results of the Michigan Nurse’s Study.

However, the findings also showed that nurses continued to report high rates of abusive or violent events, unsafe working conditions and planned career departures, the researchers noted.

A tired nurse sits at a computer desk. — Nurses cited workloads as the top reason for leaving their workplace in 2022 and 2023.
*Image: Adobe Stock*

Intentions to leave

“In the early phases of the COVID-19 pandemic, high proportions of health care workers reported their intention to leave their positions, especially female workers and nurses,” Christopher R. Friese, PhD, RN, AOCN, associate director for cancer control and population sciences at University of Michigan Rogel Cancer Center, and colleagues wrote. “News reports suggested that nurses were leaving their positions, citing unsafe conditions. Hospital leaders reported acute vacancies and demand for expensive temporary personnel, triggering congressional inquiries. Nurses reported increased vacancies, citing the workload as a primary reason. Yet the size and trajectory of the problem are unclear, which has hindered policy implementation.”

Researchers sought to examine and compare potential changes from 2022 vs. 2023 in nurses’ workplace assessments and intention to leave the workplace.

The Michigan Nurses’ Study included 9,150 nurse participants (71% women) in the 2022 survey and 7,059 participants (72.7% women) in the 2023 survey.

The workplace assessment portion of the survey included questions about abusive or violent workplace events, emotional exhaustion, and job satisfaction, among others.

Nurses’ intention to leave their current position within 1 year served as the primary outcome.

The 2023 survey asked those who intended to leave their planned next career steps as well as the main reason for their exit. Researchers used regression analysis for their assessment.

Conditions improving

Results showed that 32% of nurses surveyed in 2023 reported plans to leave their current position compared with 39.1% of nurses surveyed in 2022.

Among all nurses who planned to leave in 2023, 41.8% reported they planned to leave their current employer but remain in nursing and cited workloads as the top reason for leaving (29.4%).

Researchers additionally found that nurses surveyed in 2023 cited less workplace abuse or violence vs. those surveyed in 2022 (43.4% vs. 50.2%; P < .001), as well as less frequent use of mandatory overtime (11.7% vs. 18.7%; P < .001) and fewer understaffed shifts (41% vs. 48.2%; P < .001).

Moreover, nurses surveyed during both time periods cited workplace abuse or violence (OR = 1.39; 95% CI, 1.05-1.82) and higher emotional exhaustion scores (OR = 3.05; 95% CI, 2.38-3.91) as factors associated with increased likelihood for planned departures.

Conversely, nurses overall cited favorable practice environments (OR = 0.37; 95% CI, 0.22-0.62) as well as excellent clinical setting safety ratings (OR = 0.28; 95% CI, 0.14-0.56) as factors associated with lower likelihood of leaving.

“These findings suggest somewhat improved working conditions and possible easing of workforce pressures,” the researcher wrote. “Based on these findings, additional work is needed to elucidate why and how conditions are improving.”

‘A welcome shift’

In an accompanying editorial, Karen B. Lasater, PhD, RN, associate professor of nursing at the Center for Health Outcomes and Policy Research, School of Nursing of the University of Pennsylvania, wrote that, “These findings signal a welcome shift after several consecutive years of mounting and unprecedented rates of nurse burnout, hospital turnover and staffing vacancies — yet serious problems persist.”

Lasater found the findings “alarming” and not unique to Michigan. “For example, among registered nurses working in New York and Illinois in 2021, one in four nurses planned to leave their hospital employer within 1 year,” Lasater wrote. “Why are so many nurses planning to leave their employers?

“The latest evidence from Friese and colleagues adds further confirmation to what others have found, which is that nurses are not fleeing their profession, they are fleeing their employer,” she added. “If policymakers do their jobs to ensure the public gets safe, high-quality care in every hospital across the country, they should start listening to nurses and acting on the evidence: Safe nurse staffing policies will save lives and keep nurses at the bedside.”

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Sources/Disclosures

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Disclosures: Friese and colleagues report no relevant financial disclosures. Lasater reports receiving funding from Agency for Healthcare Research and Quality.