It’s 8:00 a.m. and Christa Thompson, BSN, RN,* is travelling to a local Houston hospital to educate nursing staff on the latest medical device. A typical day is anywhere from two hours up to 12 hours for her, but she’s not unusually tired or stressed by the end of the day. A nurse for over five and a half years, Thompson is a RN by trade and works part-time as an independent clinical consultant training other people on the use of medical devices. She credits her nursing education and curiosity at an international nursing conference for getting her this job.
“I went up to a medical device booth at the conference and asked the representative if they hired nurses, simply out of curiosity,” says Thompson. “I was pretty much hired on the spot.” She loves her consultant job and knows her new career is a dream job for most nurses, but nursing is not where her true passion lies.
Thompson plans on leaving nursing to become a doctor. Nursing has been a rewarding career for her, but she realizes she can’t do nursing forever, even if her intentions weren’t to continue on to medical school. She is not alone in the sentiment that nursing at the bedside is not something that most nurses can do for their entire career. Her path to transition from the bedside is unique but not uncommon to many nurses in the profession.
Of the 3,514,679 nurses in the United States, nearly 63.2% of RNs and 29.3% of LPNs work in a hospital setting. The RN Work Project reports an average of 33.5% of new RNs leave the bedside within the first two years. Leaving the bedside to pursue other nursing positions does not necessarily mean nurses leave the profession, but it is a catalyst to do so. Why do some nurses leave the bedside and eventually the profession? Ask any nurse and the answers are varied, but common themes seem to ring true for most.
Why Nurses Leave the Bedside (and, Ultimately, the Profession)
Poor Management. One of the greatest complaints nurses have is the lack of support from their management team. What makes a poor manager? Some nurses may say it’s one who doesn’t value open-communication and feedback from his or her staff. Some say it’s the management team that plays favorites amongst staff or a particular shift. Yet, other nurses say it’s the manager who is not supportive of a nurse advancing her career. The list could go on forever, but one common frustration among nurses is the overall lack of support for those at the bedside. It seems to some that once nurses become managers, they “forget where they come from” and are oblivious to the struggles a bedside nurse faces on a daily basis.
Management may not even be aware of the stressors their staff encounters working the bedside. It could be that they are so wrapped up with their own job that they can’t focus on what would make life better for their staff. Or it could be that they just don’t care. Whatever the case, nurses do feel strongly about poor management.
Thompson agrees that management sometimes shows little consideration for those working at the bedside: “I feel like the night shift is ignored by management, like they have no voice.” The same sentiment echoes true for many other nurses. They feel as if management does not value them as part of the health care team—just as a docile staff that follows orders without question.
The best form of leadership follows a diplomatic approach; meaning, higher-ups actively engage their employees for input on situations that may arise. The diplomacy allows for everyone to have a voice. This type of management style encourages active participation among all employees and may dissipate some of the negative feelings some nurses feel towards their management team.
Lack of Upward Mobility. Many nurses unhappy with their chosen profession find that job mobility from the bedside is difficult without an additional degree. A nursing degree overqualifies many from other jobs outside of nursing and may not pay the equivalent of a nurse’s current salary. In order to get a job that pays as much or more than the average RN makes, additional years of school are typically required. This is a sacrifice that some may not be able to make, given that going back to school requires time away from work.
For those willing to go the extra mile and complete a higher degree in nursing, many career opportunities abound. Going back for an advanced nursing degree is the way some nurses find personal satisfaction in their career. Although not in a graduate program yet, Brittany Green, BSN, RN, a relatively new nurse of three years, plans on becoming a family nurse practitioner to influence patients in an outpatient setting and prevent some of the morbidity and mortality she sees in her current job as a cardiovascular recovery room nurse.
Green believes nurses leave because they experience burnout. “It’s not a career for everyone. It takes a special type of person to handle the emotional and physical stress that comes along with nursing,” she says. “I know I won’t be able to do bedside nursing forever; the long hours and stress will start to wear more on me.”
Underpayment. A nurse’s job can be physically and emotionally draining. Many nurses feel like they are severely underpaid for the work they do. Twelve-hour shifts can feel more like 16 when you are working the job of four people, but only getting paid for one. Nurses also sacrifice holidays, weekends, and family events because of their long and ever-changing schedule.
On the other hand, one may say a nurse’s schedule is ideal; a three-day work week schedule and having the ability to take long vacations using minimal vacation time sounds appealing to many.
But at what cost?
Nurses are notorious for picking up extra shifts on their day off because they feel like they are being paid not nearly enough for the work they do. Based on the most recent Minority Nurse annual survey results, the average RN salary in the United States is $67,980 per year. This may be considered a solid middle class income for most Americans, but nurses work very hard and feel as though it is not enough most days.
Too Many Tasks. Today’s nurse does it all; you name it, nurses do it. Administer meds? Check. Assist patients with dressing, bathing, and mobility? Check. Perform bedside procedures once done by physicians? Check. Coordinate care between all disciplines of the hospital? Check. The list is endless—and that’s the problem. Nurses are responsible for so many aspects of a patient’s care that it can become overwhelming for one person to manage during a shift.
A typical nurse works a 12-hour shift that translates into much more when the nurse is doing the job of multiple people day in and day out. Sometimes a nurse is so involved in completing everything it becomes difficult to take a much needed and deserved break during her shift. This makes for a very long day. Although the typical nurse’s schedule consists of three 12-hour shifts per week, when the days are packed with multiple tasks and responsibilities each and every day, burnout is inevitable. Studies conducted to rate nurse turnover clearly show that as a nurse’s workload increases, nurse burnout and job dissatisfaction—both precursors of voluntary turnover—also increase.
Nurses performing too many tasks typically boils down to staffing, specifically understaffing, which is also known as short staffing. When nursing units are short-staffed, nurses take on a majority of tasks done by others simply because they know how to do many other people’s jobs, but those people cannot do the job of the nurse. How many nurses have had to cover the front desk because there is not a unit secretary on duty? Or how about the nurse who is behind on her nursing duties just because she is trying to complete activities of daily living for a patient that is usually carried out by a nurse’s aide? Nurses wear the hat of many, but no one can take on the role of the nurse.
Short Staffing. A resounding number of nurses blame short staffing as the most common reason nurses leave the profession. According to a recent poll on Allnurses.com, more than one third of 1,500 nurses polled say that continuous short staffing drives nurses from the bedside and, ultimately, the profession. One of the reasons for short staffing is management cutting costs as much as possible—and what better way to do that than cut staff and work on less than is needed? Nurses are notoriously known to multitask, wearing many hats on a day-to-day basis. Management knows this and may not think it’s a problem to go without a unit secretary or nurse aide on the unit because nurses will pick up the slack. Unfortunately, this unequal distribution of work leads to many unhappy nurses who burn out quickly when doing the job of many people.
Employers can ease the burden on nurses by mandating nurse-patient ratios. Since 2004, California has mandated patient ratios of 1:5 for nurses working in hospital settings. Studies have shown the benefit of such staffing ratios. The Aiken study demonstrated that nurses with California-mandated ratios have less burnout and job dissatisfaction, and the nurses reported consistently better quality of care, leading to decreased turnover.
Decreasing patient-nurse ratios has more benefits than disadvantages that could benefit US hospital systems. The Aiken study followed nurses in three states: Pennsylvania, New Jersey, and California—with California being the only state with mandated nurse-to-patient ratios. Over 22,000 RNs were surveyed, and researchers found:
• RNs in California have more time to spend with patients, and more California hospitals have enough nurses to provide quality patient care;
• In California hospitals with better compliance with the ratios, RNs cite fewer complaints from patients and families;
• Fewer RNs in California miss changes in patient conditions because of their decreased workload than RNs in New Jersey or Pennsylvania;
• If California’s 1:5 ratios on surgical units were matched, New Jersey hospitals would have 14% fewer patient deaths and Pennsylvania hospitals would have 11% fewer deaths;
• Nurses in California are far more likely to stay at the bedside and less likely to report burnout than nurses in New Jersey or Pennsylvania.
Maybe other states should follow California’s lead and mandate nurse-patient staffing ratios. What will it take to get the message across to industry leaders and make a change in how staffing levels are managed across the United States?
To Stay or Go?
The nursing profession isn’t completely lost on Thompson. She still works occasionally at the bedside on an intermediate care unit simply because of the one-on-one interaction she has with her patients. Many nurses reflect that they love nursing and enjoy spending time with their patients—something that is becoming more and more difficult with everything nurses are expected to do in this day and age.
The decision to leave the bedside affects not only the nurse contemplating such a transition but also the facility and patients who may be taken care of in a facility that is short-staffed. Replacing a nurse is costly. The RN Work Project cites the average cost to replace an RN who leaves the bedside ranges from $10,098 to $88,000 per nurse. What’s more astonishing is total RN turnover costs range from approximately $5.9 million to $6.4 million per year at an acute care hospital with more than 600 beds.
There are nurses who love their career and wouldn’t ever think of leaving. Kim Hatter, MSN, RN, is one of them. Drawn to the profession because of her mother, she was inspired by her compassion at an early age: “[My mother] was actually one of the first African Americans to graduate from Southern Arkansas University as a registered nurse.”
When questioned whether or not she had plans on leaving the profession, Hatter says no. “I’ve never thought of leaving the nursing profession, but I have sought a higher level of education in nursing recently.” Like Green, Hatter is completing her goal of becoming a nurse practitioner. She recently graduated from an adult–gerontology program and will soon leave the bedside to work at an outpatient clinic.
Because the bedside can be brutal on the body, many nurses like Green and Hatter choose to pursue nursing higher education to move from the bedside instead of leaving the profession completely. “I’ve heard of a lot of nurses with back and knee injuries,” says Hatter. “Nursing is a physically taxing job and does take a toll on your body.”
What is the Answer?
Nurses face a variety of challenges in the workplace that makes their job difficult. Based on the most prevalent and distressing issues identified by nurses, what is the overall answer to keep nurses at the bedside and, ultimately, in the profession? The RN Work Project reported when RNs leave their job, most go to another health care job not necessarily in a hospital. This is great for the general community, but it leaves a gap in coverage in hospitals where most acutely ill patients go. Where does that leave patients who need care in a hospital setting?
Green doesn’t think there is any one solution to the problem. “Burnout will always be an issue in the nursing profession,” she explains. “I think one of the most important things is for nurses to feel appreciated—by employers, coworkers, physicians, and hopefully patients.”
Hatter has a different prospective on potential solutions to this monumental problem: “I think paying nurses a higher rate of pay is always an incentive to stay. I also think nurses should receive more recognition for the valuable role they play in society.” The common denominator between Hatter and Green is that they both believe the nursing profession deserves more credit than it currently receives—and maybe this is the first step in keeping nurses happy and in the profession for the long haul.
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