The number of nurses considering leaving their jobs over the next year could be higher than previous studies suggest, according to new research from the Illinois Economic Policy Institute and the Project for Middle Class Renewal at the University of Illinois at Urbana-Champaign.
More than half of the nurses surveyed said they are considering leaving the profession within the next 12 months. Unresolved feelings of moral distress and unsafe staffing were the top reasons cited by nurses considering leaving their roles, according to the study.
More than 93% of nurses reported feelings of moral distress — or feeling unable to take the ethically correct action in a given situation due to organizational and institutional constraints. And 43% of RNs nationally reported caring for six or more patients at one time during their normal shifts, the study found.
Ultimately, as nurses rethink their careers and what organizations they want to work for, researchers found a key disconnect between the quality of work nurses want to provide and what they’re able to do with available resources.
“Nurses cannot provide the health care that they know they're capable of because of their working conditions,” said Robert Bruno, one of the report’s authors and a professor at the University of Illinois School of Labor and Employment Relations.
Some factors, including whether a state has laws on the books related to nurse staffing, might determine how heavy workloads are and how likely nurses are to pursue other jobs. Unionization status also plays a role.
Unionized nurses were 8% less likely to care for six or more patients than nonunion nurses, 4% less likely to consider leaving the profession in the next year and 10% less likely to have left nursing positions in the past six months, the report found.
They’re also 19% more likely to earn at least $75,000 a year, according to the analysis.
The tension nurses are currently experiencing could give way to more unionization among a historically active occupation, Bruno said.
“They want to do good, there's a sense of a calling and they don't want to necessarily walk away from it,” Bruno said.
“I think this will further incentivize nurses to understand that they need a collective voice to address this problem of being unable to really do their work the way they were trained to do it,” he said.
Responses also varied among nurses practicing in states with staffing legislation and those in states without such rules.
A number of states have varying laws covering nurse staffing, which can be split into three categories: those that mandate specific ratios, those requiring the formation of nurse-led staffing committees and those requiring hospitals to publicly report their staffing levels. Some states have laws requiring two of those components.
California is the only state with ratios dictating exactly how many patients a nurse can care for in multiple units. Massachusetts has a law outlining ratios only in intensive care units.
In those states, the share of nurses who reported caring for six patients or more fell by 12% compared to those surveyed overall, and moral distress fell by 4%. Nurses were also 6% less likely to say they were considering leaving the job in the next year.
Other states that have staffing laws requiring hospitals to form nurse-led staffing committees include Connecticut, Illinois, Nevada, New York, Ohio, Oregon, Texas and Washington.
In those states and among nurses who said their committees’ recommendations were enforced, nurses were 18% less likely to report caring for six patients or more, 8% less likely to experience moral distress and 11% less likely to consider leaving the profession in the next year.
Nurse responses varied little in the three states that require public reporting of staffing levels, according to the report, based on responses from more than 2,000 registered nurses in all 50 states between October and November of 2021.
Beyond having lawmakers implement public policies, the onus is also on employers who’ve recently had to boost wages and benefits to attract and retain staff.
“At a time when nurses are in high demand, we need solutions that increase job satisfaction, improve quality of care and reduce moral distress,” said Frank Manzo, executive director of the Illinois Economic Policy Institute.