Why Nurses Stay in Jobs and Why They Go

A new Press Ganey data analysis uncovers the key drivers of nurses' intent to stay in their positions.

Editor's note: This article appears in the March/April 2019 edition of HealthLeaders magazine. For more on nurse recruitment and retention visit the article, Want to Keep Nurses at the Bedside? Here's How.
 

What's the secret to creating longevity among bedside RNs?

According to the 2018 Press Ganey Nursing Special Report: Optimizing the Nursing Workforce: Key Drivers of Intent to Stay for Newly Licensed and Experienced Nurses, there's not one magic answer to that question.

Rather, it requires understanding that nurses' wants and needs change throughout their careers, says Christy Dempsey, RN, MSN, CNOR, CENP, FAAN, chief nursing officer at Press Ganey. The report sheds some light on what those motivators are.

The study analyzed responses of nearly 250,000 RNs to identify trends in intent to stay based on age, tenure, and unit type, as well as drivers of intent to stay.

Here are some of the findings:

• "Dissatisfaction with the work environment was the most commonly cited reason for leaving," Dempsey says. Nurses across all age groups and experience levels cited this as a reason they planned to leave their job within the next year.
   
• Newly licensed nurses and those who have been in practice for two to four years are at highest risk for attrition. In the next year, 24.5% of NLRNs and just over 27% of those with two to four years' experience reported they planned to change jobs in the next year.
   
• "The predictors of intent to stay for nurses who had been practicing less than two years were things like praise, recognition, nurse manager support, certification, and joy in work," says Dempsey. "Those were not so much the predictors for those who've been practicing for more than 20 years. For them it was about leadership, influence over their schedule, and quality of care."
   
• Nurses in adult step down and med/surg units were more likely to say they were going to leave within one to three years. "These are difficult and demanding units, with sick patients and less staffing than a critical care unit," Dempsey notes. "We need to make sure there is strong managerial support for those units, efficient processes, and that we keep those nurses at the bedside."
   
• Interestingly, while nurses under 30 years old were more likely to say they were going to leave their unit, they still planned to stay within their organizations. "Quite frankly, we're seeing organizations that are more focused on keeping nurses in the organization rather than in the department. I think that is an opportunity to help nurses in professional development while still keeping them in the organization."
   

Dempsey's advice for other healthcare leaders:

"We interviewed high performers, and in that analysis, we found top-performing nurse managers focused on quality of care, staffing, the professional practice environment, and interpersonal and interprofessional relationships. In other words, top-performing managers spend a large proportion of their time creating foundations for quality of care. That meant that they were visible through rounding. They trained nurses to lead clinical rounds. They developed shared governance structures led by direct care nurses. They use data to support decisions and drive practice. They involve direct care nurses in decisions involving the unit and staffing, and they promoted autonomy. And those are some of the ways that high-performing nurse managers create a positive work environment."