Nearly a third of nurses looking for the exit, survey shows. Here's what health systems can do to reverse the trend

Nurses are feeling more stress and less satisfaction with their careers and are also more likely to consider leaving their jobs than in 2021, at the height of the COVID-19 pandemic, a new survey shows.

Nearly one-third of nurses (30%) say they are likely to leave their career due to the pandemic, up seven points since 2021, according to AMN Healthcare data published Monday.

The organization's biennial nursing survey consistently warned that the "combination of growing nurse shortages due to increasing retirements of Baby Boomer nurses, a dearth in education and training for their replacements, and the rising utilization of healthcare services by a rapidly aging population would eventually lead to a workforce-related healthcare crisis," AMN Chief Clinical Officer Cole Edmonson wrote in the report.

"We called it a 'perfect storm' of approaching causes and circumstances," he wrote.

The pandemic caused a sudden spike in patient demand, overwhelmed many hospitals and caused great harm to the well-being and mental health of many nurses, Edmonson noted.

The 2023 survey revealed a sudden decline in nurses’ personal and professional views toward nursing since the last RN survey in 2021.

After remaining stable at 80% to 85% for more than a decade, career satisfaction among nurses dropped 10 percentage points from 2021, down to 71%. Nurses’ satisfaction with the quality of care they provided declined 12 points.

Nurses who said they often feel emotionally drained was up 15 points from 2021. Four of five nurses say they experience a great deal or a lot of stress, up 16 points from 2021.

More nurses worry that their job is affecting their health, up 19 points from 2021. The percentage of nurses likely to encourage others to become a nurse dropped 14 points, the survey found.

The survey polled more than 800,000 registered nurses in the U.S. from Jan. 5 through Jan. 18, 2023.

Only 15% of hospital nurses say they will continue in the same job in one year, according to the survey. The other 85% are considering a new place of nursing employment, working as travel nurses, part-time or per diem; taking a job outside of direct patient care; returning to school; or leaving nursing altogether, according to the survey.

Nurse satisfaction and quitting issues may be driven by rising mental health and well-being problems for nurses, which have dramatically increased since the middle of the pandemic in 2021. Mental health problems increased by double digits. Meanwhile, more than one-third of nurses (35%) never address mental health and well-being issues.

Particularly concerning is that younger nurses’ responses were more negative than older nurses regarding satisfaction and mental health and well-being.

One cause of the post-pandemic rise in problems affecting nurses may be a shift in public attention. “During the pandemic, nurses were widely lauded as heroes in the media and public acclaim, which buoyed our spirits and pride during the worst national public health crisis in our lifetimes,” Edmonson said. “But as pandemic conditions waned, the accolades subsided and the focus on nurse well-being wavered.”

Healthcare executives often cite workforce challenges and staffing shortages as their top challenges. Nearly 9 in 10 nurses say the nursing shortage is worse than five years ago—a 37-point increase from 2019.

Reversing the trend will require immediate and shared attention through a collaboration of healthcare organizations; professional organizations; organizations representing patient groups; civil societies such as the major health nonprofits, government agencies, elected officials and nurses themselves, Edmonson wrote.

Efforts to help reduce nurses' stress and reduction in stress and providing support through mental health and well-being services can result in better career satisfaction and job retention, according to the report.

Nurses also identified top strategies to reduce their stress including increasing salaries, more support staff, reducing patients per nurse, creating a safer working environment,and incorporating more nurse input into decision-making.

The industry also needs a systemic transformation in how it deploys the healthcare workforce, Edmonson noted.

AMN Healthcare recommends government regulatory changes and legislation that invests in the healthcare workforce. The proposed federal budget for fiscal year 2024 includes a $32 million investment in nursing education to increase the number of nurse faculty and preceptors. The budget also includes $28 million for a new program to address workforce shortages and $25 million for a new program to support workplace wellness in hospitals, rural health clinics and community health centers. 

The company also recommends large-scale efforts to advance the adoption of technology that augments the healthcare workforce, similar to the Health Information Technology for Economic and Clinical  Health Act of 2009, which created incentives for universal adoption of electronic health record systems among healthcare providers. Technology also can help take away remedial, time-consuming tasks nurses don't have to perform to free them up to spend more time on patient care.

"From our current workforce crisis, we need to develop a unified, collaborative effort, led by nurses ourselves and supported by our allies in multiple sectors of society, to reduce stress and moral injury for nurses through systemic,  professional and personal changes. Uplifting nurses needs to become a national call to action," Edmonson wrote.