One-Third of Nurses Plan to Quit. How Will This Impact Patient Care?
- Approximately 100,000 nurses left the workforce during the COVID-19 pandemic, with almost 900,000 more planning to follow suit by 2027, according to a recent study.
- The mass departures exacerbate an ongoing nursing shortage and pose significant threats to the entire healthcare delivery system.
- Nurses leaving the workforce may lead to compromised patient safety and limited access to care for many people.
A 2023 report by the NCSBN revealed that approximately 100,000 nurses left the profession during the COVID-19 pandemic. Nearly 900,000 nurses intend to leave by 2027.
In a survey of 18,000 nurses, 30% say they will likely leave their nursing career because of the pandemic, according to AMN Healthcare.
If these predictions hold true, what can nurses and patients expect for the future of healthcare? Explore the reasons for this mass departure and its implications over the long term.
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Departures: Inside the Reports
Although the COVID-19 pandemic has brought more attention to the issue, the mass departure of nurses is nothing new and sentiments have been brewing for some time. Other causes include burnout, feeling undervalued, and high patient-to-nurse ratios, according to an American Nurses Association article.
While there are many factors behind the nursing shortage, many nurses are suffering personally and professionally due to the imbalance. The shortage is a common source of dissatisfaction in the nursing community, and nurses have been voicing their frustrations for some time.
Aimee Hill, BSN, RN, LNC, a legal nurse consultant and CEO of Pacific Nurse Consulting left her hospital nurse manager position during the pandemic. When she started working at a hospital prior to the pandemic, there was always talk about nurses leaving.
Hill says, "COVID may have simply been the tip of the iceberg…The business of healthcare always took priority over the care of the caregivers. I had to sacrifice so much and it was having a negative impact on my family and my mental and physical health.”
Krista Elkins, BA, RN, CRFN, NRP, CCP-C, left a full-time role as an emergency room registered nurse last year in part because she felt unsupported by her employer during the pandemic. Attempts to communicate with superiors were in vain.
“I tried to simply go down to part-time...due to burnout, and was told by my employer that I was not allowed to do so,” Elkins explains. “Instead, they lost me completely,” she says.
Although Elkins continues to work as a nurse, she does so on an as-needed basis.
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Nurses Are Leaving: Their Impact on Patient Care
Large-scale nurse resignations and retirements will significantly affect patient care in the years to come in various ways.
Inadequate nurse staffing can raise patient-to-nurse ratios to unsafe levels.
“[The high ratio] will spread the nurses too thin, increasing their patient load, and causing them to burn out sooner," Elkins said. “This whole situation puts patients at risk for unintentional neglect.”
When highly experienced nurses begin to leave the workforce, patient safety may be jeopardized. Hill argues that when facilities are left with their most experienced nurses having only been in the field for two or three years, the risk is substantial.
“As nurses leave the workforce, we are seeing more inexperienced nurses caring for patients,” Hill explained. “...This is a direct threat to patient safety and leaves nurses and their employers open to lawsuits,” she warns.
According to a 2021 study in the journal Chest, limited years of nursing experience was identified as a risk factor for unplanned extubations— a potentially fatal medical error — in the intensive care unit. Along with direct experience, seasoned nurses can also serve as resources to their junior colleagues.
Access to Care for Vulnerable Populations
While the mass departures may have a direct impact on the care of patients in general, it may indirectly limit the access to care for vulnerable populations.
The Census Bureau reports that many people visit the emergency room for non-emergency because unemployment, limited income, and lack of health insurance limits their ability to seek care through another channel.
"Areas with high poverty and homeless populations will feel a bigger impact,” Hill says. “These areas see more hospital visits due to lack of insurance and/or preventative healthcare.”
Fixing the problem
Authors of the AMN report offered several potential remedies, many of which experts have proposed in various forms for years. Many suggestions share common themes: increasing job satisfaction and support to empower nurses.
AMN survey data showed that reduction in stress resulted in higher levels of professional satisfaction, higher levels of job retention, and a higher likelihood of encouraging and supporting future nurses.
Additionally, longer-term and changes in the healthcare system can also help address the problem, including:
- Adopting universal advanced workforce planning and analytics
- Extending the reach of healthcare staff with tools like virtual and even robotic care
- Improving population health that can reduce healthcare utilization
- Reducing barriers to care to reduce health disparities
- Increasing flexibility in the healthcare workforce
- Reducing regulatory barriers to top-of-competency practice and new emerging roles
- Expanding the capacity of nursing education programs through increased faculty and student support
Hill advises, “It’s really very simple…nurses will stay if they feel they are valued and being taken care of. When our voices aren’t heard...we feel disheartened, lose our passion [to] serve, and leave.”
Elkins K. (2023). Personal interview.
Hill A. (2023). Personal interview.
Sun, Jiesu, et al. Nursing Experience as a Risk Factor for Unplanned Extubations in the ICU. Chest Journal
The Pandemic's Consequences: Survey of Registered Nurses. (2023). AMN Healthcare
Udalova, Victoria, et al. Most Vulnerable More Likely to Depend on Emergency Rooms for Preventable Care. (2022). U.S. Census Bureau
Why Nurses Quit and Leave the Profession. (2023). American Nurses Association
Meet Our Contributors
Aimee Hill, BSN, RN, LNC
Hill is a legal nurse consultant and CEO of Pacific Nurse Consulting. She has an extensive background in specialties spanning medical/surgical and telemetry to school nursing, utilization review, and home health. Hill received a bachelor’s degree in nursing from Samuel Merritt University.
Krista Elkins, BA, RN, CRFN, NRP, CCP-C
Elkins has over 20 years of experience in healthcare as a paramedic and registered nurse. She has worked on both ground and helicopter ambulances (CCP-C, CFRN), ER, ICU, primary care, specialty care, psychiatric, and wilderness medicine. She also has a background in preventative medicine and health education. She is an RN specialist for Health Canal and works PRN as both an emergency room RN and paramedic.
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