10 Red Flags to Look for at your Nursing Jobs

Nurses work hard in high-stress environments and much is demanded of them. They deserve a positive and healthy workplace. Whether you are a new nurse or a seasoned nurse with years of experience, there are many nursing job red flags to keep in mind.

• Toxic leadership, high turnover rates, and other factors are major nursing job red flags.
• Awareness of red flags is one key to making an informed choice about where to work.
• Your powers of critical thinking can help you find the right workplace.

This article explores how to recognize 10 common red flags within the nursing workplace and what you can do to avoid or address this.

All nurses need to watch for these and other red flags. When your workplace is unhealthy, toxic, or unsupportive, the risk of burnout, compassion fatigue, and unhappiness increase exponentially. If you want a successful and satisfying career, it's good to know which nursing job red flags could arise. If you are informed and observant, you stand a better chance of choosing the right workplace, or knowing when it's time to leave for better opportunities.

Red Flags to Look for When Applying to Nursing Jobs

High Turnover Rate

When a healthcare workplace has a high nurse turnover rate, this is cause for concern. In 2019, national nurse turnover rates were 17.2%.

According to ITA Group, turnover is caused by nurses feeling overworked, stressed, and dissatisfied. Lack of role clarity, poor communication with management, lack of recognition, and other factors all contribute to this dynamic.

During an interview, you can ask about turnover rates and what nurse retention programs are in place. However, the accuracy of the response is not easy to determine.

Not Enough Time to Consider a Job Offer

Not having enough time to consider an offer is a red flag. It could mean this potential employer does not want to risk losing you to another employer, but it is more likely the facility has a staffing shortage and is desperate to fill positions.

Lack of Published Rules about Safe Staffing Ratios

A significant nursing job red flag is the lack of written policies about staffing. Several states have mandated that staffing ratios be set by nurse-driven hospital committees. California is the only state with legally required ratios for all units, and Massachusetts mandates a 1:1 ratio for ICUs.

"A hospital may be attempting to get Magnet status (which requires lower staffing ratios for safety reasons) and will claim they are maintaining said staffing ratio (ICU is 2:1, stepdown is 4:1)," states Elizabeth Clarke, FNP, MSN, RN, MSSW. "But once the Magnet committee leaves, they will return to the staffing ratios they have adhered to all along (e.g.:. 3:1 in the ICU, 5:1 or 6:1 in stepdown)."

Clarke adds, "It is always best to get the staffing ratio written into your individual contract or the union contract."If there are no set ratios where you have received an offer, do your research, speak to nurses at that institution, and make an informed decision about whether it is safe to practice. After all, your license could be at stake.

No Clinical Nursing Ladders

The lack of clinical ladders is a nursing job red flag — and a new nurse red flag. Clarke states that this "implies a lack of upward mobility or ability to further a career. It suggests the employer is not supportive of a nurse continuing their education — many times clinical ladders are linked to degrees or certifications and experience."During your interview, ask about clinical ladders, advancement, and leadership funnels. Without advancement opportunities, a new nurse might not be able to advance as far in their career.

Lack of Appropriate Precepting or Orientation

Precepting and orientation are important for novice nurses. Clarke shares:

"Many new grad RNs will apply for and accept a position assuming they will receive in-depth on- the-job precepting and training. However once hired, the precepting period is shortened to increase staffing numbers. This happened to me when I graduated with my BSN and accepted my first position. I was told I would receive 12 weeks of precepting and orienting, then it was changed to 10. From there, it was shortened to eight, and I only received four weeks of precepting on a cardiac unit."

Not every preceptor wants to be one. Those forced to precept may be resentful, provide poor guidance, and show little interest in doing the job well. Be clear during your interview regarding the issue of what you should expect from precepting and how preceptors are chosen and trained.

High Ratio of Travel or Contract Nurses to Staff Nurses

A high ratio of travel nurses to staff nurses can signal that the hospital is struggling to meet patient demand. Travelers are a stopgap, not a long-term solution. If a hospital is chronically dependent on travelers, retention of dedicated nurses is probably an issue. This lack of retention could be due to a negative culture, low morale, poor management, or low pay.

Lengthy Waiting Period to Earn or Use PTO

A long waiting period for earning or using paid time off (PTO) is noteworthy. Such a policy points directly to staffing problems. Clark explains, "Not being able to earn or use PTO in a reasonable amount of time after the hire date could mean the employee is not eligible for any holidays off, or [is not] able to take time off for medical appointments."

No Paid Parental Lave

Regarding lack of parental leave, Clarke states that this is "a sign the employer does not respect employees who may become pregnant or adopt, or have a spouse who has a child." She adds, "[It] may indicate no job protection if employees choose to take unpaid leave (employees who work or have worked less than 1,250 hours in a calendar year are not eligible for Family Medical Leave Act (FMLA). Also, companies who employ less than a certain number [are not required] to apply FMLA."

A workplace culture that tolerates — or encourages — bullying and incivility

Bullying and incivility are rampant in nursing. Younger nurses may bully older nurses, and vice versa. This behavior can lead to nurses leaving their jobs and sometimes the profession in general.

Research published through the National Library of Medicine shows that over 30% of new nurses report having been bullied.

If you can, speak with other employees to get an honest opinion on workplace culture and the presence of bullying or incivility.

Toxic leadership

An enormous nursing job red flag is the presence of ineffective, disorganized, or toxic leadership. Research shows that toxic leadership in nursing and healthcare is a major problem. The National Library of Medicine states, "Toxic leadership, a form of ineffective leadership, is increasingly becoming rampant in the field of nursing and has been strongly linked to poor nurse job outcomes, including job dissatisfaction, higher stress levels, and increased turnover intention." It also reports that "nurses who experience working under a nurse manager exhibiting toxic behaviors reported an increased frequency of nurse-reported adverse events and poorer quality of care in the unit."

How to Avoid These Red Flags

Avoiding nursing job red flags and new nurse red flags is not always easy. You can learn about some of these warning signs during a job interview, but anything an interviewer says about their organization must be taken with a grain of salt. After all, their job is to highlight the job and the institution. You can use networking websites, such as LinkedIn, to find current and former employees who might be willing to share their opinion. Consider asking a nurse if you can shadow them for a day to watch, listen, ask questions, and get a feel for the place yourself. In the end, many of these red flags simply cannot be identified until you begin working, so use your orientation period as a time for being a keen observer. If any major red flags come up, you may be faced with a choice of staying and trying to help make things better, or leaving for better opportunities.