Burnout, stress and retirement causing nearly 900,000 nurses nationwide to quit

More nurses are expected to quit the profession, including a sizable number under the age of 40, according to new national data about the ongoing nursing shortage.

Stress, burnout and retirement during the COVID-19 pandemic accelerated nurses leaving the profession, and that trend continues today, according to the National Council on State Boards of Nursing.

The independent and nonprofit organization represents state nursing regulatory bodies.

Roughly 600,000 registered nurses say they plan to leave the workforce by 2027, according to the organization.

Add to the problem: 189,000 registered nurses under the age of 40 plan to leave their jobs in the next four years.

Both figures are separate from the 100,000 registered nurses who already left their jobs during the COVID-19 pandemic.

Combined it means nearly 900,000 nurses, or almost one-fifth of the nation’s 4.5 million registered nurses, have or plan to call it quits, the data shows.

In a retiree-haven state like Florida where health care services are in high demand and care is big business, the nursing shortage has been a mainstay and competition fierce to recruit and retain nurses from a shrinking pool.

The Florida Hospital Association projects the state will face a deficit of 60,000 nurses by 2035.

“You have to think differently how you can attract and retain staff, not just nurses,” said Renee Thigpen, chief human resources officer for the NCH Healthcare System in Collier County, Florida.

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For patients in hospitals and other healthcare settings, the shortage of nurses means risk to quality of care and safety.

“The data is clear: the future of nursing and that of the U.S. health care ecosystem is at an urgent crossroads,” Maryann Alexander, the organization’s chief officer of nursing regulation, said in a statement.

Hospitals, policymakers and academic leaders need to act and “address these challenges and maximize patient protection in care into the future,” she said.

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Nurses feel 'used up' and 'emotionally drained'

The new numbers released by the national council is part of a workforce study done every two years.

More than 53,000 nurses were involved. A breakdown shows roughly 29,500 are registered nurses and advanced nurse practitioners while 24,000 are licensed practical nurses.

Here’s what they said about why they want to quit:

• 51% are “emotionally drained.”
• 56% are “used up.”
• 50% are “fatigued.”
• 45% are “burned out.”
• 29% are “at the end of the rope” every day or few times a week.

The study found these issues are more pronounced among nurses with 10 years or less experience.

Licensed practical nurses who tend to work in long-term care settings caring for the elderly have seen their ranks decline by nearly 34,000 since the beginning of the pandemic.

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The report did not say how many licensed practical nurses there are nationwide or the number employed in long-term care settings.

Also of note is a finding that newly-minted nurses may not be as clinically prepared in the workplace as hoped.

Early career data suggest a dip in practice skills and proficiency during assessments. 

That’s tied to disruptions at nursing schools during the pandemic when students were forced to switch to online training, according to the national council.

Hospital recruitment and retention

Southwest Florida hospitals are always fine-tuning their recruitment and retention initiatives to attract sought-after nurses.

On a positive note, their dependency on expensive traveling nurses which was crucial during the COVID-19 pandemic is subsiding.

Lee Health, the publicly-operated system in Lee County and one of the largest in Florida, has more than 3,500 bedside registered nurses with 550 open positions, according to Kristy Rigot, director of recruitment and retention.

The lack of affordable housing in Lee has added to the recruitment challenge along with the overall shortage of nurses across the country.

On the plus side, Rigot said the Florida lifestyle is an appeal.

“The state also doesn’t collect an individual income tax and many consider that to be a perk of living here as well,” she said in an email.

Lee Health has four acute care hospitals with a combined 1,865 beds and it operates a regional children’s hospital with 134 beds.

In the past year, the bedside registered nurse vacancy rate has gone down to 14%, Rigot said. It was at nearly 20% a year ago.

 NCH is seeing a positive trend in hiring, Thigpen, chief human resource officer, said.

The private nonprofit system in Collier has two acute care hospitals with a combined 713 beds. For this year it has 1,023 bedside registered nurse positions; in 2022 it had 948.

The voluntary turnover rate in March 2022 was nearly 22% and is now down to below 20%, Thigpen said.

The vacancy rate today is 6% with 65 openings and 958 positions filled. The vacancy rate was 15% a year ago in March with 141 openings and 807 positions filled.

Social media is a health care recruiting tool

Both Lee Health and NCH say social media is an important recruitment tool in addition to the traditional job fairs and other methods.

Lee Health’s strategy includes a branding campaign, Rigot said.

Social media is an avenue for sourcing, for career sites, chat bots, job boards and an applicant tracking system, she said.

“In addition, we attend and host various career days and hiring events to promote Lee Health and its internships, workforce development and residency programs,” she said.

 “We also use recruitment incentives, such as sign-on bonuses, relocation and employee referral bonuses,” Rigot said.

NCH uses social media, including TikTok, and the mainstay methods such as job fairs but Thigpen said what’s critical is re-evaluating benefits and incentives to keep employees once they come.

“You have to get to the core of what keeps them happy,” she said.

Another program is an enhanced mentoring program that is key for the new generation of nurses, Thigpen said.

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Are travel nurses still a necessity?

Both Lee Health and NCH are seeing their need for travel nurses drop as the extraordinary demand of hands-on help during the pandemic has ended.

While filling a critical need, travel nurses are costly and put huge stains on manpower budgets.

“Lee Health has reduced utilization of travelers by approximately 23% over the past few months,” Rigot said. “This has been achieved through retention efforts and effective staffing management.

At one point, Lee Health had 700 travel nurses, Ben Spence, chief financial officer, said last September. The system spent roughly $163 million on contract labor in 2022, with 95% of that for travel nurses, he said.

NCH had 200-plus travel nurses at a high point during the pandemic and its now down to five with contracts ending at the end of June, Thigpen said.

The budget for the travel nurses was “in the multi-millions,” she said.

“We had a lot of great travelers but their allegiance isn’t to the organization,” she said. “They are filling a need.”

One reason for the nurse shortage is that some nurses opted to become travel nurses because its lucrative and because some of them can if they don’t have family obligations, she said.

“It’s a great opportunity and I don’t blame them but it hurts when you have a hospital base and need the nurses,” she said.

What nursing schools are doing

The nursing shortage isn’t lost on nursing schools in Florida which have faced constraints to expand enrollment because there are not enough instructors and costs.

After the state hospital association released its report in late 2021 that the state would face a deficit of 60,000 nurses by 2035, Keiser University formed a nursing advisory council with 34 leaders from around the state.

Keiser has 21 campuses in the state with nearly 20,000 students, including locations in Lee and Collier, and two international sites.

Last month the group presented a series of solutions for both the immediate future and long term to state lawmakers, according to Keiser.

“Florida has one of the highest percentages of elderly residents in the U.S.” Christine Mueller, chief nurse administrator for Keiser’s College of Nursing said, in an email. “This population typically requires more healthcare services which are overwhelmingly provided by nurses.”

 The nursing shortage is exacerbated by high turnover of new nurses, she said.

“The devastating truth is that greater than 50% of new nurses leave in their first two years of employment,” she said. “Some leave the profession all together and some leave for higher paying jobs, like travel nursing.”

Muller said it’s difficult to train new nurses when the long-term employees have left or retired and there is no one to mentor incoming nurses.

In January, Gov. Ron DeSantis announced $79 million for nursing education and for training partnerships to help with a pipeline of new nurses.

The funding rewards nursing programs with matching funds to scholarship awards, for faculty recruitment, equipment and other support.

The Keiser advisory council recommendations are designed to help remove barriers for growing the nursing workforce, to help with affordable housing, burn out, a lack of nurse educators and the limitations on clinical training for advanced nursing students.