Job dissatisfaction, education drive nurse turnover

Job dissatisfaction and pursuing additional degrees were the leading reasons that nurses left their roles a few years into the pandemic, according to a new study published in the journal Health Affairs Scholar. 

The findings point to actionable strategies that employers can use—such as flexible or non-traditional scheduling—to improve job satisfaction, work-life balance, and curb costly turnover.

The COVID-19 pandemic triggered historic changes for the nursing profession; more than 100,000 nurses in the US left their jobs in 2021 alone. While the number of nurses in the profession has since rebounded, hospital leaders still have difficulty retaining their workers.

Research shows that turnover among nurses can compromise patient care. It is also costly to organizations—turnover of a single nurse can lead to $45,100 to $67,500 in recruitment, hiring, and training costs.

“As hospitals continue to grapple with turnover, understanding the motivations underlying nurses’ decisions to leave is critical to inform retention strategies and improve workforce planning and sustainability,” said Amy Witkoski Stimpfel, assistant professor at NYU Rory Meyers College of Nursing and the study’s lead author.

Witkoski Stimpfel and her colleagues analyzed data from 8,953 frontline registered nurses that took part in the latest National Sample Survey of Registered Nurses, conducted by the Health Resources and Services Administration (HRSA) from late 2022 to early 2023. Nurses were asked about whether they left their job in the past year (or primary job, if they held multiple roles). They also answered questions about job satisfaction, burnout, salary, education, whether they held more than one job, whether they were in a union, and demographic characteristics. 

“Most workforce studies ask workers about their intentions to leave their jobs. The National Sample Survey of Registered Nurses asks nurses if they actually left their job—so it’s not just intentions, it’s the behavior that actually happened,” said Witkoski Stimpfel.

The researchers found that 28.7% of nurses surveyed in 2022 and 2023 had left their job in the past year. Job dissatisfaction was the highest predictor of turnover; those who were unhappy in their roles were 2.6 times more likely to leave their primary job. Nurses who experienced burnout or held multiple jobs were also more likely to leave.

Education also played a role, as nurses currently enrolled in a nursing degree program were 1.8 times more likely to leave their jobs. In addition, nurses with graduate degrees were 1.6 times more likely to leave their jobs as those without graduate degrees, which may reflect increased opportunities as managers or advanced practice providers. 

“School enrollment is a leading indicator of a planned transition, given that gaining additional education reflects upward career and financial mobility,” noted Witkoski Stimpfel. “For current students, the combined demands of a graduate program and employment may become incompatible, leading nurses to seek more flexible options like a per diem role.”

In contrast, experienced nurses (those working for 16 to 44 years), nurses earning mid-level salaries ($56 to $120 per hour), and those who participated in labor unions or collective bargaining were less likely to leave their jobs.  

Despite the high rates of turnover, the authors note that organizations can take immediate and actionable steps to reduce turnover by focusing on improving job satisfaction—for instance, adopting flexible scheduling policies like self-scheduling or non-traditional shift lengths, which may appeal to nurses balancing work and other obligations like school or caregiving. Hospitals could also partner more closely with schools of nursing to coordinate on the scheduling of classes and clinicals, or institute more flexible models that allow for seasonal fluctuations in work based on the academic calendar.

“These are really reasonable things to do, and they are mutually beneficial—to the employer, the school of nursing, and working nurses,” said Witkoski Stimpfel.

Additional study authors include Nikhil Padhye and Maja Djukic of the Cizik School of Nursing at the University of Texas Health Science Center and Alberta Tran of the MedStar Health Research Institute.