According to a new survey from Beacon Research, 25% of nurses say they plan to leave the nursing field within two years—but the survey also uncovers ways you can persuade your nursing staff to stay.

The nursing shortage, discussed: A conversation with Advisory Board's top nursing experts

Top challenges facing nurses

For "The State of Nursing in Massachusetts," researchers at Beacon Research conducted a randomized survey of 462 Massachusetts RNs from March 30 to April 7.

In the survey, 55% of nurses named understaffing as the biggest hindrance to providing quality care. While the pandemic worsened staffing problems in many cases, the understaffing of hospitals has been a long-standing crisis that was created and sustained by the industry's multi-year push to increase profit margins by decreasing staff to unsafe levels, according to the Massachusetts Nurses Association (MNA).

Notably, the number of RNs who said they do not have enough time to provide patients with the care and attention they require increased to a record high of 71%—an 11-percentage point increase from 60% in 2021.

Among bedside nurses, 67% reported not having enough time with patients, and 92% of RNs with zero to 5 years of experience said they did not have adequate time with their patients.

Nearly two-thirds (64%) of RNs said inadequate pay or benefits is a major challenge—up from 48% reporting insufficient pay or benefits in 2021 and 27% in 2019—marking a 37-point increase in RNs reporting concerns surrounding pay and benefits over just three years.

"Nurses' concerns about inadequate pay and benefits represents the high cost of burnout, moral injury and the increase in workplace violence nurses face every day, all exacerbated by the pandemic," said Katie Murphy, a practicing ICU nurse and president of MNA, which commissioned the survey. "The recruitment and retention of nurses needed to address these problems and enable nurses to provide quality care hinges on hospital executives investing in their permanent workforce."

Ultimately, Murphy noted, the survey demonstrates that the state is not suffering from a shortage of nurses, but rather "a shortage of nurses willing to work under these conditions."

These findings add to a growing body of evidence that underscores the toll the pandemic has taken on the nursing workforce. For instance, Medscape's annual "Nurse Career Satisfaction Report 2021" found that many nurses continue to report experiencing burnout and decreased satisfaction in their jobs.

In addition, an October 2021 survey from the American Nurses Foundation (ANF) found that 42% of nurses said they had an extremely stressful, disturbing, or traumatic experience because of Covid-19, and of those nurses, around a quarter said they experienced "repeated, disturbing memories, thoughts, or images" related to the incident either "quite a bit" or "extremely" in the past month.

How nurses think hospitals handled Covid-related challenges

Overall, Massachusetts nurses gave employers mixed ratings for how well they handled the pandemic, with 43% of respondents assigning their employer an A or B grade, and 30% giving their employer a C grade. Seventy eight percent of respondents gave their employer a high rating for ensuring that the Covid-19 vaccine was accessible to staff and 77% said their employer ensured that staff were vaccinated against the coronavirus.

Notably, more than eight in 10 direct care nurses gave their employer a rating of either fair or poor for how well they:

• Compensated nurses for their efforts during the pandemic
• Provided sufficient time off to give RNs time to address the impact of working during the pandemic
• Ensured RNs had the emotional and psychological support necessary to cope with the effects of the pandemic
• Provided emotional support services

In addition, 44% of nurses reported having been infected by Covid-19. Among those respondents, 56% said they "definitely" or "probably" got infected in their workplace.

How to retain nurses

Even though nurses remain dedicated to patient care, the survey found that many feel exhausted and morally injured. For instance, while 95% of nurses surveyed said they always or sometimes look forward to being able to help their patients, and 89% said they always or sometimes feel their work is significant and worthwhile, 94% said they always or sometimes feel emotionally drained from work, and 65% reported feeling disengaged from their work.

As a result, 33% of RNs said they were planning to leave nursing sooner than they originally planned. Among newer nurses who have zero to five years of experience, 37% said they are planning to leave sooner.

In addition, 25% of nurses said they plan to reduce their hours because of their experiences during the Covid-19 pandemic, and 25% of nurses surveyed also said they may leave the field of nursing in two years or less.

Among the surveyed nurses, 80% said they wanted more time off to recuperate, 74% wanted more financial support, and 41% and 39% said they wanted counseling services and support groups, respectively.

Of the nurses who said they plan to leave the profession within two years, 69% of them identified salary increases as the number one benefit that employers could offer that would keep them from resigning. In addition, 53% said having enough ancillary staff would prevent them from leaving, and 49% said that limits on the number of patients that can be seen at one time would also keep them from resigning. Other incentives named included additional benefits, including time off benefits (44%) and pension benefits (41%). (Gooch, Becker's Hospital Review, 5/5; Massachusetts Nurses Association news release, 5/5)