Nurses report slight workplace improvements from 2022 to 2023

For the study, researchers compared data from the Michigan Nurses' Study that was collected at two different time points: Feb. 22 to March 1, 2022, and May 17 to June 1, 2023. In 2022, 9,150 nurses responded to the survey, and in 2023, 7,059 nurses responded.

Across the two survey groups, the majority of participants were women (71%–73%) and white (69%–70%). Around 21% to 23% of participants were 55–64, 19% to 20% were 45–54, 17% to 18% were 35–44, and 13% to 15% were 34 and younger.

In 2022, 39.1% of participants said they planned to leave their position within the next year, 27.9% said they planned to reduce their clinical hours, and 18.1% said they planned to pursue travel nursing. However, in 2023, these three outcomes were less frequently reported, with 32% of nurses planning to leave, 18% planning to reduce clinical hours, and 7% planning to pursue travel nursing. 

Factors associated with an increased likelihood of leaving were workplace abuse or violence and higher emotional exhaustion scores. In comparison, factors linked to a lower likelihood of leaving were favorable practice environments and excellent clinical safety ratings.

In 2023, more nurses said that their current practice environment was favorable (38.7% compared to 28% in 2022). In addition, fewer nurses reported workplace abuse or violence in the past 12 months in 2023 compared to 2022 (43.4% compared to 50.2%).

More nurses also reported feeling satisfied or extremely satisfied with their jobs in 2023 compared to 2022. At the same time, there was little change in the percentage of nurses who reported being dissatisfied or extremely dissatisfied with their current position.

Commentary

Christopher Friese, the study's lead author from the University of Michigan School of Nursing, said the findings show a "good news, bad news situation."

Although most of the measures tracked by the researchers showed improvement, "a third [of nurses] still are looking to leave their position," Friese said. "That's exceedingly high [and] has to be among the higher rates that we've seen historically in nursing over many decades."

The researchers also noted that there's a "worrisome pattern" of job dissatisfaction and intention to leave among nurses ages 34 and younger.

"These are the folks who have potentially decades of time left to practice nursing," and having them leave the profession early is a particularly "bad sign" that hasn't been accounted for in some economic models, Friese said. "So, we have to think about strategies that allow nurses to care for the appropriate number of patients for their clinical setting, and that, our data says, is not the norm in 2023."

"[T]he projections are pretty clear," Friese said. "We have enough people who hold an RN license and are within an age range to practice nursing in the country. We just have a lot of nurses who are choosing not to work under these conditions."

Last year, the Health Resources and Services Administration announced a $100 million initiative to improve nurse recruitment, including programs to help LPNs complete RN programs.

According to Friese, the package is "helpful but not sufficient" since it only focused on the supply of nurses. "You can't recruit your way out of a retention problem," he added.

In an accompanying editorial, Karen Lasater, from the Center for Health Outcomes and Policy Research at the University of Pennsylvania, said that "efforts to train and recruit more nurses are akin to fueling a car with a leaking gas tank."

"Turnover rates in hospitals are averaging over 20%," Lasater said. "Recruiting and training more nurses will not retain them at the bedside if staffing conditions are poor."

"Instead, hospitals should implement evidence-based approaches to resolve their retention issues, including listening to their own nurses who say they are experiencing burnout and leaving because of chronic understaffing," she added. "Absent hospitals' responsiveness to nurses, legislators need to step in to ensure hospitals are sufficiently staffed with enough nurses to care for the public."

Advisory Board's nursing resources

For more insights on nursing, check out these Advisory Board resources:

This expert insight outlines the three underlying causes of nurse recruitment and retention challenges and offers ways for leaders to address them. Similarly, this research explains four ways to retain early-career nurses, while this toolkit offers ways to retain first-year nurses.

Another expert insight describes five ongoing challenges of the workforce crisis and how leaders can address them. This cheat sheet explains the experience-complexity gap, as well as ways leaders can close the gap.

We also offer recommendations on how to stabilize the RN workforce, as well as a decision guide on technologies that can help address clinical workforce challenges. This featured page can also help leaders find resources to boost recruitment and retention, optimize technology, and better support their nurses. (Firth, MedPage Today, 7/19; Friese et al., JAMA Network Open, 7/18)