NATIONAL SURVEY: Stress and Lack of Staffing Standards Cause Majority of Nurses to Say They Could Leave Profession

La Grange, IL:  A national survey of more than 2,200 registered nurses (RNs) conducted in the fall of 2021 reveals that the strain of the COVID-19 pandemic and current industry staffing practices have together left a majority of RNs considering leaving the profession altogether. The survey was conducted by the nonprofit organization Nurses Take D.C., with the data analyzed by researchers at the Project for Middle Class Renewal at the University of Illinois at Urbana-Champaign and the Illinois Economic Policy Institute (ILEPI).

Read the Report: “Registered Nursing in Crisis: National Survey Reveals Insufficient Staffing, Severe Moral Distress, and High Turnover”

“While empirical research has long linked nurse-to-patient ratios or ‘safe patient limits,’ staffing committees, and other policy instruments to better overall outcomes for both patients and nurses, the impact of COVID-19 has brought a new level of urgency to these considerations,” said study coauthor and ILEPI Executive Director Frank Manzo IV. “Without policy or institutional interventions, these survey results show that the nursing shortage that already existed before the pandemic could deepen and erode quality across the entire health care system.”

The report is based on responses from 2,257 registered nurses in all 50 states and the District of Columbia to more than 50 survey questions, administered between October 1, 2021 and November 30, 2021. Conducted 18 months into the COVID-19 pandemic, the responses were collected during the wave of hospitalizations and deaths associated primarily with the Delta variant, but before the onset of the Omicron variant.

Topline results revealed high workloads, concerns about staffing and patient safety, and feelings of “moral distress” (or feeling that the ethically correct action has not been pursued due to organizational or institutional constraints). More than half of the nurses surveyed said they are considering leaving the profession within the next 12 months.

“While a small number of U.S. states have taken limited action to improve nurse staffing, survey results cry out for broader understanding of what works, and wider adoption of those measures,” said study coauthor and ILEPI Research Associate Grace Dunn. “For example, the survey results tell us that the most effective instruments to combat the crisis include legislation establishing minimum nurse-to-patient ratios, and staffing committees comprised of direct patient care providers whose recommendations on nurse staffing levels are enforced.”     

Survey results showed that in the two U.S. states that have adopted minimum nurse-to-patient ratios (also called “safe patient limits”), the share of nurses caring for six patients or more was decreased by 12 percent, the share of nurses reporting moral distress declined by 4 percent, and the share of nurses considering leaving the profession shrank by 6 percent. Notably, prior research has shown that these initiatives do not harm the financial performance of hospitals and can actually cut health care costs by reducing “adverse patient events, readmissions, and length of stays.” One recent study showed that revenue and employment growth at California hospitals exceeded national averages by 33% and 45% respectively after the state enacted the nation’s first safe patient limits law.

Similarly, amongst nurses in the eight states that require staffing committees who said committee recommendations were enforced, surveyed nurses were 18 percent less likely to care for six patients or more, 8 percent less likely to experience moral distress, and 11 percent less likely to consider leaving the profession.

A third factor that researchers found correlated to better nurse staffing outcomes was whether they were union members. Survey responses indicated that unionized nurses were 8 percent less likely to care for unsafe numbers of patients than their nonunion counterparts, 4 percent less likely to consider leaving the profession, 10 percent less likely to have left nursing positions in the previous six months, more demographically diverse, and 19 percent more likely to earn at least $75,000 per year.

“As we have seen from the skilled workforce supply disruptions across all sectors of our economy in the wake of COVID-19, job quality really matters,” said study coauthor and PMCR Postdoctoral Research Associate Dr. Larissa Petrucci. “The survey results tell us that collective bargaining is a sound tool for ensuring health care employers can deliver the market-competitive wages, staffing standards, and working conditions needed to attract and retain nurses to these in-demand careers.”

With a majority of nurses surveyed reporting plans to leave the profession within 12 months, researchers indicated that industry leaders and elected officials should not just consider long-term interventions to improve nurse staffing and working conditions, but also short-term investments to address retention and recruitment issues that plague the industry. For example, amongst those surveyed who said they were considering leaving the profession, “unresolved moral distress” was cited as the second-most popular reason behind “unsafe staffing.” However, fewer than one-third of the nurses reporting moral distress said they had access to workplace resources to deal with these issues. 

“The survey makes clear that quickly expanding access to mental health resources in the workplace is essential for hospitals looking to combat the mental strain that threatens to drive more nurses out of the workforce,” said study coauthor, PMCR Director, and University of Illinois at Urbana-Champaign Professor Dr. Robert Bruno. “Additionally, states should consider investments that can quickly attract new nurses where they are needed most—such as student loan forgiveness for those willing to contribute their talents in communities currently facing the most acute nursing shortages.”

The Illinois Economic Policy Institute (ILEPI) is a nonpartisan nonprofit research organization which uses advanced statistics and the latest forecasting models to promote thoughtful economic growth for businesses and working families in Illinois and across the Midwest.

The Project for Middle Class Renewal (PMCR) at the University of Illinois at Urbana-Champaign investigates the working conditions of workers in today’s economy to elevate public discourse aimed at reducing poverty, create more stable forms of employment, and promote middle-class jobs.