Nursing job turnover has nearly doubled since pandemic

The COVID-19 pandemic did not push nurses out of hospitals or other care settings as feared, but nurses left their primary jobs at nearly double the rate from 2018 to 2022, a new University of Michigan study found. 

The study, which appeared in Medical Care, also found that the size of the nursing workforce grew from 3.27 million to 3.57 million during the same period. 

Researchers examined whether nurses in states with higher COVID-19 hospital caseloads were more likely to shift away from inpatient hospitals, long-term care, outpatient care or nonclinical roles, said Charlotte Ahr, U-M nursing Ph.D. candidate and the study's lead researcher. 

The findings highlight the impact of COVID-19 on job changes within the nursing profession, and gives policymakers and healthcare experts insights into underlying reasons why nurses left their primary jobs, Ahr said. 

"Because we found the changes in nurse employment weren't driven by whether states had high COVID caseloads, we explored the reasons that nurses left their jobs," Ahr said. "Always rising to the top were stressful work environments, burnout and inadequate staffing."

Other takeaways: 

• About 13% of registered nurses reported that they left their primary nursing position in 2018, compared with 24% in 2022.
• Registered nurse full-time equivalents increased in outpatient settings, rising from 32.7% in 2018 to 34.9% in 2022.
• Registered nurse FTEs declined in inpatient settings, long-term care and nonclinical settings.

Across care settings, the most common reasons for leaving were a stressful work environment, burnout, insufficient staffing and lack of good management. These concerns were even more common in 2022 than in 2018, especially among nurses working in inpatient and long-term care settings.

The findings complicate the notion that the pandemic collapsed the nursing workforce, but it reinforces the idea that poor working conditions predated the pandemic and suggests that poor working conditions that predated COVID-19 continued to drive nurses to change jobs after the pandemic began.

Ahr emphasized that job turnover is not the same as leaving nursing entirely. In this study, turnover means nurses left their primary job. They may have moved to another nursing job, changed care settings, reduced their hours, become travel nurses, retired or left nursing temporarily.

One unexpected finding was that long-term care nurse employment declined slightly less in states with higher COVID-19 caseloads. Researchers said this could reflect policy responses, recruitment efforts or local labor-market dynamics rather than a direct positive effect of the pandemic.

The analysis included 99,507 registered nurse respondents from the 2018 and 2022 National Sample Survey of Registered Nurses, the largest long-standing source of data on the U.S. nursing workforce. 

Co-authors include: Claudia Gates, Christopher Friese, Milisa Manojlovich and Matthew Davis of the U-M School of Nursing, and Thuy Nguyen of the U-M School of Public Health. 

Study: The Impact of the COVID-19 Pandemic on Registered Nurse Employment Across Settings (DOI:10.1097/MLR.0000000000002294)