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A new national study found that more than one in four registered nurses left their primary job during the final years of the COVID-19 pandemic. The findings suggest workplace conditions may play a bigger role than pay alone in retaining nurses.
Published in Health Affairs Scholar, the research found that job dissatisfaction was the strongest predictor of nurse turnover, surpassing burnout, salary, and other commonly cited factors. It also points to practical strategies hospitals can implement now, such as flexible scheduling and improved workplace conditions.
More Than One in Four Nurses Left Their Jobs
Researchers analyzed responses from 8,953 frontline registered nurses who participated in the latest National Sample Survey of Registered Nurses, conducted by the Health Resources and Services Administration (HRSA) between late 2022 and early 2023.
Unlike many workforce studies that ask nurses whether they intend to leave, this survey examined whether they had actually left their primary job during the previous year.
“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 Amy Witkoski Stimpfel, assistant professor at NYU Rory Meyers College of Nursing and the study’s lead author.
The researchers found that 28.7% of nurses surveyed had left their primary job within the previous year.
“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,” Professor Witkoski Stimpfel said.
Why Nurses Are Leaving
Nurses who were dissatisfied with their jobs were 2.6 times more likely to leave than nurses who were satisfied. Burnout and holding multiple jobs also increased turnover, but job dissatisfaction was the strongest predictor.
In an interview with Nurse Approved, Professor Witkoski Stimpfel said the findings validate what many bedside nurses have experienced for years.
“This paper reflects trends towards the end of the pandemic; however, the issues contributing to job dissatisfaction are persistent and likely reflect today’s reality. Job dissatisfaction is the single most robust predictor of actual turnover, making a nurse over 2.5 times more likely to leave. It points to specific systemic environment issues rather than compensation alone.”
“Contextualized by recent nationwide nurse labor movements, this dissatisfaction is heavily tied to poor working conditions, such as inadequate nurse-to-patient ratios, a lack of protection against workplace violence, and the absence of guaranteed work breaks for staff.”
Flexible Scheduling Could Improve Retention
Asked what chief nursing officers could do immediately to improve retention, Professor Witkoski Stimpfel pointed to scheduling flexibility.
“I would suggest implementing flexible and innovative scheduling options, such as self-scheduling or customizable shift lengths,” she told Nurse Approved. “Unlike resource-intensive, long-term initiatives like credentialing programs, restructuring schedules is an actionable strategy that directly addresses job dissatisfaction by immediately promoting better work-life balance for frontline staff.”
“Flexible scheduling involves abandoning rigid staffing structures in favor of self-scheduling or introducing nontraditional shift lengths, such as parent shifts or split shifts. This layout allows nurses to successfully balance their careers with outside personal obligations, such as school, childcare, or elder care.”
The study also found that nurses balancing school or multiple jobs were significantly more likely to leave their jobs.
“This paper’s multivariable regression model proves that rigid work structures fail. Nurses balancing school or secondary jobs experience a scheduling mismatch that actively drives actual turnover.”
Career Advancement Can Lead Nurses Elsewhere
The researchers found that nurses enrolled in nursing degree programs were 1.8 times more likely to leave their jobs. Nurses with graduate degrees were 1.6 times more likely to leave than nurses without advanced degrees.
Professor Witkoski Stimpfel said the findings point to a mismatch between career advancement and workplace flexibility.
“We frame this finding as a structural mismatch where career advancement opportunities are not being properly aligned within the organization.”
“For students, the issue is the incompatibility of rigid work schedules with academic demands, forcing them to leave for flexible alternatives like per diem roles. For graduates, they become highly marketable as managers or advanced practice providers. If their current organization does not accommodate their upward mobility internally, they have the option to seek other employment.”
The study suggests that hospitals could improve retention by coordinating work schedules more closely with schools of nursing, particularly for nurses pursuing advanced education.
Burnout and Job Dissatisfaction Are Different Problems
Although burnout has dominated conversations about nurse retention since the pandemic, the study found that job dissatisfaction was the stronger predictor of turnover.
“While interrelated phenomena, job dissatisfaction and burnout are evaluated as distinct variables in our model,” Professor Witkoski Stimpfel said.
“Burnout relates to the personal, cumulative exhaustion felt by the nurse, whereas job dissatisfaction reflects a poor alignment with the work environment and labor practices.”
Professor Witkoski Stimpfel added, “Job dissatisfaction is a significantly stronger predictor of actual turnover than burnout. Employers must realize that targeting individual burnout is not enough. True retention requires fixing structural organizational issues, as evidenced by the fact that stronger workplace protections, like those found in unionized environments, may successfully shield organizations from turnover.”
Experienced Nurses May Hold the Answers
The study found that nurses with 16 to 44 years of experience were significantly less likely to leave their jobs.
According to Professor Witkoski Stimpfel, healthcare organizations should examine what keeps these experienced nurses engaged and apply those insights more broadly.
“Organizations might deduce that these nurses have stable work-life integration or operate in environments where their localized nursing needs are met.”
“Healthcare organizations can look to these units to replicate the specific labor balances, scheduling setups, or environmental supports that keep these experienced anchors from leaving. Nurses may have also found their preferred specialty or employer within this window of experience to enhance retention.”
What This Means for Nurses and Hospitals
Nurse turnover can compromise patient care while costing healthcare organizations between $45,100 and $67,500 to recruit, hire, and train each replacement nurse.
Professor Witkoski Stimpfel said meaningful progress will require organizations to address workplace conditions alongside compensation, rather than treating them as separate issues.
“My main concern is persistent nurse turnover which threatens care continuity, compromises patient safety, and can be a symptom of poor worker wellbeing.”
Still, she sees reasons for optimism.
“My main source of optimism is that frontline staff nurses are leveraging their collective voice to drive institutional changes. A massive surge in union participation and collective bargaining has given nurses a mechanism to clearly communicate their needs directly to leadership, which the data proves is highly protective against actual turnover.”
Ultimately, Professor Witkoski Stimpfel said the research points to solutions that healthcare organizations can begin implementing now.
“While hospitals often rely on minor modifications or assume hourly pay is an easy fix, RN wages have actually shown the smallest growth from 2012 to 2023 compared to other health professionals.”
“Hospitals are failing to address the foundational issue: building supportive work environments. Until organizations bridge the gap by reviewing salaries alongside immediate, impactful changes to work environment flexibility and baseline labor conditions, actual turnover rates will remain high.”
