Are NPs Becoming Less Satisfied with the APP Role?

In recent focus groups and sessions I have conducted, some nurse managers now report an interesting new trend – NPs who want to return to Acute Care Environments in staff nurse roles. While the Nurse Practitioner (NP) role is among the fastest-growing and generally one of the higher-paying roles in healthcare, recent data indicate significant pockets of dissatisfaction and burnout. Nurse managers report that while candidates they have spoken to find the NP role intrinsically rewarding, systemic issues such as administrative relations, workload, and role ambiguity contribute to high turnover rates, particularly among primary care and early-career practitioners.

Unlike nurses who entered NP programs in the past, many newer NPs assumed these roles with little or no nursing experience. One ED manager reflected on a conversation she recently had with an NP wanting to make a change:

In her current role as a Primary Care NP, which she has held for less than 1 year, this NP working in our system tells me the role is not what she expected. The workload expectations far exceed what she considers reasonable, and she does not receive the leadership support she needs. In some ways, the conversation is not much different from what I hear from new graduates. She had never worked as a staff nurse – went right from the BSN to DNP. She had little context about the healthcare delivery system. Any experienced ED RN who went back for the NP would have anticipated some of what this NP was complaining about. I find myself in an interesting dilemma. Although she has a great skill set, I am wondering whether our ED in a staff nurse role would be a better fit. 

The following data seems to support the trend that acute care nurse managers are reporting:

• Burnout Rates: Recent studies found that approximately 26.3% of primary care NPs reported burnout. This is characterized by exhaustion, cynicism, and a low sense of personal accomplishment.

• Engagement Rates: In the 2025 Press Ganey Nurse Experience Report, it was noted that despite their growing presence on the front lines, APPs
  (both NPs and PAs) remain one of the least engaged groups in the healthcare workforce. In 2025, this group experienced the sharpest drop in engagement among all roles. Only 55% feel they have a voice in decisions, while just 52% say leaders are responsive to their feedback.

• High Turnover: NP turnover has been estimated at 15% annually, twice that of physicians. Up to 32% express intent to leave their role.

• Early Career Attrition: The turnover rate for early-career NPs is even higher, estimated at 25%.

Dissatisfaction typically stems from organizational and structural barriers rather than the clinical work itself.

• Poor Practice Environments: NPs in “poor” practice environments—characterized by inadequate administrative support and limited autonomy—are significantly more likely to report dissatisfaction and intent to leave.

• Role Ambiguity: Lack of clear job descriptions and role visibility often leads to a perceived disparity in expectations. NPs now report little differentiation between themselves and their physician colleagues in terms of panel assignments and productivity expectations. Practitioners frequently feel their non-clinical functions, such as research or leadership, are undervalued or forced into unpaid overtime.

• Administrative Relations: While NPs generally report favorable relationships with physicians, they often report less favorable relations with administrators, which correlates strongly with lower job satisfaction.

• Workload and Staffing: Factors such as inadequate staffing, stressful work environments, and a heavy focus on clinical tasks at the expense of professional development are frequently cited as reasons for leaving direct-care roles.

The data indicate that nurse practitioners are not becoming universally less satisfied, but they are working in environments where burnout remains high, and turnover risk is accelerating. The issue is no longer the role—it’s the conditions under which the role is practiced.

References

Hnath JGP, Rambur B, Grabowski DC. Earnings, job satisfaction, and turnover of nurse practitioners across employment settings. Health Aff Sch. 2023 Sep 14;1(3):qxad044. doi: 10.1093/haschl/qxad044.

Norful AA, Swords K, Marichal M, Cho H. Nurse practitioner workforce outcomes and turnover intention in primary care. Nurs Outlook. 2024;72(1):101989.

Poghosyan L, Liu J, Shang J, D’Aunno T. Practice environments and job outcomes among nurse practitioners: implications for primary care workforce capacity. Med Care. 2024;62(3):215-222.

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