Intent to Stay in Nursing – Some Good News

By Rose O. Sherman, EdD, RN, NEA-BC, FAAN

Incredible Health (which now has one of four RNs in the country on its platform) just released its 2023 State of US Nursing Report. The company analyzed hiring data from more than 700,000 Incredible Health nurse profiles in March 2023. They also surveyed more than 3,000 registered nurses in the United States in March 2023.

The good news in their report is that 80% of nurses (up from 54% in 2022) now plan to stay in nursing for their careers. 54% would recommend nursing as a career to others. 10% fewer nurses plan to leave their roles in 2023. 26% (a one-point rise from 2022 but still concerning) report good mental health.

There are some warning signs in the research as well:

• 93% of nurses report that staffing shortages have worsened during the past year.
• 84% don’t think the nursing industry is moving fast enough in addressing understaffing, burnout, and pay.
• The number one factor nurses consider when seeking new employment is compensation.
• 48% of the offers managed through the Incredible Health Platform (servicing 650 hospitals) included sign-on bonuses.
• 65% of nurses have considered moving to travel nurse positions for a pay increase.
• 84% feel increased stress because of the economy.
• 59% of nurses reported feeling dissatisfied with how their organization addressed recent economic concerns with staff.

Despite the turmoil and turbulence in healthcare, nurses are not giving up on the profession. Historically, nursing has been able to maintain a labor participation rate of 83% of nurses who are licensed. This is critically important moving forward because if nurses leave the profession for good – our problems only intensify. The not-so-good news in this report is that although nurses may not leave the profession entirely, they will likely continue to leave their jobs if conditions don’t improve.

I was particularly struck by the last bullet point – that 59% of nurses feel dissatisfied with how organizations communicate their economic concerns with staff. This is one issue that we can, as leaders, immediately address. Nurses need to know two things in this environment (and leaders must keep repeating them).

The first is that the number of nurses needed and those available don’t add up, and that gap keeps increasing. You can lobby for mandated staffing ratios as many nurses (and unions do), but even if legislation passed, little would change. In a recent health leader’s media poll of CNOs, 74% now report current vacancy rates above 15%. The notion that many nurses would return to acute care if there were ratios is wishful thinking.

The second is that health systems throughout the country are in economic trouble, and the current trajectory is unsustainable. This inflationary environment has skyrocketed labor costs, pharmaceuticals, equipment, and supplies. Unlike restaurants that can raise the prices of menu items, health systems negotiate multiple-year contracts with insurers that usually don’t include escalation clauses. It means that health systems are now assuming unplanned economic risks. The ongoing pressure from payers and the public will be to decrease costs. Few staff nurses understand healthcare financing, but they need to – especially in this environment. They may have innovative ideas to figure out how to lower care delivery costs.

Many health systems are looking at redesigning their care delivery models. There is little choice because of the factors discussed above. The problem is that we are not effectively communicating the urgency of the issues to our nurses. They need to know the truth and be part of the solutions. The environment, as we knew it pre-Covid, has changed, and so must we.