Two years ago, registered nurse Amanda Sommer decided she had had enough. She was working as a bedside nurse in a large St. Louis hospital, floating among different departments and taking care of half a dozen patients for 12-hour shifts. Because of staff shortages, her manager often scheduled her to work both nights and days, and the lack of routine was wearing on her.
Sommer left that hospital in 2016 and worked as a home health nurse before leaving the workforce to start a family. She’s one of many health workers who have left their job in recent years. According to a report from the Missouri Hospital Association, health workers are increasingly leaving their jobs. Nearly 18 percent of workers in Missouri and metro east hospitals surveyed by the association left their jobs in 2017, up from 16 percent the year before.
“You show up, and you’re already going to be on a unit that’s understaffed,” Sommer said. “There was just this anxiety you start to develop because you’re afraid for the other shoe to drop … you’re overstretched and you feel like you’re not able to provide the sort of care that you know you need to.”
Nurses and support positions such as lab techs and assistants had much higher turnover rates than others. Housekeeping and nurse assistant positions had the highest turnover rate, both at close to 30 percent. Licensed practical nurses, pharmacy techs and CT techs also had job loss rates of 16 percent or more.
“A lot of the entry-level positions have the high turnover — our nurse assistants, housekeepers,” said Jill Williams, director of workforce initiatives for the hospital association. “We are finding turnover in new nurses [too.]”
High staff turnover causes a detrimental cycle for health care organizations, the report’s authors said.
“Providers face existing workforce shortages while simultaneously experiencing too few entrants and a growing rate of departures,” the report concludes. “High rates of turnover and vacancy can affect an employee’s work life, the quality of patient care and the amount of time they have to tend to patients. These factors can lead to even greater turnover rates.”
For every employee who leaves, hospitals lose money, Williams said.
“Turnover is very costly to an organization,” she said. "They obviously have to recruit, train, orient and all those costs associated with each of those positions.” It can also lead to less consistent or lower-quality care for patients.
Turnover doesn’t necessarily mean employees are leaving the field entirely, Williams said. Health care is a growing field and opportunities abound for people with experience.
“Either they’re moving out of the industry or they’re moving to a different hospital or they’re also moving up,” she said. “Entry-level jobs, especially in health care have a lot of career pathways associated with them.”
Many leave to get advanced degrees. Sommer said most of the nurses in her graduating class ended up leaving nursing to go back to school.
Employee burnout is especially common among nurses entering the field. A 2017 study in the Journal of Nursing Administration found nearly one in five newly-minted nurses left their job within a year. The Robert Wood Johnson Foundation reported similar rates in 2014. The Missouri Hospital Association recommends nursing residency programs and on-site training to help ease the transition from school to a hospital setting.
Many entry-level positions require a lot of work, often for not a lot of money. A certified nursing assistant position, which had the second-highest rate of turnover in the report, pays an average of $12 an hour.
The low pay occasionally makes it difficult to retain employees, Bobbi Utterback, nursing director at the Lewis County Nursing Home in Canton, Missouri, said. The facility is looking for two nursing assistants to work evenings.
“They don’t get paid near enough, but they work damn harder than anybody else does,” Utterback said.
For the nursing home workers that require more training and receive more money, the churn rate goes down, she said.
“We try to recognize them whenever we can,” Utterback said. “Most generally go to other health care organizations, but they come back. They want to work in an atmosphere where they know they can ask for help and they’re appreciated.”
Williams, of the hospital association, said better benefits and pay could keep people in jobs.
She also recommends training and education programs that help employees move up within the same organizations and creating partnerships with workforce organizations and academic institutions to recruit high-quality workers.
For Sommer, the former hospital nurse, that’s paramount. She doesn’t know if she wants to return to nursing in the future, but she said she will never go back to working bedside in the same environment she was in before.
“What I would not do would be to go back to a hospital setting where there weren’t more stringent things put in place to handle patient safety and staffing ratios,” Sommer said. “There’s always the option of getting an advanced degree."
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