Understanding and Preventing Departures: Surprises in Work Environment Contribute to High Turnover Rates of New Nurses

New study suggests how to better orient novice nurses, reduce turnover, stem shortage.

A new research study published in the July/August issue of Nursing Outlook finds that changes to the work environment where nurses begin their careers could help reduce turnover, an expense that can strain hospital budgets, exacerbate the nursing shortage, and negatively impact patient care. The article comes at a time when about 18.1 percent of newly licensed R.N.s are leaving their first nursing employer within a year of starting their job, and about 26.2 percent leave within two years.

Funded by the Robert Wood Johnson Foundation, the study analyzed the survey comments of 612 new nurses from 34 states and the District of Columbia. The researchers found that many novice nurses are dissatisfied with their first jobs due to a variety of unexpected situations they face in the primarily hospital-based environments where they begin their careers. Regardless of their negative perceptions, many of the nurses who responded to the survey felt hopeful that they could help reform work environments and patient care. Some suggested that improving the nurse-to-patient ratio was critical not only to improving professional and personal satisfaction but also patient safety.

“Nurses are on the front lines of an increasingly demanding hospital work environment,” said Yale University School of Nursing’s Linda Honan Pellico, Ph.D., A.P.R.N., lead researcher on the study. “Many feel they could be more effective caregivers to patients if they simply had more time to spend with them. Instead, they feel mounting pressure to rush through rounds and fill out paperwork, which is not why they chose to go into nursing,” Pellico added.

Among the findings: The nurses talked about the relentless pressure for speed and the difficulty of the many demands that are placed on them. Some nurses in the study told researchers that tasks in their first jobs do not reflect what they learned in nursing school. Many also expressed dissatisfaction with the lack of time they can spend with patients, while others felt their work was not appreciated by hospital physicians, administrators, and in some cases, more senior nurse managers. The nurses were particularly concerned with the communication patterns of those with whom they work.

Despite the economic downturn and tightening job market, the U.S. health care system continues to face a projected shortfall of up to 260,000 full-time equivalent nurses by 2025. Understanding why nurses leave their jobs within the first 18 months of their careers could help hospital managers better direct resources and keep their workforces stable, while helping to improve hospital finances—and patient care—in the process.

Many of the survey participants suggested that changes to nursing school pedagogy could better prepare them for some of the pressures they face after graduation. Survey respondents recommended that academic nursing programs include eight hour clinical days for student nurses, more realistic patient/nurse ratios, and communications activities that teach students how to interact effectively with physicians during rounds, make proper notations in patients’ charts, and give and take change of shift reports. 

“While the respondents’ suggestions for better patient-staffing ratios, smaller unit sizes and decreases in mandatory overtime have financial implications, high new nurse turnover is extremely costly to healthcare institutions and may impact patient safety,” said New York University’s Christine Kovner, principal investigator on the RWJF project. “Findings in this study suggest that if organizations take specific steps to improve working conditions, they might be able to address one of their most significant, perennial staffing challenges,” University at Buffalo’s Carol Brewer, co-principal investigator added.


The Robert Wood Johnson Foundation focuses on the pressing health and health-care issues facing our country. As the nation's largest philanthropy devoted exclusively to improving the health and health care of all Americans, the foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, meaningful and timely change. For more than 35 years the foundation has brought experience, commitment and a rigorous, balanced approach to the problems that affect the health and health care of those it serves. When it comes to helping Americans lead healthier lives and get the care they need, the foundation expects to make a difference in your lifetime.  

Yale University School of Nursing (YSN) enjoys a national and international reputation for excellence in teaching, research and clinical practice. One of Yale University’s professional schools, YSN is a leading school of nursing in the United States, with a diverse community of scholars and clinicians with a common goal: better health care for all people. More information on YSN may be found at www.nursing.yale.edu.

The College of Nursing at the College of Dentistry is located on New York University’s historic Greenwich Village campus in New York City. The College of Nursing is one of the leading nursing programs in the United States. The College offers a Bachelor of Science in Nursing; Master of Science and Post-Master’s Certificate Programs; and a Doctor of Philosophy in Research Theory and Development. For more information, visit www.nyu.edu/nursing.  

The University at Buffalo is a premier research-intensive public university, a flagship institution in the State University of New York system and its largest and most comprehensive campus. UB's more than 28,000 students pursue their academic interests through more than 300 undergraduate, graduate and professional degree programs. The School of Medicine and Biomedical Sciences, School of Dental Medicine, School of Nursing, School of Pharmacy and Pharmaceutical Sciences and School of Public Health and Health Professions constitute UB's Academic Health Center. Founded in 1846, the University at Buffalo is a member of the Association of American Universities.

Most Requested