Reflections of A Nurse: What Made Me Stay or Leave?

I would love to say that I was one of those people who knew from a very young age I was called to be a nurse. However, I truly fell into nursing. Both my grandmother and sister are nurses, but until a few months before I left for college, accepted into my university’s pre-nursing program, I thought that I may be a teacher, or a business woman, or a humanitarian. The truth is that in my decade as a practicing clinician and the time since, I’ve gotten to be so many of the above.

If you sit down and talk to a few nurses, you will hear a different story from each one of what led them to become a nurse. However, a common theme is often a desire to do work that serves a higher purpose. And while some have left clinical practice, myself included, nursing never truly leaves us.

Looking back there were several factors at play for why I switched careers to digital health product management, and I can see episodes in my career where organizations excelled and struggled to create a nurturing and thriving culture for their nurses. What follows are my personal experiences.

Two Common Themes in Nurse Retention

1. Job Fit

I remember my second year of nursing school like it was yesterday. I remember it so vividly because I was incredibly depressed. I had become completely convinced I was not cut out for nursing. While I performed well in my didactic courses, I struggled with clinical rotations and skills. I felt miles behind my peers who previously worked as CNAs in high school and knew beyond a shadow of a doubt that they were meant to be nurses. Part of the problem was that I couldn’t find a service line where I truly felt like I fit.

Two different stories:

• The expectation was that every nurse would start on a medical/surgical floor to gain competencies before going into more specialized areas of nursing. However, I truly hated working on this floor. It wasn’t until my last semester, when I was put in the pediatric emergency department, that I truly came alive as a nurse. The fast pace, variety in patients, and autonomy was exactly what I was seeking. I remember walking up to the nurse manager on one of my last days of clinicals and emphatically requesting that I get a full-time position after graduation. At that time, many emergency departments did not accept new graduate nurses; however, this manager could see that this was where I “fit.” Time spent elsewhere would likely create disillusionment with the profession and possibly cause me to leave for a different career. Thankfully, she gave me a job that day.
• A friend of mine had a completely different story. He performed well throughout his entire nursing program. He loved every second of it and excelled in many of his clinical rotations. Therefore, he was easily accepted as a new graduate emergency department nurse when the time came. However, he was miserable. He always felt behind in his shifts. He left worried that he had made mistakes. He was anxious before heading off to work every day. Seeing how well I was performing made him feel like a failure, like his success in school didn’t translate to the real world of nursing. My friend is now an amazing ICU nurse. He is one of the best of his colleagues in cardiology and is training to be a nurse practitioner to work with the cardiology physicians who can’t wait to hire him. He almost quit nursing completely, but instead, he tried a different area of care and found his niche.

Nursing is a broad and variable profession. While there are basic care components that transcend all nursing professionals, life as an oncology nurse is very different from that of a home health nurse. Many organizations have created residency programs for new graduate nurses, where participants float between services before committing to a full-time staff position in any unit.

The key is deciding how you are going to assess and determine job fit for your nurses.

If someone is struggling, consider that it may be a problem with fit. Consider whether their personalities, skills, and behaviors align themselves with success in a unit. Most importantly, intervene on their behalf before dissatisfaction takes root and forces them to leave the profession.

2. Leadership

Once a nurse finds a job that suits them well, the leadership in their organization is often what makes it or breaks it for them when it comes to staying or leaving. As the saying goes, “Employees don’t leave jobs. They leave managers.” This couldn’t be truer in nursing.

Outcome of two different leaders:

• One of the best nurse managers I had was at my first position as an emergency department staff nurse. The same manager who focused on fit over policies when deciding to hire me on her unit turned out to be a great leader in many ways. She managed an incredibly busy emergency department with very little down time. We saw tens of thousands of patients each year and had a high prevalence of traumas, code strokes, behavioral health emergencies, and substance abuse. It was a taxing 12-hour shift each day and many of the nurses felt too overwhelmed to take their 30-minute lunch break, fearing that they would be too far behind when returning to the unit. Our nurse manager, seeing that stress was increasing and the potential for burnout high, decided to block her calendar each day for four consecutive hours. During this time, she refused to take any meetings or commit to any office work. Instead she came out on the unit and relieved each nurse for 30 minutes, covering for their patients so they would be well cared for when the nurse returned. It was this servant leadership that made all of us focus on the meaning behind the work and the comradery that came with it. Her turnover was one of the lowest in the whole hospital.
• Years later I worked in a different busy emergency department. Same story, different region of the country. Despite running between patients to keep up, being responsible for unsafe nurse-to-patient ratios, and never taking breaks, I was constantly getting reprimanded for the wait time of patients in triage. Leadership never came to help on the unit. No discussions took place about hiring more staff and adding more rooms. Instead employees were made to feel like they were the problem in this impossible situation. Almost all the employees hired at the same time I was, had left within a few months. I personally only stayed a total of nine, the shortest tenure at a job I’ve had up to this day in my career.

In my opinion, nursing is one of the hardest jobs in the United States today. You work long hours and endure emotionally and physically demanding work every day. Effective leadership is paramount in creating a culture where nurses want to stay.

People stay at jobs because the work is enjoyable, there is growth potential, and they feel connected to a higher meaning. While the higher meaning normally exists in any nursing job, the first two are directly impacted by leadership.

Even when work is exhausting, collaboration and comradery will create the supportive environment needed for nurses to know they are all in it together. Further, present and attuned leadership will notice when employees are ready for promotions, need to find a better job fit, or are close to burnout. From my experience, nurses stay in this type of culture.

Final Thoughts

Nursing has allowed my career to ebb and flow in ways I couldn’t imagine. It was ultimately a love of helping others and a nagging fear over job stability that led me to the rewarding and challenging profession of nursing. My ten years as a practicing nurse was incredibly rewarding and taught me an immense amount of work ethic and empathy that I can take into any new role in any profession.

While I ultimately left nursing due to a growing desire to impact the industry in a different way, I stayed or left certain jobs based on the culture of that organization. I’ve found that two key components for nurse retention are finding the right fit and developing nurses through great leadership. I continue to hear this as I interview nurses and nursing leaders in my current position as a product manager.

Is it time for you to assess what your organization is doing to improve these aspects of nursing culture to retain your best nurses?