Nearly 40% of Michigan’s nurses plan to leave their job within the next year, according to a new survey of nearly more than 9,000 nurses licensed in the state. The biggest reasons: the job has become increasingly dangerous and demoralizing, with nurses spread too thin and a pervasive feeling that they simply aren’t supported in the workplace.
More than 80% of practicing nurses cited adequate staffing as a primary concern, followed by concerns about patient and staff safety. The vast majority said they’re experiencing “meaningful emotional exhaustion,” with thousands of nurses reporting workplace violence, including physical abuse. Salary and benefits were “among the least cited” issues driving nurses to leave, researchers found.
This means Michigan’s health system is at a critical juncture, the study’s authors concluded. If conditions don’t improve, there could soon be a “spiral of additional resignations” that “threaten the delivery of essential care.”
“We need to dispel this myth that what we're seeing and observing right now in Michigan in 2023 is because of COVID, and will get better as COVID improves,” said Christopher Friese, co-author and professor of nursing and the director of the Center for Improving Patient and Population Health at the University of Michigan. “There's nothing to suggest that. And if we continue down that path, I worry we're going to miss an opportunity to right the ship, and make things safer for nurses and for patients.”
Youngest nurses are “already looking for the exits”
Perhaps most concerning, researchers said, was the finding that the youngest nurses are now the most likely to leave: nearly 60% of those under 25, and more than 50% of those 25-34 years old, said they intended to leave their jobs within a year.
“Our incoming nurses…are seeing that the workplaces are unsafe and unsupportive, and they're not willing to work in those conditions,” Friese said. Already, the state’s health system was bracing for a “shortfall of nurses” as the large population of baby boomer nurses retired, he said.
“But when we have our youngest nurses planning to leave their positions, they've just been oriented, they've just been trained, and they're already looking for the exits. That's really alarming. And I haven't seen rates like the rates we're seeing before.”
Merely increasing the supply of new nurses entering the profession won’t work, he said. “If we prepare all these additional nurses, and they're leaving at the rates that we're seeing in the study, we sort of have a problem of a leaky bucket here, where we're bringing more people in, but they're leaving just as fast.”
Industry, nurses disagree about possible solutions
The study also reveals some solutions, the authors concluded: hospital leaders can commit to increasing staffing levels over time. “These include the implementation of safer staffing models to support higher-quality nursing care; evidence for safer staffing models and potential legislation has existed for decades,” the study said.
Friese believes that should include legally mandated nurse-to-patient staffing ratios. If you get on an airplane, he said, there’s a minimum number of pilots and flight attendants required to be on board before the plane can take off. Yet Michigan doesn’t require any staffing levels when it comes to life-saving medical care, he said.
“Your ICU nurse could care for one patient, two patients, three patients, four patients” he said. “They could be running the unit at the same time. So what we want is to establish a floor, by which we say, ‘This is going to be the minimum amount of nurses that will be assigned to these patients.’ You can always go up. And we know things are difficult. So commit to improving staffing over time. Begin to make those investments now, so that we can get ourselves in a better place.”
But the hospital industry in Michigan has vehemently pushed back against the idea of mandatory staffing ratios.
“The study published today by the University of Michigan Center for Improving Patient and Population Health acknowledges the staffing challenges that have plagued healthcare throughout the country, beginning prior to the pandemic but exacerbated by early retirements and burnout of nurses from caring for multiple surges of patients that tested Michigan’s overall hospital capacity,” said Brian Peters, CEO of the Michigan Health and Hospital Association, in a statement via email.
“However, the study incorrectly identifies mandated nurse-to-patient staffing ratios as a solution to the problem of inadequate nurse supply. This one-size-fits-all approach fails to address the complexity of patient care and the diversity of healthcare environments throughout Michigan.”
The healthcare staffing crisis has frequently been cited by Michigan hospital administrators as a key reason they urgently need billions in taxpayer money. More than $3 billion in COVID-era aid has already gone to Michigan hospitals. Just last month, Governor Gretchen Whitmer allocated another $75 million to the MHA to help hospitals “experiencing a generational workforce shortage,” an MHA press release stated.
“According to a recent survey of hospitals conducted by the MHA, there are more than 27,000 job openings in hospitals throughout Michigan, including nearly 8,500 nursing job opportunities,” according to the MHA’s press release on March 8. “...Michigan has lost a high of about 1,700 staffed hospital beds since 2020 because of workforce shortages.”
But in his statement about the University of Michigan nursing study, Peters said actually, the staffing situation may be “stabilizing.”
“Although Michigan hospitals continue to face workforce shortages, we have observed some stabilization in the workforce and its impact on hospital bed capacity. Specifically, the average number of staffed adult inpatient hospital beds in the state has not changed significantly from February 2022 to the present day,” Peters said in a statement via email.
But James Walker, a Michigan Nurses Association board member who works as a nurse at Munson Medical Center in Traverse City, said the study highlights the need for policy change.
“The study confirms what bedside nurses have been saying for years,” he said in an emailed statement Thursday. “Sending millions of taxpayer dollars with no real strings attached to hospitals has not fixed this problem. Creating a revolving door of new nurses who ultimately leave because of unsustainable working conditions will not solve this problem. The only way to address the crisis in healthcare is through strong legislative action. Nurses and patients deserve laws that prioritize patients over profits, force hospitals to maintain safe staffing levels, and limit mandatory overtime. Millionaire healthcare executives have proven time and again that they cannot be trusted to do the right thing on their own. We need legislative action now.”
