More nurses consider leaving direct patient care



Healthcare workers and their organizations continue to face unparalleled demands stemming from the COVID-19 pandemic. Thirty-two percent of registered nurses (RNs) surveyed in the United States in November said they may leave their current direct-patient-care role, according to McKinsey’s latest research. That is an increase of ten percentage points in under ten months.





To retain frontline clinicians and, over time, help begin to address widespread staffing shortages, healthcare leaders are designing and deploying strategies focused on supporting their workforce. In the exhibits below, we share eight insights to help stakeholders shape their approaches.

Given the contents below and our broader research, we see two key implications for healthcare organizations to consider over the medium to longer term.

  1. Identifying opportunities for workforce retention strategies to be more directly tailored to employee needs and preferences, including more personalized programs and support, will continue to be important. This may include the following:
  • doubling down on environmental factors (for example, team dynamics, purpose or meaning of work, feeling valued by organization), flexibility, and professional development opportunities
  • ensuring total rewards offering is aligned with organizational strategy and meets a holistic set of needs (for example, dependent care and mental-health services)
  • amplifying continuing-education programs, roles, and resources that support novice clinicians and “in need” skill sets (for example, behavioral health)
  • providing training and resources for leaders to support the individual needs of their team members, as well as collective team health

  • Minimizing workload strains, where possible, will require innovation but provide much needed relief. For example:
    • deploying advanced analytics to improve accuracy and timeliness of demand forecasting, workforce alignment, and real-time labor management
    • redesigning roles and processes (including through digitization and automation where appropriate) to reduce friction points, increase flexibility, and incorporate support to enable top-of-license practice
    • exploring new ways to grow the talent pipeline, including ensuring that end-to-end hiring processes are as efficient as possible and exploring partnerships and career pathway designs focused on highest need roles/skill sets, untapped pools of talent, and diverse cohorts

    We also recognize the need for society at large to continue to support and elevate the role of nursing and other frontline healthcare workers. We take this opportunity to thank healthcare professionals and their organizations for what they do every day, particularly during the COVID-19 pandemic.

    Surveyed nurses said staffing, pay, and lack of support are factors affecting decision to leave

    • Among surveyed RNs, 32 percent indicated a likelihood of leaving their current position providing direct patient care in November 2021, up from 22 percent in February 2021.
    • The strongest drivers of intent to leave included insufficient staffing levels, seeking higher pay, not feeling listened to or supported at work, and the emotional toll of the job.

    Surveyed nurses cited alternate roles/careers, retirement, education, and focus on family/life goals as potential plans if considering leaving

    Among survey respondents, 35 percent of RNs who were likely to leave their current roles indicated plans to stay in the workforce but in a nondirect-patient-care role (for example, another career path or alternate role). An additional 20 percent indicated plans to exit the workforce completely, such as through retirement or to focus on their family.

    There are a variety of challenges for surveyed nurses

    Efforts to support and retain today’s healthcare professionals require action across the continuum of care as well as addressing role-specific needs and preferences.

    Pay was cited as a bigger factor for early and midtenured nurses

    • Nurses in years one through five and six through ten of their nursing careers are more likely to state an intention to leave their current role than those with 11-plus years of experience.
    • Surveyed nurses with less than ten years of experience cited higher pay as a more influential factor, while retirement and the physical toll of the job was a bigger factor for surveyed RNs with 11 or more years of experience.

    What’s keeping nurses in the profession and what’s driving them to consider leaving?

    • Across surveyed RNs, the most influential factors of whether to stay in role included safety, flexibility (such as work–life balance, work schedule), and environment (for example, a trusting/caring team, feeling valued by organization, doing meaningful work). While adequate compensation remains important, it was not as influential as other factors among respondents.
      • When asked specifically about flexibility, surveyed RNs indicated that control over time off and aspects of schedule are most important.
    • Early and midtenured nurses surveyed placed particular importance on safety, compensation, ability to care for family, feeling valued by their organization, and access to professional development opportunities.

    Key factors differed in importance among surveyed nurses based on intent to leave

    Surveyed nurses who were more likely to leave the profession placed outsize importance on manageable workloads, while those more likely to stay placed outsize importance on doing meaningful work, having caring and trusting teammates, having a sense of belonging, and feeling engaged by their work. Safety, flexibility, work–life balance, compensation, and feeling valued were among factors with approximately equal weight in each group.

    Breaks and sufficient recognition continue to be most valued by surveyed nurses

    • Regarding well-being supports, embedding more breaks and sufficient recognition continued to be the offerings most valued by surveyed RNs. No single offering, however, was rated highly effective by more than 60 percent of respondents.
      • Surveyed RNs with one to ten years of experience valued “embedding more breaks” more than RNs with 11 or more years of experience.
      • When asked specifically about how they’d like to get respite and/or take a break, surveyed RNs preferred reduced patient loads, more support staff, and taking time off.
      • Emergency department RNs surveyed indicated that they valued the “availability of mental-health resources” more than their peers in other settings.

    Surveyed nurses cited behavioral-health skills as a potential gap

    • Fewer than 40 percent of surveyed RNs perceive that they have the behavioral-health skills required to be successful as a nurse in the future.





    While broader solutions—and collaboration across the public and private sector, for example, to increase nurse educator capacity and elevate the role of nursing—are critical in the long term, healthcare organizations can consider a number of medium and longer-term strategies to support their workforces. Examples include doubling down on retaining critical talent grounded in the specific needs and preferences of the front line; minimizing workload strains where possible through advanced analytics (planning, deployment) and workflow redesign; and innovating around new ways to grow the talent pipeline (including with partners).

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