Nursing isn’t an easy job. The rookie ABCs of nursing could very well read: A is for angry families, B is for bodily fluids, C is for catheter insertion… the list goes on. But despite the challenges, nurses continue to give the quality, compassionate care that has earned them the title of most ethical professionals for 14 years running.
You’re likely familiar with the term “nursing burnout.” But did you know that in 2015, job turnover for RNs exceeded the national hospital turnover rate? NSI Nursing Solutions published a report exploring this alarming trend and discovered that certain nursing specialties are more prone to high turnover than others. And high turnover is a very expensive problem for healthcare facilities.
The report revealed that the average cost of turnover for a bedside RN ranges from $37,700 to $58,400, resulting in the average hospital losing $5.2M–$8.1M. The report goes on to say that while most organizations view retention as essential, many still lack any formal retention strategy.
One thing you can do, however, is to build your RN career path on a solid foundation of awareness and preparation. Read on to discover the three nursing specialties with the highest turnover rates and what you can do to thrive in your chosen specialty and avoid becoming another statistic.
1. Behavioral health nursing
Turnover rate: 26.5%
Also known as psychiatric and mental health nursing, this specialty consistently tops the charts for high turnover. In the past two years, Behavior Health turned over 57.2 percent of their RN staff, according to the NSI report.
Turnover of highly skilled nurses is a problem for many psychiatric hospitals, according to a Psychiatric Services report. “Nurses are the frontline professional staff for psychiatric patients; without them, the provision of high quality care is difficult.” The source also states that most of the nurses in their study reported risk of assault as a major concern. One of their case studies found a total of 635 psychiatric nurses (41.3 percent) had experienced assault within the past year.
That said, dangerous or aggravating encounters with patients might not be the primary reason behavioral health struggles to retain its RNs. The problem could have more to do with caseloads, time constraints and paperwork.
Administrative problems are the real reason psychiatric nursing is in trouble, according to mental health practitioner, Emma Carroll, in her 2015 article. She stated that it used to be the best job in the world, back when she had time to truly interact and care for her patients. But Carroll went on to write that these days there is little time to make assessments and meet with patients.
Understaffed, overstretched nursing units are a common complaint everywhere in the world of RNs. But in psychiatric care, it can feel particularly devastating. Sometimes nurses are the only people a traumatized or suicidal patient will reach out to.
What nurses can do to thrive: If psychiatric nursing appeals to you, the American Psychiatric Nursing Association (APNA) suggests gaining some exposure first. Volunteering in agencies, hospitals or community programs where you interact with individuals with psychiatric problems is valuable. These experiences will help you acquire a better understanding of the full scope of a psychiatric nurse’s job.
2. Emergency nursing
Turnover rate: 21.1%
Emergency nurses specialize in rapid assessment and treatment, particularly during the initial phase of acute illness and trauma. Since this specialty is more about the severity of trouble and less about a specific demographic of patients, the Emergency Nurses Association (ENA) emphasizes that emergency nurses have to be well-versed in treating a wide variety of illnesses and injuries in every age group and condition.
“The caseload rarely matches the time you have you do your job,” says CRNA, MSN Nick Angelis of Behavewellness.com. The demands of the specialty, however, might not be to blame for the high turnover rate—at least not directly. Angelis claims that emergency nursing tends to attract adrenaline-seekers. “Once a nurse doesn't find that appealing anymore, their days may be numbered,” he explains. “Being surrounded by those types of people can be draining.”
Angelis suggests another issue worth noting deals with relationships and culture. “Several places in each hospital create their own unique culture, including the ER,” he says. He says the “thrill-seeking personalities” in this environment can result in a close, protective group of nurses. On the other hand, it can occasionally create a negative working environment. “Sometimes the chaos and subjectivity of the ER breeds bullying, competition and incivility.”
But you don’t just have to take the luck of the draw when it comes to your environment. Even nurses who feel bullied or aggravated by coworkers in the ER (or the stress of the job generally) can thrive with the right tools and attitude.
What nurses can do to thrive: Angelis believes the key to defeating an overly-competitive culture is to be assertive in your communication with everyone, while also promoting a culture of respect. “This follows the ER adage of, ‘I am here to save your butt, not kiss it’ as opposed to the smiling, passive behavior more common in other areas,” Angelis says.
Additionally, Angelis encourages all ER nurse hopefuls to sharpen their assessment skills since things move quickly in the ER. Critical thinking skills are paramount as every situation involves unique circumstances. “The ability to be adaptable, assertive and compassionate—not necessarily all at the same time—extends the longevity of the ER nurse's career,” Angelis adds.
3. Medical-surgical nursing
Turnover rate: 20.4%
Medical-surgical (med-surg) nursing has evolved from an entry-level position to a distinct specialty that represents the backbone of every institution, according to the Academy of Medical-Surgical Nurses (AMSN). The AMSN goes on to explain that some time ago, every nurse was a med-surg nurse, practicing on medical wards. But the specialty has evolved from the default position to an area of specialization.
“Medical-surgical nurses are the largest group of practicing professionals. It is one of the most demanding nursing specialties,” according to the AMSN. “Who but medical-surgical nurses can manage five to seven patients, plus the ones they have admitted and discharged throughout the day?”
Med-surg nursing is not for the faint of heart. These individuals care for a heavy caseload of patients who are admitted and discharged rapidly. It’s no secret that not every nurse can make it in this high-stakes specialty.
What nurses can do to thrive: Though it’s difficult to pinpoint why med-surg nurses face a particularly high percentage of turnover, they do represent the largest group of practicing nurses. One of the best strategies to thrive in this environment is undoubtedly prevention.
The AMSN states that med-surg nurses need to be knowledgeable in all aspects of adult health and have excellent assessment, technical, organizational and prioritization skills. These two requirements might be the difference between nurses who thrive in med-surg, and those who become part of the turnover.
Med-surg nurses also need to be highly concerned with patient safety and happy caring for patients of all ages, all demographics and multiple diagnoses across all medical specialties. If that sounds like a tall order, you’re not wrong. Med-surg nurses need every moment of their advanced education to prepare themselves for the demanding job at hand.
A world of specialties
Now you’re aware of some of the more stressful, yet incredibly important, nursing specialties out there. There are two types of people: those who see this as a warning, and those who view it as a challenge. If you feel called to overcome the obstacles in order to help vulnerable patients, know that there is much reward that comes along with the pressure.
If you’d prefer applying your abilities in a different area, there are plenty other nursing specialties out there to pursue. Learn more about your options in this Interactive Guide to Exploring Nursing Career Paths.
Do you have thoughts on why turnover rates are so high in these specialties or what can be done to prevent it? Share your comments with us below!
High turnovers! One factor I have experienced in high turnover is poor leadership! If the manager of your area is not supportive or does not “have your back”…it creates a sense of animosity. This leads to poor communication and poor teamwork. I’ve recently experienced this firsthand as a staff nurse in a surgical services department. This area of work is traditionally longevity employees…including management. When that changed and leadership from the CEO on down to leadership in our department changed (not for the better)in recent years there was a mass exodus and turnover continues with usage of agency to fill holes!
I’m a Nurse .. for 20 + years ..
I entered nursing to help others at possibly their worst or best time of their lives ..
Nursing school was far from easy ..
The boards were tough ..
I miss weekend family outings and MOST of Holidays too ..
I AM a bedside nurse on A Progressive Surgical Step Down Unit ..
I see patients cry when they get the worst OR best news of their life .
I’m happy to provide coffee. A warm blanket. A warm smile and my undivided attention..
I hold their hand when I can , with an ungloved touch when possible..
I WILL warm up your cold breakfast because you couldn’t reach the table the host / hostess left it 10 feet from your reach .
With your permission, I WILL update all 5 family members that call for an update.. a trached patient can’t do that .
As Nurses ..
WE treat the HUMAN response to their diagnosis..
And ANY time that any nurse feels yet they can’t do the minimum of that on top of ALL the madness, extra hours , burnout, rudeness by residents/ Doctor
It’s NEVER easy when you as a patient/ family call me names .. threaten me or cause me physically harm
However, I WIL ALWAYS be there .
Because ,
I’m YOUR Nurse
I’m 69 years old, have been a nurse for 40-some years, I learned on Med-surg like we all did back in the day. Then I moved to ER nursing and loved it until I just couldn’t run that fast anymore. I’ve been working as a case manager for the last 15 years and I know that I could never do med-surg the ways it’s done these days. With the patient to nurse ration so high, there is no way that you could even get to know your patients and their conditions, let alone their specific needs. The priority is on organizing your activities so that you can chart that you did them – No regard for what impact you might have had on the patient or their ability to understand their condition or how to manage it after discharge. These days patients are instructed to bring family members to the hospital with them because the nurses don’t have time to check on them! I respect clinical nurses more than ever now because of the extreme demands on all of them. Lay people don’t know what a truly difficult job nursing is today.
I think the major issues with nurse turn over is a lack of support form higher management. When a nurse is hired we are told the patient ratio will be 4:1 but when you get the job it is actually 6/7:1. It is impossible to do a good job when you do the work of 2 people instead of 1. Also managers lack training in how to manage and can often be petty, showing favoritism and difficult to work with.
JC, I agree with you 100%.
I’ve been a Nurse for 32 years. I spent 20 plus years in the ER working other Milieus concurrently. I incorporated and contracted myself. Did contracts in IR, Cardiac Cath Lab and multiple other Milieus. Which allowed a flexible schedule and excellent compensation. Nurses need to think out of the box. You have a license use it to its fullest benefit. I quit working in 2008 traveled and did volunteer work abroad. In 2016 I returned doing some PRN at a local Behavioral Health Hospital. I don’t need the money but I still feel the need to be a contribution. Don’t burn yourself out your a Nurse you have countless options. If you need more money relocate don’t let hospitals own you and your personal time.
Patient care in all areas are dictated by ratios. Computer modules that identify numbers which are unsafe. Ancillary support load is high too. Bottom line do more with less staff, equipment and you follow staff whom do not do their jobs. A blind eye is the norm, if you are a whistleblower you are considered a troublemaker. I am headed toward year 45 as a nurse, 35 as an ICU RN. I get floated or my peers to the telemetry or med.-surg. areas due to chronicity of staff shortage or call outs. Management CNO’s plan is to continue to float staff, increase RN/patient ratios, no salary increase, and nurses are leaving. A total of 17 in the 2 years in my unit. Even the CEO left. I have had enough!
You forgot Chronic Dialysis units…after being in the job for 10 years at the same clinic I moved to another state with the same company and was SHOCKED it was not at all what I was expecting or told it would be when I excepted. Many crazy contamination unsafe situations and when reported to the Manager she would walk away promptly stating “You are the charge nurse”! We were not allowed to write up employees but only to report to her and I started doing all my email to cover my butt. We lost untold wonderful staff and when I quit after 4 years the other 2 nurses were only months behind me and quit within 2 weeks of on another. When I finally had contacted HR and everybody higher up (as others had done before me) the big wigs of this company actually admitted she was undergoing anger management and would do nothing about her bullying and retaliation to everyone who had quit, so now since 2016 the unit is ran with travelers the patients are miserable because there is not continuity and now she has to be on the floor working more from what patients have told me. I went into another field that I love but it breaks my heart when the dialysis patients tell me how it is there now. One even could not longer deal with it and just went on hospice rather that continue going there and that is not right!
I am one of the 57.2% who left psych nursing in 2016 after less than a year. The facility I worked in “specialized” in child/adolescent psychiatry. Not only was their the risk of assault by my patients, yes adolescent patients, but there was never enough staff to ensure our safety. There was no security to help come in when necessary, it was all left to the nurses and techs when things went down. Having done my psychiatric clinicals in nursing school at a major academic hospital I knew that the unit should not be running the way mine was being run. The hospital also refused to computerize their medical records so everything was charted by hand. We would see the same patients over and over again that were not helped during their previous stays. There was absolutely no time to spend with the patients other than passing their meds. After several tense episodes on the unit I had enough. This particular facility and their parent company only care about money. Now working pediatric cardiology and love it! Much calmer!
I see administration as trying to prove to some unknown entity that they are ‘dealing with bullies’ by punishing seasoned nurses who stand up for themselves and PATIENT SAFETY! When newbies are ‘losing it’ in the face of difficulties and have to run to the lounge to ‘gather themselves’ and leave the seasoned nurses to face the situation alone (which we do VERY WELL) something is very wrong! You either sink or swim and if you RUN OFF, YOU WILL NEVER LEARN TO SWIM! These snowflakes need to stay and SEE how the seasoned nurses GOT SO GOOD at what they do
I choose where I work. I choose to work in Assisted Living because I see real reaction to interventions. I don’t miss the hospital, the politics, the “your just a nurse” mentality. I have the privligdge to care for and provide care to wonderful people who may not be able to say it, but they show appreciation for all we do for them. Hospital nursing is not al there is. Long term care, hospice, assisted living, adult day centers. Thses have all been very rewarding to me…..I don’t miss the ER, gang shootings, violent drug addicts, and the occasional person who after complaint for the 400th time about how gawd awful waiting is (i mean you have a toe splinter, and i have 3 people who have been shot and are not awake, who goes fist right?)
Understaffing is a huge issue. Administrations
Are always focused on finding a way to make
More money for the corporation. The nurse
Is no more than a tool to be used to that end
There is no one to talk to when it all gets to be too much ch. when you loose a special patient
Or or just overwhelmed you can’t eat or be
Tired or sick. Tears are forbidden. If you
Can’t already tell, after 30 years I am tired.
And no one cares
I know that educators are also at risk for burnout and career changes. Number one we do not get paid as well as hospital employees so once a nurse does decide to go to academic education, they find they cannot live on what we get paid. Number two the students can be very rude, demanding, and uncivil so at times we must also maintain classroom behaviors, prepare tests, do multitudes of homework grading, clinical, and also laboratory exercises.
I do it because I enjoy teaching, the students, and my faculty. It is truly a calling that tells you sometimes it is not all about the money.
The administration is responsible for ED turnover rates. Administration institutes clinical ladders for each nurse to achieve the standards set before them, this ladder is tied to the pay scale. The standards are constantly changing with the passage of years making it difficult for nursing to achieve the goals. Administration is always pushing the envelope to determine how many more patients a single nurse can handle. Nursing deals with the constant push to take on more, giving up breaks and often meal times, forbidden to eat at the desk or receive a verbal warning for failure to adhere to company policy. So many policies make the work environment more stressful than it has to be.
I also found that clinical ladder to be ridiculous. If you wanted to advance, it was about all the extra things you do and not about how good you are at patient care. It was about working on committees, community outreach programs (done outside work time), working on some type of study to improve outcomes or patient care, or having advanced degrees. It didn’t matter if you were better at patient care than those who did all these extra things. I’m not longer doing bedside nursing and have been in case management for the last 15 years. But I have to say that I do love my job.
I think the high turnover in psychiatric nursing is not only the paperwork, but that the facilities will hire anyone without experience in this department. But if I try to transfer to another department, I have no skills or experience. The attitude seems to be that psych is not “real” nursing. I have had nurses say they transferred to psych as a retirement job. I have even had other nurses talk down to me, as a psych nurse, when I need to transfer a pt for an acute medical problem. It is a speciality that is very misunderstood.
Hi Susan,
I’ve had the same thing happen to me as a med-surge nurse. I’ve had nurses in other specialties, especially critical care, talk down to me because they think med/surg is easy and patients are not “really” sick. Also, I’ve come across the perception that med-surge nurses are not as intelligent as nurses who work in higher acuity areas.
Ignorant and disrespectful attitudes of course.
I definitely think being understaffed is a BIG BIG issue. I have seen it from the patient side and to have 9 patients on a medsurg floor, all with lots of things going on it just not safe! And 12 hour shifts in some areas are just not good, I recently was a patient in the trauma ER in a city an hour away (came from local by ambulance), they were running like crazy all the time I was there, till I went to the floor to be admitted. And they all were exhausted. Each case I heard coming in was severe! Intense work like that for 12 hours! Not good, I would think they would burn out!
I definitely think being understaffed is a BIG BIG issue. I have seen it from the patient side and to have 9 patients on a medsurg floor, all with lots of things going on it just not safe! And 12 hour shifts in some areas are just not good, I recently was a patient in the trauma ER in a city an hour away (came from local by ambulance), they were running like crazy all the time I was there, till I went to the floor to be admitted. And they all were exhausted. Each case I heard coming in was severe! Intense work like that for 12 hours! Not good, I would think they would burn out!