Listening to Nurses: Dissatisfaction and Burnout on the Job
Nurses may constitute the most dissatisfied professions in the United States today. According to the Department of Health and Human Services, slightly more than two-thirds of registered nurses (69.5 percent) reported being even "moderately satisfied" with their jobs.76 By contrast, 85 percent of workers in other industries and 90 percent of professional workers are satisfied with their jobs.77
A 1999 survey done by the Nursing Executive Center reported similarly troubling findings: 28 percent of RNs said they were either "somewhat" or "very dissatisfied" with their jobs; 51 percent were somewhat satisfied and only 21 percent were very satisfied. Reporting on recent changes in the industry, a whopping 51 percent of all RNs stated that they were less satisfied with their jobs than they had been just two years earlier.78
Staff nurses have lower satisfaction (66 percent) than any other type of nurse. When analyzed by place of work, hospital nurses have the second lowest satisfaction (67 percent), just ahead of nursing homes (65 percent). All other types of nurses have somewhat higher levels of satisfaction, with the highest being nursing education (83 percent). But even this highest category remains lower than the average for professionals in other occupations.79
Nurses' dissatisfaction with their jobs is surprisingly universal. Personal factors such as age, years of experience, or education have relatively little impact on job satisfaction.80 The problem is not in the person, it's in the job. The Nursing Executive Center reports, for instance, that high levels of dissatisfaction are consistent across all pay levels: 29.5 percent of RNs making less than $15 per hour are dissatisfied, but so are 30.1 percent of those making $21–$23 per hour and 24.6 percent of those making $23–25 per hour, the top ranking.81 Similarly, while there is some variation among age groups, nurses in every age group exhibit high levels of dissatisfaction with their jobs.
Percent of RNs Dissatisfied With Their Jobs82
|Source: Nursing Executive Center. Reversing the Flight of Talent: Nursing Retention in an
Era of Gathering Shortage. 2000.
Finally, while dissatisfaction varies among different units of a hospital, the two largest groups of RNs — in ICU and medical/surgical units — report the highest rates of dissatisfaction, at 29.2 percent and 31.9 percent respectively.83
Multiple studies have confirmed that job satisfaction is directly linked to retention and turnover rates.84 Dissatisfaction is expressed most clearly in the number of nurses who consider leaving the profession. While 19 percent of RNs have actually changed hospitals in the past two years, 64 percent report that they have "considered leaving the hospital in the last two years." Furthermore, when asked how long they expect to stay at their current job, more than 40 percent expected to remain just three years or less.85
The conditions on the job for hospital nurses have negatively affected the public's view of nursing as a profession, which, in turn, makes it more difficult for nursing schools to recruit students. In 2001, nursing fell to a position of 137th out of 250 potentially desirable occupations.86 One of the most disturbing facts regarding nurse working conditions is the number of nurses who state that they would not recommend a career in nursing to others or that they would not choose such a career if they were just starting out. In New York State, a 1999 survey found that only 28 percent of current RNs would choose a career in nursing if they were starting their work lives today. Many of those disillusioned with nursing remain interested in health care as a profession. Thirteen percent of nurses stated that they would choose another clinical health care profession rather than nursing, and 31 percent stated they would choose a career in non-clinical health care; thus, it appears that the problem is not that nurses do not care for the work of health care, but rather that the conditions on the job have become untenable.87 Similar findings emerged from a survey conducted for the American Federation of Teachers' Federation of Nurse and Health Care Professionals, which found that 49 percent of nurses report that if they were younger and just beginning their careers, they would not go into nursing again. Only 44 percent said they would become a nurse again. Across both groups, 50 percent of working nurses stated that they have considered leaving the field for reasons other than retirement.88 When the ANA conducted a nationwide on-line survey, 55 percent of respondents reported that they would not recommend a nursing career to their friend or child.89
Staff Reporting Job Satisfaction
|Certified nurse anesthetist||83%|
|Private duty nurse||72%|
|Clinical nurse specialist||70%|
Respondents reporting they are "extremely satisfied"
|Source: The Registered Nurse Population, March 2000, Table 29, p. 67.|
While nurses face worsening conditions in many countries, American hospitals seem to be particularly hard-hit. In her five-country study of nursing, renowned scholar Linda Aiken reported that 41 percent of U.S. nurses were dissatisfied with their jobs, and that nearly one in four plan to leave their jobs within a year.90 The rate of dissatisfaction in the United States was the highest of all five countries studied, and American nurses were found to be three to four times more likely to be dissatisfied with their jobs than the average U.S. worker.91 This study used a standardized measure of burnout, and found that 43.2 percent of nurses scored in the "high burnout range according to norms."92
One of the most telling findings of the study is that 33 percent of nurses under the age of 30 were planning to leave their job within the year.93 The fact that even young nurses are already dissatisfied and thinking about leaving nursing points to the futility of focusing on the pipeline of nursing students as a strategy for solving the nursing shortage. The American Hospital Association similarly measured employee satisfaction according to a concept developed by Aon Consulting, which sets out a hierarchy of employee needs and then measures the extent to which employers have met each category of need.94 The American Hospital Association concluded that "hospitals fail to meet the expectations of their employees far more frequently than employers in other industries do." And indeed, the data show that health care employers are worse off than the national norm in every category.
The multiple frustrations facing nurses are reflected in survey after survey. One recent study, for example, asked nurses to describe how they felt at the end of a day's work. Nearly 50 percent reported that they typically felt "exhausted and discouraged"; 40 percent felt "powerless to affect change necessary for safe, quality patient care"; 26 percent felt "frightened for [their] patients"; and 24 percent felt frightened for themselves.95
Employees Whose Expectations Are Not
|Health Care Employees||Employees In General|
|Source: In Our Hands, p. 28; Aon Loyalty Institute.|
While nurse dissatisfaction is endemic, survey after survey reports that nurses would like to continue working as nurses if job conditions were improved. The American Organization of Nurse Executives, for instance, reported that four of 10 working RNs (43 percent) say that they plan to leave their current positions within the next three years. However, the authors go on to observe that many RNs who plan to leave their present jobs in the next few years say they would consider staying — and many others who have left nursing altogether say they would consider returning — if certain conditions were met. Among these conditions are better compensation, an improved work environment, better hours and more respect from management. Nurses with no plans to leave echo many of these same sentiments.96