Many nurses aren’t just unhappy with their jobs. They’re losing the love of nursing.

Nurses have been saying for years, even before the COVID-19 pandemic, that they need more support and better staffing.

However, Beth Ulrich, the lead author of a study released earlier this month by the American Association of Critical-Care Nurses, pointed to one especially troubling finding.

Nurses aren’t just frustrated with certain aspects of their jobs or their employers. They’re no longer happy being nurses.

Among more than 9,000 nurses surveyed in October 2021, only 40% said they were satisfied being a registered nurse, compared to 62% in a previous survey in 2018. The most recent study is the fifth national survey the AACN has undertaken since 2006.

“We've never seen that number that low,” Ulrich said.

Even in other periods with widespread nursing shortages, “nurses still told you they were satisfied with being a nurse,” she said.

“When a nurse tells you she’s not satisfied with being a nurse, now we’ve got a problem,” Ulrich says. “And we have to find a way to re-engage those nurses and help them find joy in their profession again. That to me is one of the critical issues because that's such a foundational issue.”

A professor of nursing at the University of Texas Health Science Center in Houston and a longtime healthcare executive, Ulrich spoke with Chief Healthcare Executive about the frustrations of nurses and what hospital leaders can be doing to retain their nurses.

“Nurses can do anything,” she said. “You go follow a nurse and you’ll realize, nurses can run the world. Give them a little room to move and a few resources, and nurses can run the world. But when they’re not happy being nurses, or not satisfied being nurses, they don’t have that same energy.” (See excerpts of our discussion in this video. The story continues below the video.)

The COVID-19 pandemic has added to the problems facing nurses, leading many nurses to say they’re exhausted and their mental health is being affected. Many of these difficulties began long before the coronavirus became a household word.

“And they’re not going to be gone with the pandemic,” Ulrich said. “They got exacerbated in the pandemic.”

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Nurses don’t feel safe

Nurses say they need more help and staffing shortages are hurting their ability to do their jobs. Roughly one out of four nurses (24%) said they have adequate staffing more than 75% of the time, according to the survey.

Many nurses said they don’t feel safe in the workplace. Only 47% of the nurses surveyed said they felt that their organization values their health and safety, down from 68% in the 2018 survey.

“That one surprised me a little bit,” Ulrich said. “That one dropped way off from previous years.”

Hospital nurses have complained about an increase in violence during the pandemic. About half of hospital nurses (48%) reported an increase in workplace violence, according to a survey by National Nurses United released in April.

However, the latest AACN survey indicates less than half of nurses believe their employers care about their safety. Hospital leaders should take notice of that finding, Ulrich said.

“That’s a no-cost item to fix,” Ulrich said. “As a hospital executive … as a hospital VP or a chief nursing officer, I can deliver the message that I care about your health and your safety. And then I have to do some things with that, but first I’ve got to deliver the message and mean it.”

Nurses were asked if they experienced verbal abuse and physical abuse in the past year. Of the nurses who responded, 65% said they experienced verbal abuse at least once, and 28% said they suffered physical abuse at least once.

“You get people at the most vulnerable time in their life, when they’re in the hospital or their family is in the hospital,” Ulrich said. “That’s not to make an excuse for it. There isn’t one. But it’s to say you have to be more aware, and you have to make sure you put some safety mechanisms around your staff.”

• Read more: To address burnout, ‘Return nurses to being nurses’

Seek input from nurses

Hospital executives can do a lot of good by just focusing on a couple or areas to improve, especially those that don’t involve heavy spending at a time when hospitals are financially challenged.

Leaders can boost the morale of nurses by incorporating nurses more in decisions involving the care of patients, Ulrich said.

“You can start looking at things that don’t cost you a lot. One of the other things is decision-making, whether RNs are involved in decision-making regarding patient care, policies on patient care,” Ulrich said.

The latest survey found a steep drop in nurses saying they are included in decisions regarding patient care, she said.

“If you’re a nurse, it’s OK if they don’t let you make decisions about what color they’re going to paint the building, or what they’re going to put in the lobby, or any of that sort of stuff,” Ulrich said. But if you don’t have input on policies that affect patient care, and that’s your specialty, it doesn’t feel so good.

“I think that’s another one that’s a no-cost, low-cost solution, but boy, would it make a difference to nurses,” she said.

Retaining nurses

Nurses say they’re considering leaving their jobs, or at least working outside the hospital.

Two out of three nurses (67%) said they intend to leave their position within three years. Among those who say they would leave their post, 36% of those nurses said they would leave within the next year.

“When somebody tells you they’re going to leave in the next six months or the next seven to 12 months, they’re serious,” Ulrich said. “When somebody says, ‘I’m going to leave in three years,’ you’ve got some time to maybe convince them, they don’t want to leave.”

Among the nurses who said they are thinking about leaving, most (63%) said they would reconsider if they received better pay and benefits. “Nurses are worth more than their getting paid,” Ulrich said. “Organizations are going to have to come to terms with that.”

“We asked nurses what might get you to stay, and they’re very clear. Staffing. Respect,” Ulrich said. “They want additional salary, not unreasonable when you look at comparative salaries for what people do.”

A strong majority (57%) said they would stay if they have better staffing.

Hospital executives should talk to their nurses to find out why some are thinking of leaving, Ulrich said.

“If you’re going to talk about what’s going to keep nurses in your institution, you need to talk to the people that are leaving, not the ones that are leaving, but the category of people who are leaving,” Ulrich said. “That's the people who will tell you what would get them to stay.”

Coming Wednesday: Finding ways to keep younger nurses and veterans with decades of experience