In an email survey taken in March 2022, 9,150 state-licensed registered nurses in Michigan answered questions about their plans to leave their current nursing jobs, reduce hours or switch to travel nursing contracts. Researchers also surveyed 1,224 registered nurses who had left their roles in the two years prior to the survey.

Nurses most likely to leave were more likely to report physical, emotional or sexual abuse, or bullying or have answered survey questions in ways that reflected higher levels of exhaustion, according to the study.

Nearly three in 10 practicing nurses — 28% — reported plans to reduce their clinical hours within the next 12 months.

Among those nurses, 84% reported “emotional exhaustion.” Higher exhaustion scores were also linked with increased likelihood of leaving or reducing clinical hours within the next year.

The findings are especially worrisome for Michigan, an aging state already facing a dire shortage of health care workers.

And the problem, according to those surveyed, is not COVID or pay and promotions.

COVID made “an already bad and unsafe situation worse,” and revealed pressures that have increased over time, Christopher Friese, a study author, told Bridge Michigan.

“We’ve known, pre-pandemic, that nurses’ work environments were unsafe and unsupported,” he said. “I think nurses had been suffering in silence, and the pandemic has allowed the public to better understand what nurses do on a daily basis, their challenges.”

“We’re starting now to see nurses telling us not not only are (their environments) unsafe and unsupported, but that they’re going to make a change because (the environments) remain intolerable,” he said.

Friese is also a professor of nursing and health management and policy and a practicing oncology nurse at the University of Michigan.

It’s the highest rate of burnout that he’s seen in his career, he said, and Friese has monitored and led research in the area of nurse job satisfaction for years.

Certainly, nurse burnout isn’t new.

Over the years, studies and surveys have revealed “very high burnout rates in some areas. And nurses for about a decade, have been telling us their work environments have been unsafe, unsupported and chronically understaffed,” he added.

But the latest findings are different, said Friese.

“I’ve never seen a broad swath of nurses telling us … that they plan to leave their position,” he said.

A clearer trend line or year-to-year comparison is impossible because the new questions have never been asked this way, he acknowledged. Rather, the survey is new, and the results, which appeared this month online in the peer-reviewed journal Medical Care, will provide the baseline for follow-up, he said.

The study focused on registered nurses. Left out are other health care professionals, the study noted. Licensed practical nurses or nurse aids, who have different responsibilities, also were not part of the study, Friese explained.

And the nurses were mostly female and white. Still, for the most part, they represented the state’s larger nurse population, according to the study authors, suggesting that the results mirrored those of other nurses.

“We’re trying to bring in more diverse nurses, of many different backgrounds,” to the workforce, said Barbara Medvec, another U-M nursing professor and study author.

For the study, an overwhelmingly white response rate “is a limitation, but it’s not a major one,” she said.

The nurses had responded to email requests sent to nearly 160,000 emails of licensed registered nurses throughout Michigan.

And to be clear, many of those nurses in the survey may be moving to other nursing jobs, Friese acknowledged. But even that change underscores a discontent with their current position.

Among the study’s other key findings:

• More than two in five — 43% — reported emotional abuse.
• Nearly one in five nurses reported a plan to begin travel nursing, which typically pays much higher. (According to one analysis in December, Michigan’s travel nurses are paid, on average, $3,123 weekly, compared to staff nurses, who are paid, on average $1,460 weekly.)
• Mandatory overtime was associated with a higher likelihood of departure in the past two years.

The study results don’t surprise Kelly Rivera-Craine, a long-time nurse who now represents nurses as a business agent for Teamsters, Local 332 in Flint.

With too few nurses, nurses are too often caring for too many patients on a shift. That means not only poorer patient care, but faster staff burnout, she said.

Nurses “feel like they can’t give it their all,” she said.

Michigan could attract and retain nurses by allowing nurse practitioners to work without a doctor’s oversight — much like many other states do. It also could allow nurses in other states to practice more easily in Michigan, and enact anti-violence legislation protecting nurses while on the job, Friese said.

Study authors also called for reduced overtime.