Should I stay, or should I go? Australia’s nurse retention dilemma

Even before the pandemic, Australia faced nursing shortages, caused in part by a shrinking supply of nursing-school graduates and a decline in the number of nurses migrating from other countries. In the immediate future, the Australian health system could see further shortages due to the longer-term impacts of the COVID-19 pandemic. These short-term demands are superimposed on longer-term demand caused by Australia’s population growth and ageing demographic. Furthermore, many nurses have told us they plan to leave the profession, and this will only compound the situation.

The McKinsey 2021 Future of Work in Nursing Survey found that one-fifth of Australia’s registered nurses say they intend to leave their current role in the next 12 months. Forty-one percent of these nurses say they are planning to move countries or leave direct-care roles entirely (Exhibit 1). By 2025, anywhere from 20,000 to 40,000 nursing positions could be left unfilled. An earlier McKinsey global survey of nurses in Australia, Brazil, France, Japan, Singapore, the United Kingdom, and the United States found similar results.

Among nurses who said they planned to leave their roles, 41 percent indicated that they would move countries or leave nursing entirely.

Surveyed nurses cited a desire to seek higher pay as the number-one reason driving them to leave the profession. However, having a positive work environment—caring teammates, a safe space, and a sense of purpose—is important to nurses who said they want to stay. The same was true in the global survey. The 2021 survey also found that Australian aged-care nurses are more likely to be ambivalent about remaining at their jobs compared with non–aged care nurses, suggesting the former segment of the workforce is even more at risk.

Mitigating the risk of severe nursing workforce shortages requires a comprehensive approach. The challenges revealed by this survey are complex and resolving them will require time and sustained efforts. We encourage governments, industry groups, and employers to deploy a three-pronged strategy—build, excite, and utilise—to begin to address the challenge.

Build. Building up the workforce can create a positive feedback loop, because increased staffing levels facilitate retention practices. A comprehensive, long-term effort to redesign the training pipeline could attract greater numbers of potential nurses to Australia and the sector. To facilitate employment, providers and industry groups could also work together to further streamline and digitalise recruitment.

Excite. Retention is the most powerful lever to address the short-term supply gap. However, merely offering competitive compensation won’t be enough. To excite and better engage nurses, stakeholders need to work together to pilot practices to increase nurses’ autonomy, recognise them more effectively, and build goodwill (Exhibit 2). Offering opportunities to provide virtual care through increased roster and location flexibility may also be attractive.

The work environment is the most important factor in nurses' decision to stay in their current role.

Utilise. Employers need to consider the composition and capabilities of care teams to better utilise existing skill sets and qualifications. Tasks could be redistributed to nursing-support workers when appropriate to ensure nurses can work nearer to the top of their practice scopes. Additionally, to attract nursing staff and provide rostering flexibility, employers, the health industry, and governments need to foster better ways of working—an approach that became more common during the pandemic.

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