Around the world, nurses say meaningful work keeps them going

While some surveyed nurses said they plan to leave direct patient care, the effects of COVID-19 on the nursing workforce may be leveling off.

The effects of the COVID-19 pandemic on the nursing workforce are explored in a new global survey from McKinsey, which asked frontline nurses in various countries if they want to stay in their current role. Between 28 and 38 percent of nurse respondents in the United States, the United Kingdom, Singapore, Japan, and France indicated they were likely to leave their current role in direct patient care in the next year.

The reasons for leaving vary. In some countries, more than half of respondents said their decision to leave was not directly related to the pandemic. Yet responses may reflect some weariness with direct patient care—in the United States, for example, surveyed nurses who said they anticipate leaving their direct-patient-care roles increased by about ten percentage points between February 2021 and November 2021.

While compensation and a view of total monetary rewards remain important for nurse respondents who plan to stay in their jobs, those respondents also cited reasons that go beyond salary: factors such as feeling engaged by work, doing meaningful work, and maintaining good health were the top drivers in surveyed nurses’ decisions to stay.

The survey findings highlight a striking degree of consistency around how nurses feel in their roles today, despite the different healthcare systems and delivery networks in each of the six countries. While more research is needed to understand the intricacies of nurses’ viewpoints in each country, one thing is becoming clear: a substantial population of nurses are expressing a desire to leave direct patient care. This means nursing shortages may be a rising risk in many countries. For example, we recently estimated that in the United States there may be a shortage of between 200,000 to 450,000 nurses (10 to 20 percent) by 2025.

Sidebar

By learning and sharing promising paths forward across nations, stakeholders could support their clinical workforce and look to solve what has become a consequential global problem. Positive leadership initiatives—such as directors rounding once a week to show support—have been correlated in studies with higher retention, reduced medical errors, and administrative efficiency. 1

In the exhibits below, we explore the details of these findings, as well as steps employers could consider to provide nurses with better support. (For more information about the survey, see sidebar, “Methodology.”)

In most surveyed countries, a substantial proportion of nurses indicated they were likely to leave.

In five out of six countries surveyed, between 28 and 38 percent of respondents said they wanted to leave their current direct-patient-care role. Across the six countries, surveyed nurses cited lack of recognition and being overworked and understaffed as contributing factors in their decision to leave direct patient care.

Surveyed nurses said they were drawn to opportunities where they could have a break from the stress and challenges of direct patient care.

More than a fourth of nurse respondents in most countries said they are likely to leave direct patient care.

The decision to leave is not always related to COVID-19.

Our survey indicates that COVID-19 has had a varying impact on nurses’ desire to leave their roles in direct patient care.

While the percentage of nurses leaving may have grown in countries such as the United States, currently about half of all nurses in surveyed countries said their likelihood to leave or stay was the same or unchanged since the COVID-19 pandemic began. In Brazil and Singapore, more than 20 percent of nurses said they were less likely to leave because of the pandemic.

Nurses who responded that they were unlikely to leave their current role may be motivated by a variety of factors, such as financial considerations, plans to retire, or plans to further their education, but more research is necessary to determine the specific factor.

A substantial portion of nurse respondents said the COVID-19 pandemic did not influence their decision to leave.

Doing meaningful work is a top reason to stay, nurse respondents said.

Across geographies, respondents said the most important factors keeping them in their direct-patient-care roles included doing meaningful work, a positive and engaging work environment, and feeling healthy and safe. In most of the countries, compensation was not a leading factor influencing nurses to stay in their current role. Japan was the only country with respondents including compensation among their top three factors.

Feeling valued by a manager and efforts to create positive working environments were ranked with high importance. In the United Kingdom, for example, 63 percent of respondents said “positive interactions” were important and 49 percent said feeling “valued by manager” was important.

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Respondents cited recognition and more work breaks as helpful for well-being.

In all countries, respondents overwhelmingly ranked greater recognition for their work as among the most effective approaches to keeping them in the job, along with the ability to take more breaks.

Yet countries vary in terms of which well-being initiatives can help nurses the most. For example, US and UK respondents were more likely to list open lines of communication as an effective well-being support initiative, while France and Brazil respondents were more likely to say monitoring signs of nurse distress was effective.

The increased availability of mental-health resources was not perceived as important to respondents, with surveyed nurses across all geographies ranking it lowest among the top effective support initiatives.

Most respondents highlighted more recognition as effective for wellbeing support.

Many respondents prioritize the ability to set their hours.

Respondents in most countries highlighted the ability to take time off and to work specific hours or days of the week as important.

The ability to work remotely was listed as more of a priority by respondents in the UK and Brazil than their cohorts. Respondents in France, the UK, and the US cited the ability to work three shifts per week while keeping full-time status as a priority.

Flexibility, including ability to take time off, is important to most nurse respondents.

Many surveyed nurses indicated uncertainty around whether they had enough advanced clinical skills.

Across all countries, nurse respondents reported being less confident about their advanced clinical skills. Japanese respondents also listed less confidence in having enough technical skills and higher analytical skills, such as interpreting new data and analysis. In fall 2021, US nurse respondents indicated behavioral health skills as an area where they need more support.

Outside of Brazil, many surveyed nurses indicated uncertainty around whether they had enough advanced clinical skills.

Even countries with slowing rates of COVID-19 may face continued staffing shortages and departures of nurses in direct patient care. As we wrote recently, “If companies make a concerted effort to better understand why employees are leaving and take meaningful action to retain them, the Great Attrition could become the Great Attraction.” No matter the country, examining what is important to nurses and why they leave could help organizations adjust. Healthcare stakeholders in all countries may consider strategies to recognize the contributions of nurses, embed more breaks, create positive interactions, and build caring teams, all with the goal of boosting well-being in the workforce. In the long term, these efforts could improve retention.

While this survey is far from exhaustive, it offers a snapshot of the factors that could help retain nurses in the future, especially for those on the front lines. Health systems may find that positive environments reflecting nurses’ priorities may attract new workers or lure back those who have left direct patient care over the past two years. In the long run, investment in nurses could offer stability and support top-quality care for patients.

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