Differences in Ambulatory RN Intent to Leave by Age and Tenure

Problem/purpose: The nursing profession faces challenges related to a retiring workforce. Schools of nursing are at capacity and yet fewer new nurses are staying in direct patient care or remaining in the nursing profession. The result is that as veteran nurses continue to age and leave the workforce, fewer experienced RNs are available to take their places, particularly in specialty areas such as ambulatory care. With an increasing proportion of patient care being provided in ambulatory settings, nursing leaders are working to understand the impact the shortage is having on ambulatory patient outcomes. This study’s purpose was to examine the trends and differences in ambulatory RN intent to leave by age, tenure, and select ambulatory unit types.

Data analysis: This is a descriptive design study using data from the 2017 RN satisfaction survey from a national nursing quality database. The sample consisted of 33,044 ambulatory RN responses in 36,20 ambulatory units in 545 hospitals. For the purposes of this study, “ambulatory” units consisted of outpatient clinics, interventional cardiology/radiology, endoscopy, cancer care, cardiac services, short stay/observation, and other procedural units. Descriptive statistics were calculated by age, tenure, and ambulatory unit type for intent to leave in the next year and in the next three years. ANOVA modeling was used to determine statistical significance in both age and tenure group differences in one-year and three-year intent to leave.

Results: Overall, 16% of ambulatory RNs planned to leave their current position in the next year, and 20% planned to leave in the next 3 years. Intent to leave was highest among RNs 65 years and older and among RNs with more than 19 years of nursing practice. Overall, the primary reason for leaving in the next year was dissatisfaction with work environment (44%), and the primary reason for leaving in the next three years was home/personal life (43%). There were significant differences (p-value ≤ 0.001) in intent to leave in the next year between majority of tenure groups and all age groups. With intent to leave in the next three years, differences were found between majority of tenure groups and all age groups. Short stay/observation units had the highest intent to leave of all unit types (p-value < 0.001). For this group of nurses, reasons for leaving in the next year included home/personnel life (37%) with less than 50% wanting a career change in the next 3 years.

Ambulatory nursing implication: The findings indicate that age and years of practice influence RNs intent to leave in the next year and in the next three years. Nursing leadership should assess workforce characteristics in addition to work context when developing retention strategies.