By Shannon Firth

Of RNs who left hospital work in the last 5 years without retiring, 65% said they might return if staffing were adequate.

Flexible scheduling and better wages and benefits motivated nearly as many RNs to consider returning to nursing.

Eight percent of nurses said there was nothing that would make them consider going back.

Adequate staffing, flexible scheduling, and better wages and benefits might entice registered nurses (RN) who recently left hospital employment to return to practice, a cross-sectional study suggested.

Among roughly 1,700 RNs who left their jobs in the last 5 years without retiring, 65% said they would be more likely to return if staffing were adequate, according to Karen Lasater, PhD, RN, of the University of Pennsylvania School of Nursing in Philadelphia.

In addition, 59% said they might return if flexible scheduling were an option, while the same percentage signaled a possible return to direct care for better wages and benefits.

"Consensus among major nursing organizations is that the retention crisis is a problem that cannot be resolved by training more RNs. Continuing to expand the nursing workforce without addressing the underlying reasons why nurses leave hospital employment (and what would re-attract them) is akin to fueling a leaking gas tank," Lasater and colleagues wrote in a research letter.

If the primary driver for nurses leaving hospitals is unsafe staffing, then improving nurse-staffing ratios is key to bringing them back, said co-author K. Jane Muir, PhD, RN, also of the University of Pennsylvania.

"Policies that address nurse staffing levels, such as hospital minimum nurse staffing requirements in California and Oregon, have been shown to reduce nurse intent to leave the job and increase the number of nursing hours that patients receive," as well as improving patient safety, Muir noted in an email.

"Nurses beget more nurses ... The cycle of nurse turnover can be halted if employers invest in safe nurse staffing levels that support nurses with a manageable clinical workload," Muir added.

The problem may be deeper than that, noted Allison Squires, PhD, RN, of Rory Meyers College of Nursing at New York University in New York City, and Simon Jones, PhD, of the NYU Center for Healthcare Delivery System Science.

"[A]s patient assignments become more complex, a simple ratio does not capture the whole picture," Squires and Jones wrote in an accompanying editorial.

"For example, when a patient does not speak the same language as the nurse and an interpreter is required, studies consistently document that it takes longer to work with the patient to meet their needs. Regular staffing standards do not account for that," the editorialists said.

"Adequate staffing also varies by specialty, with nurses often perceiving general medicine units as chronically understaffed because patient complexity and acuity (i.e., the patient's needs) have increased substantially. Patient assignments that adequately factor in acuity are the holy grail of hospital nursing practice and one yet to be realized," they added.

Squires and Jones argued that with multifactorial staffing perceptions, research must move past "binary measures and place greater emphasis on context so that nurse-centered solutions can be developed to address these issues systematically."

Flexible scheduling might be an easier fix to mitigate retention and recruitment issues. "When life transitions including childrearing or other family caregiving obligations arise, nurses may leave hospital employment due to lack of scheduling flexibility," Muir noted.

Squires and Jones suggested that artificial intelligence solutions may help address scheduling problems, but only if nurses are involved in their design.

The study surveyed more than 4,000 nurses who left hospitals and were not currently working in healthcare. Among them, 8% reported working outside of healthcare, 36% were not currently employed, and 56% were retired. Fully 79% reported being "very or moderately satisfied" with their nursing career, with 90% of retired RNs reporting high satisfaction.

Half of all RNs not currently working said they had recently searched for jobs in healthcare, and 67% said they were likely to return to work. Most RNs who worked outside of healthcare said they were less likely to return to RN roles, but 20% reported that they were "very likely" to do so.

Eight percent of nurses said there was nothing that would make them return to nursing.

Among retired RNs, 37% said they retired earlier than planned. But most retirees said they were unlikely to return and had not recently looked for work; for that reason, they were excluded from the rest of the analyses, the authors noted.

For this study, Lasater and team relied on data from the Nurses4All survey of RNs in 10 states. RNs were eligible to participate in the study if their last job was working as a hospital staff RN but they had left their job in the past 5 years (2019-2023) and were now employed but not in healthcare, were not currently employed, or had retired.

RNs were asked what would increase their likelihood of returning to work as a nurse and given a list of options to choose all that applied. They also were asked about their career experiences and career satisfaction.

One limitation was that the study included only licensed RNs, which might have biased the sample towards nurses who were more likely to return to work, Muir noted.