The Real Issues Driving the Nursing Crisis

Our analysis of nurses' employer reviews reveals the true source of burnout and why nurses are leaving the field. Here's how health care leaders can improve nurse job satisfaction to fight a looming nursing shortage.

- Donald Sull and Charles Sull

HEALTH CARE LEADERS FACE A DAUNTING SET OF CHALLENGES — rising costs, the transition to digital health, and shifting payment models, to name just a few. But according to a recent survey from the American College of Healthcare Executives, the No. 1 problem hospital CEOs face is staff shortages and burnout.¹ Ninety percent of the CEOs surveyed cited nursing shortages as a particularly acute pain point.

In 2021, the total number of registered nurses working in the U.S. dropped by the largest amount in 40 years, with younger nurses leading the exodus.² By 2025, the U.S. health care system could suffer a shortfall of up to 450,000 nurses, or 20% fewer than the nursing workforce required for patient care.³

High levels of job dissatisfaction and burnout are driving nurses from the profession. The COVID-19 pandemic placed tremendous pressure on all health care workers, but dissatisfaction and burnout among nurses have not improved since the pandemic ended. And by some measures, it might be getting worse: In 2021, nearly two-thirds of registered nurses would have encouraged others to become a nurse, but only half said they would recommend nursing as a profession two years later.⁴

One of the richest sources of insight on dissatisfaction among nurses is how they describe their job, in their own words, on employment sites like Indeed and Glassdoor. This information is voluminous but difficult to synthesize because most of it takes the form of unstructured free text. To understand the challenges nurses face, we analyzed how 150,000 of them had described their employers in Glassdoor reviews since the beginning of the pandemic. (See