Some improvements, but challenges continue.
The more than 3,500 nurses who took part in the American Nurse Journal’s seventh annual Trends and Salary Survey helped paint a slightly more hopeful portrait of nursing in 2023 with regard to turnover rates, higher salaries, and personal safety. However, challenges still exist. For example, although a smaller percentage of nurse managers report more open positions in the past 12 months, they told us that recruiting to fill those vacancies has been harder this year than last. And most nurse managers say turnover increased in the past 12 months, though at a lower percentage than in 2022.
Job satisfaction (flat for nurse managers at 63% but up from 65% to 70% for clinical nurses) may play a role in the slight improvement in turnover. A contributing factor to the job satisfaction rise could be improved staffing levels, with 56% of clinical nurses reporting that staffing levels at their organization met patient needs at least 80% of the time— an increase from 49% the year before.
Most nurse managers and clinicians report that their workload has increased in the past year, but the percentage is lower than in 2022 (59% vs. 66%). The percentage who said their salary increased in the past 12 months fell 1.5%, but more nurses are moving into the top tiers of the salary range; however, this year’s cohort skewed toward longer-tenured nurses.
Trends and Salaries Interactive Results
2022 nursing trends and salary survey results
Safety from patient and visitor abuse remains a concern, but most nurses said that they believe their organization is working to help reduce workplace violence. Although verbal abuse from coworkers increased, bullying from managers declined slightly, and those reporting being physically assaulted by a coworker or manager fell into the single digits.
Nurse managers’ perspectives
Most nurse managers (57%) participating in the survey told us that they’ve noticed an increase in open positions in the last year, but that’s down from 63% in 2022 and 71% in 2021. Similarly, more than half (54%) report that turnover increased, down from 61% last year and 71% in 2021.
Most nurse managers said that they’re satisfied with their job and have positive relationships with coworkers. However, when we asked what about the future of nursing keeps them up at night, nurse managers voiced concern about staffing shortages, recruitment challenges, and the experience level of their staff. “It is getting harder and harder to find people that want to work in healthcare. Between staffing shortages and budget cuts, I fear for the safety of future nurses and patients,” said one respondent.
As salaries increase to attract nurses, some nurse managers expressed concern about the ability to compete. “Working for an academic medical center, we don’t pay as well as other private hospitals and cancer centers. We have lost many nurses and support positions to competitors and have also had many job offers for new candidates turned down due to pay,” one wrote. “It’s exhausting trying to continually make the claim that our institution needs to increase pay. They continue to hire and pay for nurse travelers, which costs a lot more than if they increased pay for current employees or new hires who want to work for us permanently.”
Other nurse managers expressed concern over the broader healthcare system, from the impact of health insurance on the quality of care and the patients they see. “I worry about the broader medical systems’ ability to care for patients without adequate primary and preventive care,” said one respondent. “My area of expertise is emergency nursing, and we see a system that is increasingly unable to care for patients with conditions that used to be routine. ICU capacity over 95% across our region seems to be common, and we are increasingly boarding and discharging patients from the ED.”
What’s on your mind?
When we asked clinical nurses and nurse managers what, other than staffing, are the most important issues facing the nursing profession, salary was mentioned most often.
Here’s what else they told us:
- Facilities would do well to bridge the pay gap between staff and travel nurses. I’d be thrilled to make more than half what most travelers make in my facility.
- The most important thing is to care for patients and to provide safe, high-quality medical care.
- The culture of “mean” nurses. There is a toxic underlying culture that if not nipped by the institution is very damaging to our future generations of nurses.
- Many nurses are not in the profession for the right reasons so the focus of leadership has shifted to making nurses happy instead of patient care and patient satisfaction.
- Patients not getting the care they need due to lack of insurance or increased prices of healthcare. Nursing feels more like working in an assembly line with focus on the number of patients being pushed through.
- Poor quality and short orientation for new nurses is another huge issue. Nurses are burnt out and don’t want to precept new grads. New grads have much less clinical experience than is appropriate due to the pandemic causing most students to lose invaluable hours of hands-on patient care learning.
What keeps nurse managers up at night
We also asked nurse managers what about the future workforce keeps them up at night.
Here’s a sampling of what they had to say:
- I worry about what mandated staffing ratios might do to population health and access to care. I understand why nurses think mandated staffing ratios is the answer to reducing burnout, but the short- and long-term implications on quality of care are extremely worrisome.
- Younger nurses aren’t seeing the big picture when it comes to their patients’ health. Many are purely task-focused.
- Keeping nurses at one site long enough to have a “seasoned” workforce again. New RNs job hop now.
- How am I going to accomplish everything that is needed without the staff I need?
- We won’t have enough nurses in the future to take care of us.
- The lack of experienced nurses still in the workforce available to train the next generation of nurses.
- Nurses unable to provide safe care due to staffing shortages then being punished for any failures when it’s too much for one person to reasonably take care of safely and adequately.
Clinical nurses’ perspectives
The percentage of clinical nurses who said that they’re somewhat or very satisfied with their current job increased from 64% to 71%. More of them expressed satisfaction with their salary (54% vs. 48%) and benefits (55% vs. 53%).
Salary remains an important factor in retaining and recruiting nurses, as more than three-quarters (76%) of the clinical nurse respondents chose salary as one of the most important aspects of nursing, up from 71% in 2022. Other key categories include flexible hours (56% vs. 51% in 2022) and providing patient care (54% vs. 55% in 2022).
Salary and job choices
Although roughly the same percentage of nurse managers and clinical nurses reported that their salaries increased within the past 12 months, these increases appear to be lifting more nurses into the highest tiers of the salary scale. The portion making less than $69,000 fell while those making $80,000 and above increased. However, more of the nurses responding to this year’s survey had 15 or more years of experience and fewer of them had less than 5 years.
These higher salaries may be why nearly three-quarters (73%) of respondents said they had no intention of seeking another job in the next 3 months. However, more said they could be swayed by an offer with a higher salary—68% vs. 56% last year. Those who did intend to leave their job cited dissatisfaction with the salary as one of their top reasons. In fact, when we asked nurses what, other than staffing, were the top two issues facing nursing, salary was mentioned most often.
Assault and bullying from patients and colleagues
A slightly smaller percentage of nurses reported witnessing bullying in the past 2 years compared to 2022 (61% vs. 66%). More than half said that they’d been verbally assaulted by a patient or a family member/visitor over the past 2 years, and 22% said they’d been physically assaulted. In both cases, most nurses reported the incidents, and overall, 64% of nurses said that their organization has been supportive in reducing workplace violence, roughly the same level as last year.
Coworker bullying saw an increase in 2023. Nearly 40% of respondents said that they’d been a victim of verbal bullying by a colleague, up from 35% in 2022. However, reported bullying by a manager was down slightly. Nurses reporting sexual harassment in the workplace went down slightly from the prior survey, dropping to 14% from 17%.
We asked nurses to tell us about their experience with workplace violence. Most of the more than 1,000 responses dealt with abuse and physical assaults by patients or their families. Many felt discouraged that this kind of patient behavior has become viewed as the norm.
“Nurses should not accept violence as just being part of the job,” said one. “Any assault on any hospital or healthcare worker should be reported to local police and prosecution should result, with the employer’s support.”
Many comments drew a distinction between patient behavior that’s due to mental conditions, such as dementia, and what they see as a broader willingness by patients and their families to act abusively toward healthcare workers.
“Violence among coworkers and healthcare workers towards each other has significantly decreased,” said one. “Violence towards healthcare workers from patients has increased significantly over the last 10 years.”
Nurses speak about workplace violence
Several nurse respondents shared their experiences and opinions about workplace violence.
- I see an increase in the way that patients are allowed to treat nurses, and it seems to be okay with the organization, and there are no repercussions for the patients or their family members.
- My hospital is taking patient/family and coworker aggression more seriously. This is long overdue. Nurses are battered and nobody cares because “we signed up” for this job.
- If you wouldn’t tolerate the behavior toward your patient, it isn’t acceptable to happen to you!!
- Have seen a huge increase of verbally abusive patients. We refuse to treat them if they continue to behave this way.
- The idea of “it’s part of the job” is being addressed, but there is still a long way to go.
- I’m amazed by the idea that workplace violence is just part of the job for healthcare professionals. We have to stand up for ourselves and each other and state that violence will not be tolerated.
- My employer’s attitude is one of saying they have a total nontolerance policy, yet when someone actually is being harassed or bullied, the victim is made to feel as if they caused the issue.
- It has escalated. It’s why I left bedside nursing.
- In my previous job, it was expected for staff to have to deal with verbal and physical violence at times due to the population I served. At my new job it is not tolerated on all levels and [I] feel more supported at my current job.
Percentage who reported witnessing someone being bullied in the past 2 years:
A difficult job that most would choose again
Despite all of the challenges reflected in the survey results, most respondents rated their mental health as healthy or very healthy in this year’s survey, although a smaller percentage chose that top category compared to 2022. We also saw a small increase in the percentage who described their well-being as not mentally healthy. In the end, however, when asked if they would choose to be a nurse if they had to do it over again, 79% said yes, slightly lower than the 82% who gave that affirmation the year before.
Many nurses may feel inspired by the words of wisdom they’ve received over the years. We asked them to share the best of that advice, and more than 1,500 did. Here’s a sampling:
Be like a duck (swimming like crazy under the water, calm appearing on the surface).
As a nurse manager, the best advice I’ve received is to hold people accountable, even when it involves tough conversations.
Empower those you lead to be leaders so that they can function effectively when you are not in the building.
Find the specialty you love, then get an advanced degree in it and get certified in it.
Take the time required to do the task correctly no matter how far behind.
Save your back and take your breaks no matter what.
You’re the last person in line before a patient error is made or a patient is harmed. It is your responsibility to speak up.
You are competent before you are confident.
Diversity, equity, and inclusion at work
We asked survey respondents to tell us what steps their organizations are taking to improve diversity, equity, and inclusion (DEI). More than 1,500 of them responded. Many said DEI committees and staff positions have been created in their institutions, and others mentioned special training for staff, special events, and hiring initiatives. Others said nothing was being done, and many said their organizations were already very diverse, both in their staff makeup and their patient mix.
Here are some of the more specific responses we received:
- Strong DEI program and history of recruiting and supporting a diverse population of students.
- The company I work for is inclusive. I am a lesbian and one of my PCTs is nonbinary. We feel very accepted and supported.
- Diversity and inclusion is one of our core values at my current institution. From groups within the workplace to celebrating and recognizing differences in a positive light, we work inclusivity into our daily practice with both our peers and patients.
- We have a DEI council, which helps with education and events for employees. We have three employee resource groups to support marginalized employees and gather staff input for patient services for the marginalized groups. Our health system was awarded grants to increase health services to the ZIP codes with the worst health disparities in the state by addressing social determinants of health.
- The absolute bare minimum. We have a couple policies related to DEI, but actively resist outward allyship.
- Spending too much money and time on telling adults how to be kind to others. We are in the nursing profession to care for others regardless of their ethnicity, race, sex, or who they identify as.
- Active recruitment with HBCUs [historically Black colleges and universities], hiring LPNs and other nontraditional students, DEI team on nursing recruitment calls.
- Enterprise-wide we have an effective structured tiered plan. My overall department of health and wellness for staff is very diverse, and we have scheduled time to educate all of us on programs, provide discussion and time to deepen our actions to build and sustain a diverse work environment. Our overall staff have been the target of verbal assault and threat from the community. Our local county government is supportive though our state legislature is very regressive.
- My hospital hired older new grads such as myself and is very diverse. On my floor, between all of us, we speak at least eight different languages.
If you had it to do all over again, would you still become a nurse?
To read more comments in response to this and the other open-ended questions, visit myamericannurse.com/trends-and-salary-results/. We at American Nurse Journal thank you for what you do every day for your patients, students, colleagues, and general public.
David J. Gilmartin is a digital content editor at HealthCom Media in Doylestown, Pennsylvania. Cynthia Saver is president of CLS Development, Inc., and editor of Anatomy of Writing for Publication for Nurses, 4th Ed. Her blog, The Writing Mind, is available at myamericannurse.com/category/the-writing-mind.
American Nurse Journal. 2024; 19(1). Doi: 10.51256/ANJ012419
