Nursing is a highly specialized profession that serves as the core of the medical team, supporting patients’ lives and well-being. However, due to its harsh working environment, it is one of the professions with a high turnover rate. The biggest factors are the irregular and physically demanding night shift system, the immense mental pressure associated with patient crises and life support, and the excessive workload due to chronic staff shortages. While high professionalism and ethical standards are demanded, the difficult working conditions accelerate the exhaustion of the mind and body.
This article provides a detailed explanation of the factors leading to the high turnover rate in this profession, examining them from four perspectives: working conditions, compensation/benefits, workload, and career development.
Turnover Rates in the Medical and Welfare Industry (Reference Data)
The turnover rate for the Medical and Welfare industry, which includes nurses, remains higher than the all-industry average. Specifically, the turnover rate for nursing staff in hospitals is reported at 10.5% (2022, based on full-time equivalent), with early turnover among new and young graduates being a particular challenge.
| Category | Medical and Welfare Turnover Rate | Average Turnover Rate Across All Industries |
| Annual Turnover Rate | 15.5% (2022) | 15.0% (2022) |
| Turnover Rate within 3 Years (New University Graduates) | 38.9% (March 2022 Graduates) | 33.8% (March 2022 Graduates) |
| Turnover Rate within 3 Years (New High School Graduates) | 44.9% (March 2022 Graduates) | 37.9% (March 2022 Graduates) |
1. The Issue of Working Hours (Burden of Night Shifts and Irregular Work)
Since hospitals operate 24 hours a day, night shifts and long working hours are unavoidable, significantly impacting physical and mental health.
Burden of Night/Shift Work:
- Disrupted Life Rhythm: Night shifts are essential under two-shift or three-shift systems, disrupting life rhythms and easily leading to sleep deprivation and poor physical condition.
- Heavy Labor During Night Shifts: Night shifts operate with fewer staff than day shifts, significantly increasing the workload (emergency response, rounds, documentation, etc.) per person, making it physically and mentally demanding.
Normalization of Long Working Hours:
- Post-Shift Duties: Tasks such as completing documentation, performing handovers, and attending conferences after the scheduled shift often lead to overtime.
- Emergency Response: Long hours of overtime due to unpredictable events like patient emergencies or urgent admissions are unavoidable.
- Training and Study Sessions: In-house training and study sessions for skill enhancement are often scheduled outside of working hours or on holidays, imposing a burden on private time.
2. The Issue of Compensation and Benefits (Wages Not Commensurate with Responsibility)
Despite the demand for advanced medical knowledge and the heavy responsibility concerning life, some feel that the compensation does not match the immense pressure.
Dissatisfaction with Wage Levels:
- Mismatch of Expertise and Responsibility: Nurses are required to have extremely high responsibility for life and expertise to keep up with daily evolving medical technology. Yet, many feel the salary does not reflect this pressure.
- Reliance on Night Shift Allowances: When the basic salary is low and income heavily relies on night shift allowances, nurses face the contradiction that the greater the burden of night work, the higher the income.
Difficulty Taking Paid Leave:
- Chronic staff shortages make staff reluctant to take paid or long-term leave, believing their absence places a heavy burden on colleagues.
Pressure of Student Loan Repayment:
- Repayment of student loans taken out for specialized education can be a major financial burden for young nurses.
3. Workload and Mental Stress (Pressure of Life Responsibility and Emotional Labor)
Constantly confronting “life” results in mental pressure far exceeding that of other professions, making nurses highly susceptible to burnout.
Mental and Ethical Stress:
- Pressure of Responsibility for Life: The mental pressure is immense, stemming from involvement in patient crises and treatment decisions, and being present during end-of-life care.
- Burnout: Nurses can become mentally exhausted due to the gap between ideal and reality, continuous busyness, and ethical dilemmas (inability to provide high-quality care).
Stress from Multi-professional and Interpersonal Relations:
- Coordination with Physicians/Other Professionals: Communication and coordination friction with busy doctors and other professionals are sources of stress.
- Patient/Family Correspondence: Cases exist where nurses suffer from unreasonable demands, complaints, or harassment from patients and their families.
Physical Strain:
- Transfer/Repositioning: Tasks involving the physical movement of patients, such as repositioning or transferring them to a wheelchair, are physically demanding, making nurses prone to occupational illnesses like lower back pain.
4. Issues with Career Development and Training Systems
Despite being a specialized profession, insufficient guidance systems for new staff and complex workplace dynamics can lead to turnover.
Insufficient Education and Training Systems:
- Personalization of OJT: Due to the busy environment, guidance for new and mid-career hires often relies on On-the-Job Training (OJT), leading to inconsistency in quality based on the instructor.
- Co-burnout of Preceptors: Veteran nurses assigned as preceptors (mentors for new hires) often struggle to balance their own duties with mentorship, leading to potential exhaustion for both parties.
Complex Interpersonal Relations:
- The high ratio of female staff often leads to interpersonal issues within the department, and lack of communication due to the high workload can be a major cause of turnover.
Fluidity of Career Paths:
- While career paths like Certified Nurse Specialist and Certified Nurse exist, achieving them requires time and expense, making them difficult to pursue. Furthermore, the availability of numerous alternative jobs in clinics or care facilities encourages nurses to leave hospital settings.
The Structure of the Vicious Cycle
The nursing industry suffers from an extremely severe vicious cycle: “Mental and physical exhaustion from night shifts and pressure for life safety → Excessive workload and long hours due to staff shortages → Experienced staff quit → Remaining staff cover harsh shifts.” Crucially, the high sense of mission (“protecting patient safety”) often leads nurses to sacrifice their own health, which is a factor accelerating turnover.
