Retirement, burnout, emotional exhaustion, insufficient staffing — these are the top reasons 7,887 registered nurses said they left their jobs from 2018 through 2021. And they are far from alone.

Compelled by a U.S. health care system that continues “to struggle with recruiting and retaining nurses,” researchers from the University of Pennsylvania, New York University and the University of Pittsburgh explored what made these near 8,000 nurses in New York and Illinois leave their jobs.

“In this cross-sectional study, nurses primarily ended health care employment due to systemic features of their employer,” according to the report, published in JAMA Network Open last week. “Reducing and preventing burnout, improving nurse staffing levels, and supporting nurses’ work-life balance (eg, childcare needs, weekday schedules, and shorter shift lengths) are within the scope of employers and may improve nurse retention.”

A March 2023 International Council of Nurses report revealed 13 million nurses will need to be replaced worldwide over the coming years. In 2019, the global nursing shortage hit 30.6 million, and the pandemic only made things worse. The council would go on to call the world’s nursing shortage a “global health emergency” in its report.

During the pandemic, roughly 100,000 U.S. nurses left their jobs, according to the National Council of State Boards of Nursing. By 2027, about 20% of America’s nurses are expected to leave the health care system. It all begs the question: What’s causing the mass exodus?

“In this cross-sectional study of 7887 nurses who were employed in a non–health care job, not currently employed, or retired, the top contributing factors for leaving health care employment were planned retirement (39% of nurses), burnout (26%), insufficient staffing (21%), and family obligations (18%),” the recent study reported.

“The horizontal violence and bullying was obscene,” a registered nurse under 30 years old who left a hospital position said in her survey. “Nurses are still ‘eating their young’ and there is a lot of poor leadership and workplace prejudice against minorities. It’s 2021 and we are still suffering to create a positive work environment. It’s so sad and unimpressive as a young new graduate nurse.”

Another survey respondent, also a registered nurse under 30 who formerly worked in a hospital, explained it was the lack of support that caused her to leave.

“I did not want to leave my team, peers, and patients, but the unsupported weight created by the hospital system was too much to (bear) any longer,” they said. “In trying to help others become the best version of themselves, I was becoming the worst of mine. I have not ventured back into the healthcare world. I have contemplated leaving the profession altogether.”

In total, 41% of nurses surveyed said they left their positions for a reason other than planned retirement.