Korea’s nurses walking away from careers that are too tough

Ms. Kim, a 28-year-old nurse at a university hospital in Seoul, quit her job in June after nearly six years - though she would have preferred to quit a year earlier.

But such was the boot camp mentality at the hospital that her bosses wouldn’t let her leave. She finally managed to get a transfer to another department and then make a graceful exit.

“Working as a nurse isn’t what most people think it is,” Kim says. “Medical staff are taking care of too many patients and doing too many things at the same time. We skip meals to complete our tasks. We don’t have time to go to the bathroom. And we have to try even harder to blend in with other nurses - and especially to get along with our superiors.”

Nursing is a tough profession anywhere in the world. But it is unusually tough in Korea.

According to a Hospital Nurses Association’s report released earlier this year, nurses in Korea have a turnover rate of 13.9 percent - and the turnover swells to 29 percent among nurses with less than a year of experience.

By contrast, the average turnover rate for workers in general in Korea was 4.7 percent in 2014, according to the Ministry of Employment and Labor.

Korea’s medical industry is highly stratified with the big general and university hospitals at the top of the ladder. They’re the places patients want to be admitted, and they are prestigious workplaces for both doctors and nurses.

But for staff, they’re also the most stressful medical centers, partly because they are profit driven.

“At general hospitals and university hospitals, about half the nurses quit their jobs within five years,” said an official from the Korea Nurses Association (KNA). “The main reason is that they need to work too hard because hospitals minimize the number of nurses for financial reasons.”

Korean nurses have much bigger loads than nurses in other advanced countries.

According to the KNA, a Korean nurse takes care of an average of 31 patients on a shift, which is much higher than U.S. average of 10, and the 8.8 in major European countries.

Data in the Organization for Economic Cooperation and Development (OECD) Health Statistics 2015 backs up the notion that nurses in Korea are responsible for more patients than in many other countries. The report says that for every 1,000 people in the population, Korea has 5.6 as of 2014, compared to an average of 34 OECD member countries of 9.1. Korea ranked 29th on a list of 34, above Greece, Israel, Mexico, Spain and Turkey.

“Hospitals are willing to spend a lot of money on doctors and equipment, but they are employing a minimum number of nurses,” the KNA official said. “And then they make the most of them. Those who can’t adapt decide to quit, especially when they get married or have children.”

Korea’s nursing shortfall is particularly striking because it produces far more nurses than other countries. The OECD report also says the number of nursing graduates per 100,000 population in Korea stood at 97.3 as of 2013 - the highest among member countries. The average was only 46.7.

Data from the Ministry of Health and Welfare also shows that only 114,088 of 307,797 licensed nurses were active nurses, while the rest were doing other jobs or were jobless as of 2013.

The unforgiving top-down culture of the nursing community is a big reason people quit.

“Some of us felt we couldn’t even get married, get pregnant or quit the job when we wanted to because it would put more of a burden on the nurses left behind,” says Kim, the 28-year-old who quit in June. “So if we had to get married or have a child, our superiors would tacitly persuade us to wait our turns.”

The culture is also not kind about mistakes.

“We call it ‘burning’ someone when they grill us for our faults,” said another active nurse surnamed Park, who has worked at a general hospital in Incheon for five years. “It’s very unfair, but the only choice is to adapt because the only other option is to quit.”

The tough culture can have a negative impact on the patients and the care they receive.

“It’s like a vicious cycle because the strict atmosphere makes younger nurses feel nervous and make more mistakes, and that leads to another round of ‘burning,’” Park added. “I even gave the wrong medicines to patients in my first year because I couldn’t properly focus.”

Cho Sung-hyun, a professor of nursing at Seoul National University, points out that the high turnover rate among nurses has a direct influence on patients. According to a study she conducted in 2006, every time a nurse is given charge of an addition patient per shift, 15 more fatalities out of 1,000 patients occurred.

“The level of medical services provided by nurses has a huge impact [on patients],” Cho says, “because they are playing a very important role between patients and doctors.”

Experts say the government should invest more in the field to provide more public medical services.

“Unlike the United States and Europe, where about 30 percent of all hospitals are public, public hospitals in Korea account for less than 10 percent,” said a KNA official. “As private hospitals pursue profit rather than patient management, they try to spend less and less on nurses. The government should invest more to make the medical sector more public.”

Otherwise, the situation is expected to get even worse, especially since nurses who quit can take an alternative career path: working abroad.

“Every single country is suffering a shortage of nurses,” said Lee Yeong-geun, a director of Thomas and Amkor, an immigration agency that has helped nurses migrate for 13 years. “Immigration to the United States, for example, has become easier since 2013 because the United States widened the quotas for foreign nurses, and the waiting list has been shortened a lot.

“It used to take about six years before, but it now takes about a year.”

BY KIM BONG-MOON [kim.bongmoon@joongang.co.kr]