
Episode #20
The Decision No Nurse Should Make From Survival Mode
A nurse gives her two weeks' notice after nine years, and the morning after she leaves, something surfaces that nine years of survival had buried. In this episode Dr. Lorre Laws follows two nurses from the same hospital, Camille who stayed and a colleague who left, to show that the door a nurse walks through is not the thing that matters. What matters is the state of the nervous system that made the choice. Drawing on the newest workforce data and the neuroscience of survival physiology, Dr. Lorre makes the case that no nurse can truly decide her future from inside survival mode, and that the awakening begins the moment the body finally settles enough to ask what she actually wants. Key Points More than 138,000 nurses have left the workforce since 2022, and roughly 40 percent of those remaining intend to leave within five years, per the 2024 National Nursing Workforce Survey. The median age of the nurse still at the bedside is now 50. The ones leaving are the seasoned, not the new grads. Chronic exposure to the four forces compromises a nurse's cognitive, behavioral, and emotional systems, with the prefrontal cortex most directly affected, per a 2025 systematic review of allostatic load in nurses. The prefrontal cortex is the seat of reflection and the capacity to know what you actually want. In survival states, that capacity goes offline. Through a polyvagal lens, high-order reasoning is only fully available once the nervous system reads safety. A decision made from survival is not made from the part of us that can weigh what we want. The awakening is not the leaving or the staying. It is the moment the body settles enough that the question of what you want becomes yours to ask. Featured Stories Camille, the labor and delivery nurse introduced in Issue 96, who stayed and is doing the reclaiming work. Her colleague, a composite nurse drawn from the many who have written to Dr. Lorre, who left after nine years and found the real question waiting for her the morning after. Resources Mentioned Free Nurse Trauma Assessment: https://drlorrelaws.com/assessment 2024 National Nursing Workforce Survey (Smiley et al., 2025, Journal of Nursing Regulation): https://www.journalofnursingregulation.com/article/S2155-8256(25)00047-X/fulltext Allostatic load in nurses systematic review (BMC Nursing, 2025): https://link.springer.com/article/10.1186/s12912-025-04105-6 Polyvagal Theory overview (Polyvagal Institute): https://www.polyvagalinstitute.org/whatispolyvagaltheory Porges 2025, current status and future directions: https://pmc.ncbi.nlm.nih.gov/articles/PMC12302812/






