A cross-sectional study analyzed survey data from 7887 registered nurses in New York and Illinois who had recently left health care employment between 2018 and 2021. The top factors contributing to nurses leaving health care employment were planned retirement (39%), burnout or emotional exhaustion (26%), insufficient staffing (21%), and family obligations (18%). Among retired nurses, 41% left for reasons other than planned retirement, with burnout and insufficient staffing being the leading factors. Nurses who were not currently employed cited family obligations as the top reason, while those working in non-health care settings cited burnout, insufficient staffing, and better benefits in other industries. Age and prior employment setting influenced the factors cited, with younger nurses more likely to cite burnout and insufficient staffing. Older nurses were more likely to cite planned retirement. The study highlights that systemic issues within health care systems, such as burnout, insufficient staffing, and poor work-life balance, are major contributors to nurses leaving the profession. Employers are urged to address these issues to improve nurse retention and attract existing nurses back into the workforce. The findings suggest that current nursing shortages are not due to a lack of interest in nursing but rather due to systemic challenges in the health care system. Employers should focus on improving nurse staffing, work environments, and work-life balance to retain nurses and address the ongoing nursing care crisis.A cross-sectional study analyzed survey data from 7887 registered nurses in New York and Illinois who had recently left health care employment between 2018 and 2021. The top factors contributing to nurses leaving health care employment were planned retirement (39%), burnout or emotional exhaustion (26%), insufficient staffing (21%), and family obligations (18%). Among retired nurses, 41% left for reasons other than planned retirement, with burnout and insufficient staffing being the leading factors. Nurses who were not currently employed cited family obligations as the top reason, while those working in non-health care settings cited burnout, insufficient staffing, and better benefits in other industries. Age and prior employment setting influenced the factors cited, with younger nurses more likely to cite burnout and insufficient staffing. Older nurses were more likely to cite planned retirement. The study highlights that systemic issues within health care systems, such as burnout, insufficient staffing, and poor work-life balance, are major contributors to nurses leaving the profession. Employers are urged to address these issues to improve nurse retention and attract existing nurses back into the workforce. The findings suggest that current nursing shortages are not due to a lack of interest in nursing but rather due to systemic challenges in the health care system. Employers should focus on improving nurse staffing, work environments, and work-life balance to retain nurses and address the ongoing nursing care crisis.