Nurse on staffing shortages: 'It's not only physically toxic, it's mentally toxic'
04:22 - Source: CNN
CNN —
As an emergency room nurse, Terry Foster has cared for people on their worst days. He loves his work, and as president of the Emergency Nurses Association, a group that represents about 50,000 nurses, he’s met countless others who share a similar commitment to helping others. But he’s concerned about the future of his profession.
“I’ve worked in the emergency department 45 years, and you’re not going to hear people say that again. I don’t think you’re going to see that kind of tenure anymore,” he said.
Something changed with the Covid-19 pandemic, Foster said. That change is among the many captured in the 2023 Survey of Registered Nurses from AMN Healthcare, a nurse staffing company.
The biannual survey of 18,000 nurses, published Monday, points to what AMN Chief Clinical Officer Dr. Cole Edmonson called a “perfect storm” of problems for the profession that could leave the US health care industry without the nurses it needs.
The survey, which was conducted in January, shows a group of professionals who care very much about their work, but it also shows a significant decline in work satisfaction and a significant increase in stress levels. Many are thinking about leaving the profession.
“A crisis in nursing is upon us,” Edmonson says in the survey.
Nurses typically like their profession, surveys have found over the years. For more than a decade, their career satisfaction was around 80% to 85%. Yet when they were asked in the new poll whether they were extremely satisfied or somewhat satisfied with their choice of nursing as a career, the number dropped a full 10 percentage points from the most recent AMN survey, done in 2021.
If 71% of nurses say they are satisfied with their work in 2023, that’s still a lot of people, but the drop is concerning, said Christin Stanford, vice president of client solutions for AMN Healthcare.
“I don’t think any of us were prepared to see just how drastic the drop was in career job satisfaction, mental health and well-being, and what the overall feeling of the nurse profession today was,” she said.
Another troubling sign, she said, is that younger nurses seem less satisfied with their careers than older professionals.
Research has shown that nurses who are satisfied with their work typically stay on the job. But only 63% of millennials and 62% of Gen Zers said they were satisfied with their career choice, as opposed to 78% of baby boomers.
“The overall data is very concerning. But if you segment out and look at a few different splices or populations within the survey data, it is even more distressing,” Stanford said.
The survey found that many nurses are thinking about leaving their jobs.
Hospitals could face the most instability. Only 15% of hospital nurses say they will continue in the same job in one year, the survey found.
Nearly a third of all the nurses surveyed said they are likely to leave the profession, up 7 points from the 2021 survey.
Only 40% said they will stay in the same job in one year, a 5 percentage-point drop since 2021. The rest said they will look for work as a travel nurse, move to part-time or per diem work, take a job outside of nursing or patient care, or return to school.
Foster, who works as an emergency room nurse in Northern Kentucky and was not involved in the AMN survey, in part faults typical burnout. About 100,000 registered nurses in the US left the workplace due to the stresses of the Covid-19 pandemic, according to the results of a survey published this month by the National Council of State Boards of Nursing.
Foster says patients and their families have also changed in recent years.
“There’s just a new level of incivility from the public,” he said.
The same violence seen in social media videos of people attacking flight attendants or fast food workers is happening more and more in health care settings, he said. Health care workers are five times more likely to experience workplace violence than employees in all other industries, government surveys have found.
“We’re just trying to take care of people, and they’re lashing out at us,” Foster said. “It’s patients who don’t want to wait, or they act out or are very dramatic or violent. And sometimes our patients are fine, but their families will lash out at us and threaten us.”
This new survey showed that 4 out of 5 nurses said they experienced “a great deal” or “a lot of stress” in their work, an increase of 16 points since 2021.
More nurses said they worried that their job was taking a toll on their health, and they often felt emotionally drained.
Nearly 40% of nurses surveyed said they felt burnt out. Nearly a third said they felt misunderstood or underappreciated, and about the same number felt that they were not getting what they needed out of their job.
Another part of the problem is a lack of adequate staffing.
Only a third of those surveyed said they had the ideal time they needed with patients, a 10-point decrease from 2021. The percentage of nurses who were satisfied with the quality of care that they were able to provide fell 11 points, from 75% in 2021 to 64% in 2023.
Stanford said that in just a couple of years, the profession will be 1 million nurses short, partially because of a demographic change.
Baby boomers are reaching the age of retirement, and there will be more demand for nurses because boomers are also reaching the age when they need more medical care.
Another problem is education. While the number of candidates who passed the nursing licensure exam has steadily grown over the years, according to the union National Nurses United, there are still many more people who want to become nurses than there are classes. Schools just don’t have enough people to teach, Stanford said.
There may also be a lack of interest in doing the work in today’s environment.
There are about a million registered nurses with active licenses who are not employed as nurses, according to a National Nurses United analysis of Bureau of Labor Statistics data from 2021.
Coming out of the pandemic, far too many hospitals cut corners on staffing and allowed a higher nurse-to-patient ratio, said Kristine Kittelson, an RN in Austin and a National Nurses United member. Essentially, that’s placed nurses in a moral dilemma, she said, where they can’t completely help their patients even if they want to.
“We are being put in these challenging work environments that really forced us to feel like we, as nurses, aren’t providing the best care that we can,” said Kittelson. who also was not involved in the new survey. “We’re just not being given the resources that we need and the staffing that we need.”
More flexibility in schedules could help, Stanford said. Do nurses have enough flexibility to take time off and take care of themselves?
Get CNN Health's weekly newsletter
Sign up here to get The Results Are In with Dr. Sanjay Gupta every Tuesday from the CNN Health team.
Nearly every nurse who participated in the new survey said they wanted increased staff support, a reduction in the number of patients per nurse, an increase in salary, a safer working environment and more opportunities to share their input with decision-making.
“This is a great profession, and it’s very rewarding, but I think that the pandemic has really shown how undervalued we are,” Kittelson said. “We should just be able to put in a position to give patients what they deserve and not feel stressed.”
FAQs
What is the impact of pandemic to nursing field? ›
Nurses are leaving their positions due to the “crushing” stress brought on by COVID-19 patient surges (Fortier, 2020). From approximately March through October 2020, thousands of nurses across the country experienced reduced work hours or were cut all together.
What caused a nursing shortage in us? ›The American Association of Critical-Care Nurses referred to the inadequate staffing of nurses as “an epic catch-22”. Understaffed facilities rely heavily on their nurses to take on an impossible workload, leading to burnout and turnover, which fuels the nursing shortage.
What impact has COVID had on nurses? ›Moreover, 21% to 35% of respondents, depending on their nursing role, reported decreased career satisfaction as a result of the pandemic. This drop in career satisfaction was reported by 40% of nurses working in acute care settings and even higher proportions of nurses in long-term care and hospice settings.
How bad is the nursing shortage in the United States? ›The national nursing shortage dates back decades, but the COVID-19 pandemic pushed it to crisis levels. One study predicts that, in the next two years, there will be a shortage of up to 450,000 bedside nurses in the U.S. In countries around the world, medical workers are pleading for more support.
What are the struggles of nurses during the pandemic? ›Nurses have faced several challenges working during the Covid-19 pandemic. These include; shortages have resulted in many working overtime, early lack of personal protective equipment to protect them from Covid-19 and witnessing widespread suffering and death.
How did the pandemic affect the healthcare system? ›The arrival of COVID-19 disrupted healthcare in various ways. Less urgent services were cancelled or postponed, while barriers imposed by curfews, transport closures and stay-at-home orders prevented some patients from attending appointments.
What is the biggest contributing cause to the nursing shortage? ›The nursing profession continues to face shortages due to a lack of potential educators, high turnover, and inequitable workforce distribution. The causes related to the nursing shortage are numerous and issues of concern.
Why are so many nurses quitting? ›Nurses also said their jobs offer little flexibility over their schedules, leaving them with little time to spend with friends and family and not enough opportunities to advance in their careers. More time off could help improve nurses work performance and alleviate burnout, the report said.
Where is the highest nursing shortage? ›California has the worst nursing shortage in the United States. It's predicted that by 2030, California will be in need of over 44,000 nurses. Other states with major hospital staff shortages include New Mexico, Vermont, Rhode Island, West Virginia, and Arizona.
How is COVID-19 causing nursing burnout? ›The main risk factors that increased nurses' burnout were the following: younger age, decreased social support, low family and colleagues readiness to cope with COVID‐19 outbreak, increased perceived threat of Covid‐19, longer working time in quarantine areas, working in a high‐risk environment, working in hospitals ...
What impact did COVID-19 have on healthcare? ›
The COVID-19 pandemic and the associated community mitigation efforts enacted have altered the delivery of and access to healthcare across the U.S. For example, emergency department (ED) visits are down by an estimated 40% in many communities across the country; many in-person office visits have been either postponed ...
How has the COVID-19 pandemic affected nurses working in critical care in the United States? ›Conclusion. Nurses working in ICUs during the COVID-19 pandemic experienced negative psychological outcomes, including anxiety, depression, stress, distress, PTSD, and burnout.
Is this the worst nursing shortage ever? ›Between 2020 and 2021, the number of working U.S. nurses dropped by over 100,000, the largest single-year decline recorded in four decades of data, according to an analysis of the Current Population Survey published in Health Affairs in January, 2022.
Why is there a nursing shortage 2023? ›The COVID-19 pandemic pushed these shortages to crisis levels, with demand outweighing supply nearly everywhere.
What factors are causing stress for nurses during the pandemic? ›(2020) conducted a cross-sectional survey of healthcare workers in the United States (U.S.), including nurses, with results demonstrating higher levels of psychological stress during the pandemic due to a variety of factors, including isolation and having to send cohabitants away during the height of COVID infections.
What are the health care challenges during the pandemic? ›However, most healthcare workers did not receive proper training for treating patients suspected of coronavirus infection. Physicians and nurses were overworked and suffered fatigue. Many healthcare workers reported difficulty sleeping as a result of pandemic stress and workplace fatigue.
Why is there a shortage of healthcare workers? ›One of the main causes is the aging population: both patients and health care workers. As the general population ages their need for medical care increases, but as aging doctors, nurses, and health care workers retire or leave the workforce, they are not being sufficiently replaced by new ones.
How did COVID-19 pandemic change the use of technology in healthcare? ›The COVID-19 pandemic provided a real-life, intensive use case for the role of technology throughout health care. This included moving acute care from the hospital to the home and significantly leveraging remote monitoring, telehealth, and audio-only interactions for care delivery.
What are the implications for the US health care system? ›This system has a number of adverse effects in normal times. It creates incentives to raise prices and push up volumes, shortages of poorly compensated services such as primary care and behavioral health, and an undersupply of services in less financially attractive poor and rural communities.
Has the nursing shortage improved? ›Line chart showing that the number of registered nurses per 1,000 people in the United States age 65 and older has declined from 68.9 in 2003 to 73.2 in 2021.
What are the factors affecting the nursing shortage? ›
- Nurses migration, frozen pay, ageing workforce drive projected shortages. - Job satisfaction, burnout and demographic factors, work environment, commitment, demand of work and social support.
When did nursing shortage begin? ›The Beginning of the Shortage
This is exactly what happened in the mid-1930s, when several technological, economic, and health care-related events combined to increase the demand for registered nurses and to lay the groundwork for a shortage.
- 7% of both women and men retired at age 63.
- 8% of women and 7% of men retired at age 64.
- 11% of women and 13% of men retired at age 69.
- 9% of women and 6% of men retired at the age of 70 or beyond.
Early Retirement and Burnout
This is on top of those who are already close to retirement age. Most nurses have decided to retire early due to physical and emotional demands. The demand for nurses has only increased, causing many to burn out and leave to maintain their physical and mental health.
The survey found that chronic under-staffing was the No. 1 issue driving nurses away from bedside care, with hospital management and "burnout" as other factors. Just 1% of the nurses who responded to the survey considered the COVID-19 pandemic as a top issue driving them away from the job.
Where is the hardest place to work as a nurse? ›- Intensive Care Unit (ICU) nurses. ICU is an extremely high-pressure environment and these nurses work with patients who have significant injuries and disease with added morbidity risks. ...
- Emergency Department nurses. ...
- Neonatal ICU. ...
- OR nursing. ...
- Oncology Nursing. ...
- Psychiatric Nursing.
In the United States overall, the average registered nurse salary is $82,750 and the median (50th percentile) is $77,600. California, with RN salaries averaging $124,000, is the highest-paying state for nurses as of May 2021 (according to the Bureau of Labor Statistics).
Why was COVID hard for nurses? ›It was difficult for the new nurses to care for a range of patients during the initial months of the pandemic due to the growing number of COVID patients. Therefore, they did not learn the range of skills they would have traditionally learned when managing care for people with other diagnoses.
What is the trauma of nurses during COVID-19? ›Learn to identify and manage this condition in yourself and your colleagues. Takeaways: Frontline nurses are at high risk for developing PTSD as a result of direct or indirect exposure to traumatic situations and events during the COVID-19 pandemic. PTSD is a growing concern for frontline nurses.
What is the burnout rate of nurses during COVID? ›More than half of the nurses (54%) reported high and 37% reported a moderate level of burnout in emotional exhaustion. About 52% of the participants expressed a moderate level of depersonalization, whereas only 12.5% were had a high level of reduced personal accomplishment.
How many nurses have left the profession? ›
About 100,000 registered nurses in the US left the workplace due to the stresses of the Covid-19 pandemic, according to the results of a survey published Thursday by the National Council of State Boards of Nursing.
What are the factors affecting access to care in the US? ›- Insufficient insurance coverage. A lack of insurance often contributes to a lack of healthcare. ...
- Healthcare staffing shortages. ...
- Stigma and bias among the medical community. ...
- Transportation and work-related barriers. ...
- Patient language barriers.
The United States has one of the highest costs of healthcare in the world. In 2021, U.S. healthcare spending reached $4.3 trillion, which averages to about $12,900 per person. By comparison, the average cost of healthcare per person in other wealthy countries is only about half as much.
How did the COVID-19 pandemic affect the mental health of nurses? ›The gravity of COVID-19 pandemic is triggering further mental health challenges among nurses. The continuous stress nurses are facing, could trigger post-traumatic stress symptoms, poor service delivery, suicide ideation and suicide.
How stressed are healthcare workers with COVID-19? ›Stress in Health Care Workers during the Outbreak
Health care workers who are called upon to assist or treat those with COVID-19 may experience stress related to: physical strain of protective equipment (dehydration, heat, exhaustion) physical isolation (restrictions on touching others, even after working hours)
On a scale of 1 (poor) to 10 (excellent), nurses rated their current mental health and well-being at an average of 5.8, compared to an average of 7.8 before Covid-19, representing a decline of 26%.
Why is there is a shortage of nurses in the healthcare? ›An Aging Workforce
An aging population also means that the average age of nurses is also increasing. The median RN age is 52 years old, with 19% of RNs aged 65 or older. Within the next decade, many of these nurses will retire, leaving vacancies.
Nursing shortages can significantly impact staffing levels, which is critical to delivering quality care. To deal with staffing shortages, hospitals may reduce the number of nurses they employ at any time. This can result in understaffing and nurse fatigue, both of which contribute to hospital errors and accidents.
How can we fix the shortage of healthcare workers? ›- Increase the number of doctors, nurses, and other health care professionals being educated. ...
- Intentionally recruit and train more students who reflect communities. ...
- Encourage newly minted health care workers to practice in underserved areas.
According to the U.S. Bureau of Labor Statistics, the country will need more than 203,000 new registered nurses every year through 2026 to fill the gap in care left by a retiring workforce. The average age of a nurse right now is 51.
Is nursing becoming saturated? ›
Right now, there is oversaturation in many areas. Hospitals are increasingly requiring applicants for jobs to have a BSN for entry-level positions. Leadership positions are usually reserved for nurses with an MSN. Your BF may want to check out www.allnurses.com.
Why are nurses getting paid so much? ›In addition to education, nurses must pass the NCLEX-RN exam to become licensed in their state. Because of the training and education students receive, many healthcare organizations pay their nurses well. Receiving an excellent salary is even more common in high-demand areas with a limited supply of qualified nurses.
Why is it so hard to hire nurses? ›Some of the factors that have affected supply and demand of nursing candidates have included: Aging baby boomers in need of more medical services. A significant percentage of nurses nearing retirement age. Bottlenecks in nursing education constraining the talent pipeline.
How bad is the nursing shortage in America? ›The national nursing shortage dates back decades, but the COVID-19 pandemic pushed it to crisis levels. One study predicts that, in the next two years, there will be a shortage of up to 450,000 bedside nurses in the U.S. In countries around the world, medical workers are pleading for more support.
What is the average age of a nurse? ›Average Age Of Nurses
The average age of a registered nurse in the United States is 44, though this may change as the demand for nurses increases.
The nursing profession continues to face shortages due to a lack of potential educators, high turnover, and inequitable workforce distribution. The causes related to the nursing shortage are numerous and issues of concern.
What are the biggest stressors for nurses? ›In the United States, the number one cause of stress among nurses is teamwork — pressures associated with working together as a group, such as poor communication, conflict, and tension. This was followed by stressors linked to job circumstances, like employer demands and work satisfaction.
What do new nurses struggle with the most? ›Performance anxiety, fear of making mistakes, lack of confidence in nursing skills, communicating with doctors, exhaustion from workload demands, and having the responsibility of your own patients can be a lot to handle in your first year.
What are 5 common stressors that causes stress among nursing students and why? ›Three main groups of stressors have been identified: (i) academic stressors (testing and evaluation, fear of failure in training, problems with workload, etc.), (ii) clinical stressors (work, fear of making mistakes, negative responses to the death or suffering of patients, relationships with other members of the ...
Why are RNs leaving the profession? ›Nurses are feeling more stress and less satisfaction with their careers and are also more likely to consider leaving their jobs than in 2021, at the height of the COVID-19 pandemic, a new survey shows.
How can we solve the nursing shortage problem? ›
- 1 | Listening to Nurses Concerns. ...
- 2 | Prioritizing Workplace Culture Increases Retention. ...
- 3 | Prioritizing Nurse Retention Levels. ...
- 4 | Increasing Diversity in the Nursing Student Body. ...
- 5 | Addressing the Need for More Nurse Educators. ...
- 6 | Using Innovation to Address the Nursing Shortage.
Around California — and the nation — nurses are trading in high-pressure jobs for a career change, early retirement or less demanding assignments, leading to staffing shortages in many hospitals.
How is COVID-19 causing Nursing burnout? ›The main risk factors that increased nurses' burnout were the following: younger age, decreased social support, low family and colleagues readiness to cope with COVID‐19 outbreak, increased perceived threat of Covid‐19, longer working time in quarantine areas, working in a high‐risk environment, working in hospitals ...
How long will the Nursing shortage last? ›According to the U.S. Bureau of Labor Statistics, the country will need more than 203,000 new registered nurses every year through 2026 to fill the gap in care left by a retiring workforce. The average age of a nurse right now is 51.
Are nurses quitting because of COVID burnout? ›Widespread burnout driven by the COVID-19 pandemic is still causing major challenges across the healthcare workforce. While nurses have reported feeling burned out, leading them to consider leaving their jobs throughout the pandemic, physicians have also expressed those sentiments in more recent surveys.
How did COVID affect healthcare workers mental health? ›At the heart of the unparalleled crisis, doctors face several challenges in treating patients with COVID-19. The psychological burden and overall wellness of healthcare workers (HCWs) have received heightened awareness, with research continuing to show high rates of burnout, psychological stress, and suicide.