Nurse.org's 2021 State of Nursing Survey won the Gold Award for the Digital Health Awards, Best Media/Publications Article, Spring 2022
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The 2021 State of Nursing - This is the REAL Nursing Shortage
"There are systemic issues causing nurses to leave the profession. It's time to address those issues," - Nurse Alice Benjamin, Chief Nursing Officer, Nurse.org
The results of the 2021 State of Nursing Survey revealed findings that nurses already knew to be true - that the so-called "nursing shortage" was complex and had deep-rooted issues that had been brewing for years.
"Yes, nurses are leaving the profession, but the so-called “nursing shortage” should not be blamed on nurses alone. There have been whispers for years, now we are screaming for change. We are overworked, and underpaid and are collectively feeling the effects of burnout, compassion fatigue, and moral injury. Despite all this, I believe that true change is possible in the nursing profession. Will it be easy? No. Will it be worth it? Yes. I can’t do this alone. I need your support. Please sign the pledge and let’s change the reality of nursing, forever," Nurse Alice, MSN, APRN, ACNS-BC, FNP-C, CCRN, CEN, CV-BC (Chief Nursing Officer, Nurse.org)
And, fun fact: Nursing is actually the entire nation’s largest healthcare profession. So what will it take to continue to keep nursing that way and ensure that RNs can remain at the bedside? Nurse.org is taking a closer look.
If you are a current nurse considering leaving the profession, be assured that you are not alone in your struggles. If all you’ve had the energy for is keeping your head down and getting through your shifts, sleeping, and getting up to do it all over again, know that you are doing enough. It’s not your responsibility to solve the nursing shortage.
Nurses Need Mental Health Counseling, Too
During a time that may feel out-of-control for many nurses, it’s important to take control of our mental health. That's why Nurse.org has partnered with BetterHelp - affordable, private online therapy available anytime, anywhere. Get started today and enjoy 10% off your first month by entering code "nurseorg" at checkout.
Contact Your Elected Officials To Urge Change
It’s time for elected officials to stand up for nurses. Write them a letter. Call their office. Demand change for nurses. Click here to get the contact information for your local and state Officials.
The U.S. was already predicting a dire nursing shortage. Then, COVID hit.
Chances are, you’ve probably heard about the fact that the U.S. was facing a nursing shortage that’s only been made worse in the wake of the COVID-19 pandemic.
In short, what was already going to be a critical nursing shortage has worsened due to nurses leaving the workforce from extreme burnout, understaffing, concerns over COVID, and other pandemic-related factors, such as a lack of childcare. An April 2021 survey by Vivian found that nearly 1 in 4 nurses were considering leaving the profession, a number that was even higher among ICU nurses who have borne the brunt of caring for critically ill COVID patients.
Just how bad is the shortage? Well, it’s so bad that the American Nurses Association sent a letter to the U.S. Department of Health and Human Services (HHS) on September 1, 2021, urging the country to declare the current and unsustainable nurse staffing shortage facing our country to be a national crisis. In a letter to HHS Secretary Xavier Becerra, the ANA called for the administration to acknowledge and take concrete action to address the current crisis-level nurse staffing shortage that puts nurses’ ability to care for patients in jeopardy.
According to an analysis from the National Center for Health Workforce Analysis, the U.S. could be in need of as many as 3.8 million nurses by 2030. Globally, that number is estimated to be 13 million.
- According to the Bureau of Labor Statistics (BLS), there will be 179,600 new RN positions created each year until 2029 - The BLS explains that the need for RNs is projected to grow by 7%, which is faster than the average for all occupations. But unfortunately, those numbers may not even reflect the actual numbers of nurses that will be needed now, thanks to record numbers of RNs leaving the workforce this year. That, the BLS notes, coupled with an aging baby-boomer population and increased chronic conditions like diabetes and obesity, means the nursing shortage could be even worse than ever.
- There’s a shortage of qualified nursing faculty to teach the next generation of nurses which causes over 80,000 nursing school candidates to be turned away each year.
- Only 84.5% of Registered Nurses work at the bedside. As the American Academy of Colleges of Nursing (AACN) explains, there are more than 3.8 million RNs nationwide, but only 84.5% are actually employed in nursing.
Why Are Nurses Quitting?
The answer to this one is probably pretty obvious, but a large part of the mass exodus of nurses has been due to COVID. Not only have some nurses with young children been forced out of the workplace due to school shutting down and a lack of reliable childcare, but many other nurses have left due to their mental health suffering.
According to a survey from Vivian, this year, more healthcare workers are considering leaving the workforce as compared to last year. They cited reasons for their wish to leave as:
- A decline in morale
- Increase in stress
- General dissatisfaction about pay
Let’s take a closer look at each of these points, along with some other factors that are leading to nurses leaving the workforce.
The point about pay is an important one: as hospitals have dealt with nursing shortages from burnout, quarantining, staff illnesses, or simply not enough nurses for patient loads, they have turned to travel nursing to fill the gaps.
- There’s a huge disparity in pay between staff nurses and travel nurses - for instance, some areas have paid travel nurses wages as high as $10,000/week during critical times. Just take Ivette Palomeque, a former ICU nurse who quit her $45/hour staff job to become a travel nurse. She now earns around $120/hour. “Going back to a staff job is just not an option,” Palomeque told WSJ. “Absolutely not.”
- Lack of hazard pay amid a worldwide pandemic - staff nurses have seen how much hospital administrators are willing to pay temp nurses while refusing to raise staff nurse wages or in some cases early on in the pandemic, even provide adequate PPE.And as of March, despite Congress passing the$1.9 trillion COVID relief bill, no legislation explicitly spelled out any type of hazard pay due to nurses now or who worked the frontlines at the beginning of the pandemic. This has inevitably led to extreme frustration.
- Some states are attempting to retain nurses by making it harder for them to quit their jobs to work crisis-contract assignments - some state governments and hospitals, like those in Texas, have mandated that staff nurses are not allowed to quit their jobs and take temporary, high-paying, disaster response positions in-state, leaving nurses feeling even more frustrated.
Stress and morale
Nurses have faced extreme stress, traumatic work conditions, understaffing, and in some situations, a lack of clear support from their administration. For nurses who have worked on the frontlines of COVID, the sheer amount of suffering and death they have witnessed–without adequate training or coping resources in place–is more than even seasoned nurses have seen in their entire careers.
This could translate into nurses exiting the nursing field very early on. For instance, Vivian’s survey found that healthcare workers who were early on in their career were also more likely to be considering leaving the healthcare field as opposed to those with 10-19 years of experience.
“My mental health suffered more than I had ever experienced,” Audra Williams, an 8-year veteran ICU nurse who recently quit her job, told CNBC Make It.
Frustratingly, about 73% of healthcare workers feel that abuse is part of the job. Any nurse you talk to can tell you about an experience of being verbally or physically assaulted by a patient or in some situations, a fellow healthcare worker.
And sadly, abuse towards healthcare workers only seems to be increasing every year. Violence against healthcare workers was found to have risen by a staggering 67% and according to the JAMA, the pandemic has exacerbated workplace violence more, even worldwide. Patients and families frustrated by COVID, misinformation, volatile politics, and restrictions have all led to more violent outbursts.
As you can imagine, the combination of stress, abuse, and unsafe work conditions has taken a toll on nurses’ mental health.
Although data is still being collected on just how exactly nurses’ mental health has been affected by the pandemic (and in many ways, nurses themselves aren’t even far enough out to realize the impact yet), preliminary studies have found that compared to non-healthcare workers in the pandemic, healthcare workers have higher levels of:
- Obsessive-compulsive disorders
A 2021 study in JAMA Psychiatry found that the suicide rate for nurses is already much higher than the general population (and much higher than physicians, a notable difference).
And experts have already warned that those numbers could increase in wake of the pandemic, as two key risk factors for suicide--poor work conditions and mental stress--have increased significantly. Early reports of nurses committing suicide in the wake of the pandemic across the world are a sobering reminder of what can happen when nurses are left alone to face traumatic situations without support.
According to the AACN, around 500,000 RNs will retire in 2022, so they predict that to replace those retirees and ensure there are enough new nurses to fill already-existing position gaps, 1.1 million new nurses will be needed next year.
That’s a lot of nurses. And because the average age for a nurse in the US is 42.7, there are even more retirees on the horizon, which means–you guessed it–even more new nurses are needed.
Location has a large impact on what conditions nurses are facing. For instance, rural hospitals have been especially hard-hit, with already smaller pools of employees. Alaska recently sounded an alarm that critical staffing shortages combined with even severely ill infants leaving the area at risk for what the director called a “hospital system collapse.”
Speaking of Alaska, the state is predicted to be the hardest hit in terms of nursing shortages.
The states that will have the worst nursing shortages, in order, are:
- South Carolina
- South Dakota
- New Jersey
If you’re looking at that list and thinking, “Huh, that also looks suspiciously like the list of a lot of the states that have been hit hard by COVID,” you would, unfortunately, be right.
Beyond the Bedside
Another key aspect of the nursing shortage is that it’s important to realize that nurses leaving the bedside––especially early on in their careers––also has a tremendous impact on future nursing roles. Because nurses who work the floor early on go on to take other advanced nursing roles, such as nurse managers, nurse educators, nurse administrators, or advanced practice nursing roles.
For instance, the BLS predicts openings in the following positions:
- Nurse anesthetists. 51,000 nurse anesthetist roles will be needed by 2029.
- Nurse practitioners. 322,000 nurse practitioner roles will be employed by 2029, massive growth of 52%.
- Nurse-midwives. 8,100 nurse midwife positions will be created by 2029.
- Nurse managers. 555,500 medical and health services manager roles--many of which are filled by nurses--will be needed by 2029.
Without students choosing nursing or nurses working in early clinical roles early on in their career to gain the necessary experience and discern future career paths, there could be a growing shortage of roles outside of the bedside as well. And that’s definitely a problem.
This report has been a bit of a doom-and-gloom one so far. A world without enough nurses is a dangerous one indeed, but we have time to turn this around. The data isn’t entirely clear on what strategies have helped with nurse retention, as there has been a lot of variability with the pandemic. However, countries that are committed to nursing retention focus on three main issues:
- Encouraging nurses to return to the workforce
- Improving workplace conditions
- Investing in nursing education
The pandemic has shown us, more than ever, how crucial nurses are to keeping our nation running in both times of health and crisis. And it’s time we support nurses, because if nurses aren’t cared for, who will care for us?
“I think about going back to the bedside a lot,” one former ER nurse who quit her job during the COVID pandemic told Nurse.org. “I loved being an ER nurse, and I was good at my job. I truly felt it was a ministry to be present and provide care for the sick, suffering, and dying. But I think about the lack of support I faced, and how that might affect my family and my mental health. I have an easier job that pays fine now and lets me be emotionally available for my family. Healthcare providers are my people though, and I truly do feel guilty for not standing beside them during this time of immense struggle they're currently facing.”
Here is a list of just a few of the things we need to start with to better support nurses:
- Better pay. Clearly, pay needs to be addressed for staff nurses. If a staff RN could make as much as 4X more leaving their staff position for a temp nursing position, why wouldn’t they? Although travel nurses will always have a necessary and pivotal role in the nursing industry, the pandemic has highlighted the need to better support staff nurses in times of crisis too.
- Protective equipment. After stories like the nurse who watched her manager physically lock up rationed N95s in a cabinet so the nurses couldn’t use them, ensuring adequate PPE at all times is critical.
- Adequate staffing. A survey by Vivian found that an overwhelming majority of healthcare workers--87%--felt like their hospitals and facilities were still not adequately staffed. Understaffing is a problem that will only perpetuate the cycle of nurses quitting, so it’s a crucial one to address.
- Childcare support. An overwhelming majority of RNs in the US are women in their childbearing years. And while we would never go as far as to assume every woman of reproductive ability wants children, it’s still important to ensure that women who do want to have children are supported in the workplace.
- On-floor support. If you’ve ever worked a short-staffed shift, you know how exhausting it is. Missing a break or a lunch here or there is usually accepted as a nurse (but again, should it be?), but chronic missed breaks, lunches, and a lack of on-floor support shows nurses that they will not have the resources they need to do their jobs. And as professionals, they know they deserve better than that. Nurses need practical support during their shifts and even a 15-minute break is not a “small” thing that can be waved away. It’s necessary in order for nurses to continue to do their jobs.
- Mental health support. And no, we’re not just talking about a flyer posted in the break room or a basket of cheap candies in the break room. We’re talking, real, tangible mental health support: virtual and in-person therapy services that are fully covered, adequate PTO in order to refuel and recharge, a work culture that supports mental health days, and administration that will listen and not pressure nurses to work more than they feel they are able to.
“The place I previously worked also used mandatory overtime to fill staffing holes--I'd be scheduled for 4 hours and end up staying for 16, all night,” the same former ER nurse tells Nurse.org.
“I do not want to do that ever again. I don't think that forcing nurses to stay over their scheduled shift on the threat of patient abandonment lawsuits or job loss is a good plan to cover short staffing. If I ever go back, I would only accept a job somewhere where I was certain the manager and charge had my back. I don't want to work and feel as unsupported and unsafe as I did when I quit.”
The nursing shortage is an issue that affects us all, from the youngest of patients to the oldest, and from our families at home to the communities we live and work in. Nurses fill so many roles, from the bedside to administration to shaping the healthcare policies of the future.
We need nurses and now, nurses need us.
If you are willing to share your story, we can all help support nurses who are going through similar issues. Speak up, talk to your managers, write to your congresspeople, and join an advocacy group. You're not alone - read the State of Nursing Report here.
We’re listening--because if we want to solve the nursing shortage (and we do!), it starts with supporting each other, one by one.
And if you’re a student considering becoming a nurse, please know that you are not walking into a doomed profession. You will never meet anyone who is more determined, more resourceful, or more ready to jump in and lend a helping hand than a nurse. The problem is not with nurses or nursing; the problem is that nurses have been so busy taking care of others that no one has taken care of them. And we’re here to change that--and by entering the nursing profession, you will be part of the solution too.
- Take the 2022 State of Nursing Survey - to help current and future generations of nurses
- Read The 2021 State of Nursing Report
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