The COVID-19 pandemic has seen healthcare workers leaving the profession in droves. Nurses, physicians, and every specialty in between have been suffering from shortages across the country. In 2021, the American Association of Critical Care Nurses conducted a survey that showed 66% of respondents considered leaving nursing for good.
On the surface, the source of the problem seems obvious. A sudden influx of COVID-19 patients is putting a massive strain on limited hospital resources. While this is certainly a contributing factor, it doesn’t tell the whole story.
What’s really behind the nursing shortage?
Research suggests that what’s really driving away nurses are flaws in our healthcare infrastructure that predate the pandemic. University of Michigan faculty Deena Kelly Costa and Christopher Friese argue in the New England Journal of Medicine that if hospital working environments were safer, we wouldn’t see such a severe shortage of healthcare professionals.
The evidence they’ve gathered shows an alarming number of hospitals with pervasive unsafe working conditions. Inadequate PPE, increased violence, unreasonable workloads, and furloughs are just scratching the surface of issues nurses have been facing since before the pandemic began.
How can working conditions be improved for nurses?
There is a wide range of problems that have contributed to the nursing shortage. Many of these issues are not limited to one poorly managed hospital or negative patient experience. Nurses have been advocating for policy changes, both big and small, that will improve quality of life for nurses and create better patient outcomes.
Most states do not mandate a patient-to-nurse ratio. In fact, the only state that does is California. The more patients a nurse must care for in a single shift, the more likely mistakes will be made, resulting in more patient deaths. Nurse advocates across the US have supported legislation that will mandate safe patient-to-nurse ratios in every state.
Costa and Friese support the funding of research into new care delivery systems and new protective equipment for nurses. With more efficient modes of providing care, and improved measures to limit exposure to disease, both nurses and patients will benefit.
Mental health has been an ongoing concern for medical workers in every discipline, and the national discussion on mental health care for nurses is now more active than ever. In a high-stress working environment, it is extremely important for nurses and clinicians to have access to the best possible mental health care, in order to lower the rate of nurse burnout and promote compassionate patient care.
Another strain on the national healthcare system has been a lack of educational resources for student nurses. Nursing schools have struggled to attract and keep faculty, causing them to reject a large number of student nurse applicants that they cannot accommodate. By creating new incentives for nurses to take on faculty roles, and opening up more nursing school programs, we can help offset the nursing shortage with a new generation of graduates.
Speaking of education, many nurses cite student loan debt as a major stressor. Student loan repayment programs and lower interest rates can help ease the financial burden faced by nurses, and potentially encourage more students to study nursing.
One of the major sources of job dissatisfaction for nurses has been clinical documentation. The national requirements for medical documentation are interpreted differently from hospital to hospital. While keeping proper records is essential for patient care, we can restructure the way that hospitals handle documentation to decrease burnout and streamline patient care.
Finally, many nurses report facing harassment and even physical violence from patients, which has only been worsened by the pandemic. It is crucial that hospitals implement better protections for nurses who treat aggressive patients in order to minimize harm.
What will happen if the status quo does not change?
The projected outcome if we stay on our current trajectory does not bode well for our healthcare system.
If we fail to implement safe patient-to-nurse ratios, better protections for nurses, and educational reforms for student nurses, there will be a large drop in qualified nurses in this country. The remaining healthcare workers will face unbearable workloads in hospitals with inconsistent and inadequate regulations.
Historically, nurses have tended to reduce their hours or outright leave the profession during times of economic growth, and have done the opposite during recessions. As the US economy recovers in the wake of the COVID-19 pandemic, we will undoubtedly see a similar situation. For our healthcare system to function, it is vital that we do what we can to not only encourage nurses to stay, but allow new nurses to study and explore the profession without fear.
What can I do to help?
Whether you’re a nurse, a hospital director, or a non-healthcare worker, there are ways you can help improve this situation.
If you’re a nurse and you work in an unsafe environment, speak up and tell your story! The more that the public understands the conditions that nurses face, the more likely we are to see policies shift in nurses’ favor. For egregious workplace violations, contact the proper labor board for your area.
There are many nurse advocacy groups that are working to raise awareness of these issues. National Nurses United has a dedicated campaign in support of patient-to-nurse ratio regulations. The Show Me Your Stethoscope organization builds networks and leads movements to improve nurse working conditions. The American Organization for Nursing Leadership brings together nurse leaders to transform healthcare and suggest federal policy changes.
If you oversee nurses in a clinic or hospital, create an environment where their ideas and concerns are heard, and act on them. Look for ways to build on and improve existing systems. Medicine is constantly evolving, and so should workplace practices. When you take care of nurses, you take care of their patients, too.
Support the nurses in your life by listening to their experiences and learning about the types of policy changes that they need. Share information that is fact-checked, up to date, and that comes from primary sources. With everyone’s help, we can change healthcare for the better.
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