Incoming! The exclamation is not foreign to the ears of those in the military. Those who’ve been under the incessant bombardment of the enemy are well aware that this word of warning means that another munitions round is on its way. From the trenches of WWI to the killing fields of Ukraine, men under arms have had to face the stress of that familiar whizzing sound, signaling the hurtling of yet one more shell toward their position.
This is the essence of real stress—not just the single advent of bad news but the continual barrage of bad news. It seems that this is what hospitals in the U.S. have been experiencing for some time now, and the bad news keeps coming.
Even before the pandemic, there were the incipient stages of the doctor shortage crisis, as well a general increase in financial pressures. And we don’t need to recount the panoply of predicaments endured by the nation’s frontline medical facilities during the darkest days of the public health emergency (PHE). It bears repeating, however, that the COVID crisis continues to have ramifications on the healthcare system long after the peak of the pandemic. Now that the PHE is winding down, hospital board members have been looking forward to a break in the bad mojo and getting back to business as usual. Unfortunately, there is one issue that continues to act as a major stressor for many an American hospital: the nursing crisis.
GAUGING THE SITUATION
According to Forbes Magazine, the U.S. Bureau of Labor Statistics recently reported that more than 75,000 additional nurses will be needed from 2020 to 2030. Employment opportunities for nurses are projected to grow at a faster rate (nine percent) than all other occupations from 2016 through 2026.
So, the need for nurses has been solidly established, but will this need be met? All indications are that, unless conditions change, we may be looking at a long-term problem.
The American Nurses Foundation (ANF) and Joslin Insight conducted a survey of nurses across the U.S. this past November. Over 12,000 individuals participated, and all 50 states were represented. According to the ANF, the survey has a 1.15 percent margin of error.
The nurses completing the survey work in a wide spectrum of settings, including 53 percent employed in acute care hospitals of all sizes. Seventy-two percent of respondents provide direct care to patients, with 78 percent being employed full-time. Four percent of respondents identified as a travel nurse. Importantly, 41 percent of respondents indicated being 55 or older.
FEELINGS OF FATIGUE
The survey revealed several significant findings that will have widespread implications for hospitals’ ability to provide patient care over the long term. Sixty-four percent of nurses reported feeling stressed, with 57 percent identifying with the term “exhausted.” Surprisingly, it is those younger and more inexperienced nurses who “are struggling more with emotional health than their more experienced colleagues.” Nearly one-third of nurses with less than 10 years of experience indicated being “not emotionally healthy.” This is compared to just eight percent of nurses with 41-50 years’ experience.
Ominously, 33 percent of nurses under 35 years of age indicated feeling depressed in the past 14 days, compared to 18 percent of nurses 55 or older. This is a trend that has been identified and monitored since 2021, according to the ANF report.
ROOTS OF THE PROBLEM
We’re all well aware that burnout has been, and continues to be, a significant problem among hospital nursing and other clinical staff. When asked what the prime contributors were to their feelings of fatigue, burnout and low morale, the leading responses from the nurse survey were as follows:
- Not enough staff to adequately do
- their job (38 percent)
- Lack of respect from employer
- (14 percent)
- Too many administrative tasks
- (10 percent)
- Insufficient compensation
- (nine percent)
I was talking with a trauma nurse at a major medical center just recently. She told me that the administration had recently increased the patient-to-nurse ratio, due to an insufficient number of nurses at the facility. That is, there would now be less registered nurses (RNs) for each patient than what prior protocol had allowed. This, of course, only makes it more difficult for her to sufficiently do her job, and patient care is thereby compromised. The role of licensed practical nurses (LPNs) had also been expanded at the facility to fill in the care gap, which may further compromise patient safety.
The scenario described above is no doubt being seen in multiple hospitals in multiple states. To address the problem, some are looking to their legislatures. It is being reported that organizations representing the nursing profession in the states of Washington and Oregon have been instrumental in getting bills introduced that will mandate patient-to-nurse ratios that are in keeping with established standards that stress patient safety. If passed, such bills would mandate either the hiring of sufficient numbers of nurses or the reducing of a facility’s patient volume.
Let’s look again at the bulleted survey data above, as it may prove helpful to hospital decisionmakers to see this quantification of the reasons behind the growing dissatisfaction among nurses. For example, from the above numbers, one may derive that it may not be as important to raise the wages of current workers as it is to hire additional nurses and to foster a better working environment. The bottom line to this section is the following message: retaining and recruiting a sufficient number of nurses will be a vital mission for many U.S. hospitals over the foreseeable future.
THE PROBLEM MAY GET WORSE
The bad news is that there is more bad news—at least potentially. According to the survey we’ve been discussing, some 22 percent of nurses said they have changed positions in the past six months. As an indication of what hospitals may expect in the future, 19 percent said they intend to leave their position in the next six months, and 27 percent said they are considering leaving. While this is a modest improvement compared to survey results from one year ago, it is still cause for concern.
Of those who intend on, or are considering, leaving their position, 13 percent said they plan to leave nursing altogether. From an anecdotal perspective, one nurse stated, “I have seen many caring people step aside from nursing because they have found it is no longer worth it.” Another nurse echoed this sentiment, stating:
The staffing shortage has gotten even worse and most of the medical staff currently working are burned out and ready to leave. It’s hard to stay positive in this type of environment. I’m at the point where I want to leave nursing, but I am unable to because I’m supporting my family. The report concludes this section by stating, “The effects of burnout are far-reaching, and employers need to heed the warning.” So, unless hospitals intervene, the nursing shortage may continue to intensify. It is, therefore, incumbent on hospital administrators to recognize the severity of the crisis, admit its potential for worsening, and take steps to reverse it. This may include an array of options based on the particular circumstances of each facility. What hospital executives cannot do is sit back and hope for the best.
Justin Vaughn, MDiv, serves as vice president of anesthesia compliance for Coronis Health. Mr. Vaughn has over 20 years of experience in anesthesia compliance and has been a speaker at multiple national healthcare events. He has written two books on compliance-related issues and is the author of numerous articles relevant to the hospital space. Justin can be reached at Justin.Vaughn@CoronisHealth.com.