After two years of a pandemic, nurses are more stressed and burned out than ever, and too many are leaving the profession. What are the systemic changes needed to truly support them?
I confess I have felt ambivalent about Nurses Week since 2011, my first year as a second-career registered nurse. Back then, in addition to a full-time communications job, I was working weekends in a long-term care facility. Despite having no experience other than clinical rotations just nine months before, I had been given a short orientation that I essentially had to structure myself; I was then thrown onto a skilled nursing floor with 15 residents during the day and 32 residents at night—most of them unable to walk on their own, some with dementia, and all with at least one chronic condition. I was hanging tube feeds, flushing central lines, and dressing stage IV pressure ulcers, all while trying to keep everyone safe and happy.
My colleagues and I received many tributes during Nurses Week—a message from the administrator, posters and food in the break room, giveaways. Don’t get me wrong; the gestures and the sentiment were lovely. But what I wanted more than encouraging emails and pizza was help. What I wanted was permission to say “I’m scared and could use some more support,” but nursing culture there—and in many places, still—was “sink or swim.” Not long after, I decided to “swim” out of long-term care, rather than make an error that would cost me my license or, worse yet, a resident his or her life.
I’m not telling you this so you’ll feel sorry for me; I’m telling you this because I have come to realize that I wasn’t alone in feeling frightened and overwhelmed on the job. Almost anyone who takes their nursing responsibilities as seriously as they should has felt that way at one point or another. And now, this Nurses Week, with two years of this awful pandemic under our belts, nurses—particularly those on the front lines—are feeling more stressed and burned out than ever; many are leaving the profession.
Whitney Fear (Oglala Lakota), a psychiatric nurse practitioner, discusses the impact of nurse burnout.
New research supported in part by the Robert Wood Johnson Foundation (RWJF) shows that throughout the entirety of 2021, the total supply of RNs decreased by more than 100,000 in one year—a far greater drop than ever observed over the past four decades. Numerous studies conducted throughout the pandemic have revealed frighteningly high burnout rates among nurses. In a May American Journal of Nursing editorial, two nurses argue that it’s time to stop assessing the prevalence of nurse burnout and instead “focus on what we know might mitigate burnout.”
The profession is at a critical inflection point, and not just because we need nurses at the bedside and in the clinics. Numbering nearly 4 million, nurses have more contact with patients than any other healthcare providers. Nurses play an essential role in ensuring all patients get high-quality care. Fewer nurses, coupled with widespread burnout, will only exacerbate the inequities already rampant in our healthcare system. Writer Savala Nolan, in her essay, How I Survived a Racialized Pregnancy in the American Healthcare System, describes the numerous touchpoints along her journey where her care was negatively impacted by the implicit bias of healthcare providers—including her nurses—and systematized racism. While education is partly key to alleviating this centuries-old problem, we need broader systemic change that digs deep into the roots of structural racism and provides the kind of support that reduces stress and burnout in those who deliver care. In the documentary Who Cares: A Nurse’s Fight for Equity, mental health nurse practitioner Whitney Fear (Oglala Lakota) points out that patients who receive poor care are often getting that care from a burned-out provider.
In other words, it’s hard for exhausted and stressed nurses to provide the compassionate and patient-centered care that they were trained to provide, that they want to provide.
So what’s the solution? The National Academies of Medicine report The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity, funded by RWJF and released last year, lays out a number of key steps educational institutions, employers, policymakers, and others can take to drive the kind of systemic changes that will improve nurse health and well-being post-COVID. It’s no surprise that free donuts and coffee mugs aren’t on the list. The bottom line: Until we care for our nurses, they’re not going to be able to care for us.
There are two kinds of people in our country: Nurses, and those who love nurses. So during Nurses Week 2022, I hope that nurses and those of you who love them will come together to call and work for the changes that will give us the tools to do what we came into this profession to do. Nurses, let’s come together as never before to share our stories, raise our voices, and tell our employers, our communities, and this country’s leaders what we need. If you’re among those who love us, we hope you, too, will fight for change on our behalf.
As for me, I am now fortunate enough to work here at the Robert Wood Johnson Foundation, where I spend my days using both my communications and nursing knowledge. Off the clock, I volunteer for my county’s medical reserve corps and a nurse-run community clinic, where I have the systems and supports I need to provide the holistic, person-centered care I was trained to provide.
And it reminds me why I became a nurse in the first place.
Beth Toner, director, Program Communications, has more than 30 years of experience in marketing and corporate communications. She is also a registered nurse with clinical experience in long-term care and community health settings.