Nearly 32% plan to retire or leave the field altogether, while 40% plan to pursue a nursing role elsewhere.
More than one-third (34%) of nurses surveyed said they likely will quit their job by the end of 2022, primarily because of burnout and a high-stress working environment, a new study says.
Not all are leaving nursing; 40% plan to pursue a nursing role elsewhere. But nearly 32% of nurses plan to either retire or the field altogether, according to Nursing in the Time of COVID-19, an annual report by staffing agency Incredible Health, which surveyed 2,500 nurses.
Among the study's findings:
44% cite burnout and a high-stress environment as the reason for their desire to leave.
65% said they've been verbally or physically assaulted by a patient or patient's family within the last year. Anger regarding hospital/COVID guidelines (52%) and frustration around staffing/care (47%) were the contributing factors leading to this aggression, the survey said.
32% said they've experienced racism at work.
High Turnover
Compensation is a crucial issue for nurses, but it is just one contributing factor leading to high turnover.
Nearly half (42%) of survey respondents have started a new nursing role since January 2021. The main reason nurses moved to new roles was higher pay, as 58% reported pay as their motivating factor to find a new job, while 44% plan to change jobs because of burnout and a high-stress environment.
Other primary reasons nurses changed jobs included:
Searching for a different role (33%)
An improved schedule (31%)
Their preferred location (25%)
Career advancement or training opportunities (24%)
Better staffing overall (24%)
Travel nurses
An ongoing frustration for the nursing industry remains travel nurses. More than 75% of nurses surveyed reported seeing an increase in travel nurses in their unit during the past year and one-third of those polled indicated that increase made them dissatisfied or extremely dissatisfied.
Pay is at the heart of the issue, with 86% of nurses reporting that compensation differences were the main cause of their dissatisfaction with travel nurses, who are often highly paid by temporary staffing agencies to solve critical gaps.
Additionally, 47% of nurses believe the quality of patient care is compromised from such temporary staffing, and 33% note that unit culture changes with the addition of travel nurses.
Pickets will be held Tuesday, March 15, because Sutter Health officials 'refuse to invest in the resources we need,' health system RNs charge.
RNs at 15 Sutter Health hospitals across Northern California are planning to hold informational pickets on Tuesday, March 15, to protest what they call Sutter’s "refusal to address RNs’ proposals about staffing, workplace violence, and pandemic readiness," according to the California Nurses Association/National Nurses United (CNA/NNU).
"We have been on the front lines before and during this pandemic," said Amy Erb, a critical care RN at California Pacific Medical Center of San Francisco.
"Throughout this time, we have witnessed Sutter Health become profitable while they refuse to invest in the resources we need in order for us to provide safe and effective care to our patients and community," Erb said.
Nurses notified Sutter Health corporate officials on March 4 that they would hold an informational picket.
Sutter Health RNs have been in contract negotiations since June 2021 for a new contract, said a press release issued by CAN/NNU.
The RNs are requesting a contract that provides:
safe staffing that allows nurses to provide safe and therapeutic care;
pandemic readiness protections that require the hospitals to invest in personal protective equipment stockpiles and comply with California's PPE stockpile law;
presumptive eligibility for workers’ compensation that covers infectious diseases and protocols; and
workplace violence protections that include plans to mitigate and prevent violence within the hospitals.
"Sutter Health is not investing in us, the nurses, or the community they should be serving," said Renee Waters, RN in the trauma neuro intensive care unit at Sutter Roseville.
"Instead, they are frequently using the word 'commitment' in their responses to us without actually agreeing to proposals that hold them accountable," she said. "Our proposals are intended to correct Sutter’s gaps in pandemic readiness and workplace violence prevention. We want to have a proactive approach to the protections we deserve. We need Sutter to back up their statements that we are heroes and valued, with agreements to our proposals at the bargaining table."
Sutter responded to a HealthLeaders request for comment with a prepared statement:
"We remain focused on reaching a shared resolution," the statement reads.
"Just as Sutter’s commitment to safe, compassionate care remains unchanged, so does our goal of reaching an agreement that reflects the good and important work of our nurses and maintains our strength and stability as an organization. As we continue with negotiations, our patients will continue to receive uninterrupted, quality care."
Caring for the Nurse Retreat's average satisfaction score is 4.89 on a 5-point scale and nurses report significant improvements in self-care and stress management, chief nursing officer says.
A half-day retreat that takes frontline nurses off the floor of UAMS Health at the University of Arkansas for Medical Sciences (UAMS) and to a serene riverside setting to learn about the importance of self-care seems to be working, says the chief nursing officer (CNO) who engineered it all.
"Skeptical people go in saying, 'I don't know about this,' and they come out thanking us," says Trenda Ray, PhD, RN, NEA-BC, the Little Rock, Arkansas, health system's CNO and associate vice chancellor for patient care services.
The Caring for the Nurse Retreat originated from a survey nearly three years ago—before the COVID-19 pandemic—by a UAMS researcher who was focused on physician wellness and burnout. Inexplicably, he included nurses in the survey. The results were eye-opening.
"They were so surprised in that RNs led the way in burnout," Ray says. "Nurses surpassed residents, students, and attending physicians and that became the signal for us that we needed to do something."
At a conference she was attending, Ray heard another organization speak about nurse retreats, and she took the idea back to UAMS with her.
"In October 2019, pre-pandemic, we had our first Caring for the Nurse Retreat and we modeled it based on what I had heard from another organization, but modified it a bit to fit our needs," she says.
Open to all frontline RNs, advanced practice RNs, and licensed practical nurses (LPN), the monthly half-day retreat is held off-site in a large, windowed conference room at the Department of Arkansas Heritage, which sits on the Arkansas River.
The hospital system's director of wellness and Ray's assistant facilitate each session, which is limited to 12–14 participants.
"Each session, I try to do the welcome. If I can't do it in person, they play a video where I explain the premise behind the retreat and why it's so important to us that we want healthy nurses not just at work, but we want our healthy nurses back at home with their families," she says.
Yoga is a large part of the retreat, so they start the day talking about the importance of movement, followed by a yoga session focused on mindfulness and gratitude, she says.
A healthy cooking demonstration from a UAMS culinary medicine faculty member shows the nurses healthy, easy foods they can cook for their families and bring for lunch. During a healthy lunch, participants also learn about journaling and how it can be an effective tool in managing mental health.
Evaluations from retreat attendees have consistently ranked high, Ray says.
"We have had a total of 18 retreats so far over the past year with a total of 190 participants. The average satisfaction score is 4.89 on a 5-point scale and, post-retreat, nurses reported significant improvements in self-care—nutrition, physical activity—and in management of stress," she says.
Feedback from nurses includes such statements as:
"Thank you for valuing us and our time [Nurses are paid for the four hours they spend in the retreat]."
"Thank you for investing in our wellness and giving us tools to use in everyday life."
"This was much needed, especially after the past year in the pandemic. I have become so focused on work and school that I've lost focus on what matters."
"And those are a few of the comments from just one session," Ray says.
'Focused on wellness'
The nurse retreats are sponsored by the Chancellor's Circle, the annual giving society for the entire UAMS system, providing funds to support key mission areas in healthcare education, research, and patient care.
"I didn't know how to get the financial backing and when the Chancellor Circle awards came through, we are so fortunate that our chancellor is focused on the wellness of our nurses and of our campus," she says.
Additionally, UAMS's foundation office has made the retreats part of its philanthropy efforts, and the Caring for the Nurse Retreat received more than $10,000 in donations in just a few weeks.
"Everyone has recognized this as something very special," Ray says.
Of the health system's roughly 2,000 nurses, nearly 200 have attended the retreat, which is why Ray plans to expand it to twice a month. And the retreat program that started out as a pilot is now being designed for other staff members across the medical center campus, she says.
How to get started
Nurse leaders interested in starting a nursing retreat at their hospital should first review what resources are available within their institution, Ray says.
"One of our nursing leaders was a yoga instructor and we started with her," Ray says. "We're lucky that we have a wellness program here and someone who teaches mindfulness."
The retreat location at the Department of Arkansas Heritage is free because both are state institutions.
"The cost of this is low. We bought yoga mats and we buy food every time and a few other supplies here and there, but the cost is so low considering the benefit that we're seeing," Ray says. "I would suggest they look internally, that they talk to one another and ask who in their organization are experts around mindfulness or nutrition, and then find ways to partner."
Most voters said they would be more likely to vote for a legislator who agreed to remove restrictions against NPs.
Nearly three-fourths of Kansans back state legislation that makes it easier for patients to choose nurse practitioners (NPs) as their primary care providers, a new poll reveals.
If enacted into law, House Bill 2279 would make Kansas the 25th state to give patients full and direct access to NP-delivered care through full practice authority (FPA), which eliminates the requirement for NPs to have a government-mandated written practice agreement with a physician.
Full practice authority legislation, which has been embraced by the National Academy of Medicine, National Governors Association, American Enterprise Institute, and many others, has been adopted in 24 states, streamlining healthcare delivery by granting patients full and direct access to the comprehensive services NPs are educated and clinically prepared to provide.
The National Academy of Medicine's The Future of Nursing 2020-2030 report recommends that nurses be allowed to "practice to the full extent of their education and training by removing barriers that prevent them from more fully addressing social needs and social determinants of health and improving healthcare access, quality, and value."
The Kansas poll, conducted by the Mellman Group February 16-21, shows broad bipartisan support. In fact, support extends across key demographics for the state, including gender, age, party identification, and regions of the state.
Furthermore, most voters said they would be more likely to vote for a legislator who agreed to remove these restrictions.
"The data shows that Kansas patients are seeking NP-delivered care, and they want the legislature to modernize policies to allow them to choose NPs," Kapu says. "It's time for Kansas to retire these barriers that limit patient choice and access to NPs. Kansans want to implement tried-and-tested policies already embraced by nearly half the nation."
Nearly 781,000 Kansans live in a federally designated primary care health professional shortage area where only about 52% of the need for primary care services is met, according to the U.S. Health Resources and Services Administration. Even more alarming, mental health professional shortages affect more than 1.3 million Kansans, with just 32.74% of the need being met.
"This is a no-cost, no-delay solution that immediately cuts red tape in our state’s health system," says Christie Kriegshauser, director of political affairs for the Kansas Chamber of Commerce. "We know 24 other states with this model in place are, frankly, more competitive. They have better access to care and more choices available for their patients."
The state Senate passed the bill this week by a vote of 30-7. It now moves over to the state House for approval.
The campaign is in response to an AONL Foundation study where, of more than 800 managers who completed a quantitative survey, one in three reported they were not emotionally healthy and 20% said they were contemplating leaving the profession, Zimmermann says.
Respondents participating in the qualitative portion of the study reported a need for meaningful recognition and support, according to AONL.
"Their contributions have been reported in the literature for over 20 years. They are the chief executive officers of their unit. They recruit, retain, drive organizational success, and create a culture of trust and excellence and performance," Zimmermann says. "So, these were alarming all of us who saw this."
The campaign is divided into three phases.
Phase 1: Provide meaningful recognition
"The first part is public recognition of the complexity and contribution of nurse managers and an increased awareness of the nurse manager role and their work and to publicly thank them for their work," Zimmermann says.
Organizations are provided ready-to-use materials, such as emails, to express their gratitude to nurse managers. They can be found at nursemanager.org.
Phase 2: Redesign nurse managers' work
"We've known for 20 years that there needs to be a redesign of the work of nurse managers, and in the survey they've given us some guidelines related to that," Zimmerman says.
"One is to recognize their work, look at their span of control, and [see if] they can have more flexible hours," she says. "These are not necessarily easy, but they are within the control of healthcare organizations, so we are asking senior leaders to sit down with their nurse managers and begin to discuss the role and how can we make this a sustainable, worthwhile career."
Phase 3: Conduct research of nurse manager recognition
Meaningful recognition of leaders has been linked to greater job satisfaction, productivity, loyalty, and engagement in the business sector, but little has been published about nurse manager recognition, according to AONL.
Little also has been done to recognize nurse managers, Zimmermann says.
"The third part of the campaign is to conduct research to demonstrate that meaningful recognition and redesign in the work really does have an impact on nurse leaders the same way that research on clinical nurses has already been evidenced," she says.
Part of that recognition is DAISY's Nurse Leader Award, which will be a way to "sustainably recognize their contribution," she says.
Of the 5,000 hospitals participating in the DAISY Foundation, only about 400 of them honor nurse leaders, Zimmermann says.
That's because many weren't aware of such an award or they didn't think they were eligible while others said they didn't they should be recognized because it was more important to recognize their staff, she says.
"What we have found, though, is when nurse managers are recognized," she says, "it fills their cup the same way that it fills those of the clinical nurses."
The power of 'thank you' extends beyond the nurse and stimulates innovation, teamwork, retention, and clinical outcomes, says the CEO of The DAISY Foundation.
A simple "thank you" and recognition of a job well done creates far-reaching benefits for nurses, their patients, and healthcare organizations, says the CEO of an organization created on the premise of gratitude.
"And that's not just in the healthcare literature," she says. "That's in the literature at large and also supported in the nursing literature."
The DAISY Foundation partners with healthcare organizations to formally recognize clinical skills and compassion of nurses at the bedside. It was created in 1999 by the Barnes family to honor the memory of J. Patrick Barnes and to express gratitude for outstanding nursing care received prior to his passing.
Zimmermann, who began her role with the foundation last November, previously ran The DAISY Award® program when she was chief nursing officer (CNO) and vice president of Patient Care Services at Virginia Commonwealth University Health System.
HealthLeaders spoke with Zimmermann about the importance of meaningful recognition for nurses.
This transcript has been lightly edited for length and clarity.
HealthLeaders: Generally, what are the far-reaching benefits of nurse recognition?
Deborah Zimmermann: There's all different kinds of recognition and what I will speak to is meaningful recognition. It's powerful and it's high to purpose. I see meaningful recognition as an acknowledgement of one's behavior and how it has impacted on others.
In healthcare, meaningful recognition comes from our patients, families, peers, and leaders. It fills the cup of nurses and creates a reserve for the future. And researchers have been able to demonstrate that recognition can buffer the negative effects of burnout.
Recognition can lead to positive work environment, a culture of gratitude and trust, and when there is trust and positivity, there's teamwork, there's innovation, and then you have that desired healthy work environment and all of them tie to patient outcomes. So meaningful recognition is just key and when an organization builds a culture of recognition and positivity, the impact continues to grow in significance on the work. Healthcare is about people giving care to people and that's why those interactions and that positive feedback is so crucial to the work of nursing and so crucial to healthcare at large.
HL: I've read where nurses have said that recognition is more important to them than salary raises. Is that true?
Zimmermann: Recognition, unlike compensation and traditional incentives, provides some intrinsic value and fosters a cycle of engagement and reinforces what we're looking for in desired behavior. Salary is important, and of course, nurses should expect to be compensated fairly; however, compensation is typically not a motivator, particularly for nurses. Nurses are motivated by their ability to contribute—their ability to make a difference in the lives of their patients and in the health and wellness of their communities.
HL: In your former role as a CNO, how did you see nurse recognition make a difference for your nurses?
Zimmermann: The nurses asked to bring DAISY into the organization [because] they wanted a mechanism to recognize colleagues as extraordinary nurses and to provide families the opportunity to give feedback directly to the nurses who cared for them. So, I said "yes" and that was 12 years ago, and what I saw grow was fascinating.
We received over 200 nominations a month, and a team would review all nominations and select one. What was so interesting is that it wasn't just the one honoree that felt like they were a winner; it was the other 199 nurses who were nominated. They believed that they were winners because they received feedback—that the work they were undertaking was making a difference.
And I wrote notes to each of the 199 nurses who were nominated each month and I … would also include the letter that the patient wrote. It became the most revered recognition, and validated that their efforts were worthwhile, it nursed their soul, and it helped build their resiliency.
It also helped create a culture of recognition. And often, they would then go beyond just that DAISY Award; they would look at other data such as patient satisfaction data and then say, "How can we make it better?" And what they realized is that gratitude also was important, and that positive thinking was important, so they would have daily huddles where there was gratitude that was shared.
If somebody called in sick, they would not think, "I'm going to have a terrible day." They would turn it around so that positivity and gratitude became a habit.
It stimulated innovation, it stimulated teamwork, and it had an impact on recruitment and retention. Even clinical outcomes were impacted by all of it, so it was pretty incredible.
HL: What are some informal ways that nurse leaders can meaningfully recognize their nurses?
Zimmermann: Handwritten notes really do make a difference. Giving thanks to one another for teamwork in daily huddles or daily check-ins, or, organizationally, having something like Gratitude Fridays.
They can provide opportunities for professional growth and innovation. Continuing education is such a reward to nurses and the opportunity to participate and to be able to network with colleagues is positive.
HL: How does a hospital or health system get involved with the DAISY Awards to create more formal meaningful recognition?
Zimmermann: If an organization is interested in honoring their nurses, they just contact us. It's incredibly reasonably priced and, in fact, we're a foundation so the cost of the awards is in part supported by our industry sponsors who help fund some of the awards so that the cost is not significant for healthcare organizations. And if a healthcare organization can't afford it, we will subsidize that for them.
HL: Why has there been such growth in the DAISY Award program?
Zimmermann: It is a tie to purpose. It lifts up not only the honoree but the entire unit, because the [winning] nurse will always say, "I am being honored, but it is because of you, my teammates, that makes this award possible."
Nurses often go from one thing to another, but the DAISY Award allows them to stop and think about the difference they make and the significant impact they have, [which is] why they chose to go into the profession. And it doesn't matter if the nurse has been a nurse for four years or 40 years; the impact it has on that nurse is profound.
Problems are 'only going to worsen if we don’t address the chronic, underlying work environment issues,' says the executive director of the American Nurses Foundation.
Younger nurses are struggling more with mental health challenges than their older counterparts as the United States enters the third year of the COVID-19 pandemic, a new study from the American Nurses Foundation says.
The study, which surveyed nearly 12,000 nurses nationwide between January 8-29, 2022, also indicates that some of the stress is caused by an increase in workplace violence.
Findings include:
Nearly half of nurses surveyed under age 35 said they have sought professional mental health support since March 2020.
Of the survey respondents under age 25, 69% say they have suffered from burnout—more than double than those older than 25 (30%).
Nurses under age 25 (47%) and nurses between 25- 34 (46%) consider themselves as being not or not at all emotionally healthy compared to nurses over the age of 55 (19%) and were more likely to have experienced an extremely traumatic, disturbing, or stressful event due to COVID-19.
Two-thirds of nurses surveyed said they have experienced increased bullying at work while one-third report increased incidents of physical violence at work.
"Mental health challenges endured by nurses is a serious ongoing dilemma that will have long-term impacts on the profession as this younger generation of nurses have been hit the hardest, as noted in the survey," said Wilhelmina M. Manzano, MA, RN, NEA-BC, FAAN, Board of Trustees president of the foundation, which is the charitable and philanthropic arm of the American Nurses Association (ANA).
"As we think about the future of nursing, this is particularly disturbing because nurses are our most valuable resource in healthcare, remaining a constant force in the recovery efforts to end this relentless pandemic by administering COVID-19 vaccines, educating communities, and providing safe and quality patient care to millions," she said.
Some 89% of respondents say their organization is experiencing a staffing shortage, with more than half (53%) saying it is a serious problem.
Younger nurses are leaving their current positions and roles in increasing numbers. Nurses ages 25-34 and 35-44 were more likely to change positions than nurses over age 55, the survey says.
Similarly, 60% of nurses under age 25 and 57% of nurses 25-34 do not believe their organization cares about their well-being and generally feel unsupported, according to the research.
"As we enter the third year of this incessant pandemic, the survey findings are even more alarming than what we found in the survey done last year," said Kate Judge, the foundation's executive director. "It’s extremely disheartening that we are still seeing and hearing about the same issues nurses have been burdened with since the start of the pandemic in 2020."
"Nurses are still struggling with mental health issues, feeling unsupported, and suffering from severe burnout and post-traumatic stress because of their sustained response to the COVID-19 pandemic," Judge said. "The nurse staffing shortage has had a domino effect on the profession and it’s only going to worsen if we don’t address the chronic, underlying work environment issues."
The key to closing the door on the COVID-19 pandemic is a sustained, robust nursing workforce operating at peak health and wellness, Manzano said.
"We need to ensure nurses are consistently and completely protected and supported," she said. "There is too much on the line."
'Relaxing safety protocols will only continue unnecessary and unwarranted loss of life,' National Nurses United president says.
The latest rollback of COVID-19 safety guidelines by the Centers for Disease Control and Prevention (CDC) is a serious risk for prolonging the pandemic, says National Nurses United (NNU), which is calling on the CDC to reverse the new guidelines.
"Regrettably, the CDC is once again responding to political pressures from those desperate to remove any safety protocols during this deadly pandemic that is still causing unacceptable numbers of infections, hospitalizations, and deaths every day," Zenei Triunfo-Cortez, RN, president of NNU, said in a press release.
Residents of counties at "medium" risk—about 42% of the country's population—should wear masks if they have a compromised immune system or some other heightened risk.
Those in areas with "low" levels of COVID—nearly 30% of the population—will no longer need to mask up indoors, according to the CDC.
The CDC is adopting new metrics on when it is safe to lift universal indoor masking protections, but the population figure required to meet the "high" risk level the CDC is basing the proposal on is "relatively useless," Triunfo-Cortez said.
"Under the new metric, anything up to 200 new cases per 100,000 could still be considered 'low' so long as COVID admissions and hospital capacity stay under a new threshold," she said. "The new 'low' could now be up to 20 times higher than the previous standard, which is certainly not warranted with the ongoing numbers of hospitalizations still occurring, and ever-escalating reports of new variants such as the BA-2 variant now spreading in many countries, including the United States."
The "medium" level of transmission under the CDC's revised guidelines also is relatively useless, she continued.
"Advising people to talk to their healthcare provider about whether they should wear a mask puts the burden on individuals, but also ignores inequities in healthcare and the fact that millions of Americans don't have a regular physician. Instead of recommending masking, the CDC is creating an additional, unnecessary risk and burden for vulnerable individuals," she said.
By focusing largely on hospital capacity, the CDC is also making masking "contingent on hospital capacity rather than about individual and community protection," Triunfo-Cortez said. "If you wait until hospital capacity is strained, it will be too late and you are courting disaster."
Widespread rollback of current protocols has already resulted in far too many people relaxing their vigilance, as seen in the dropping numbers of people receiving vaccinations and booster shots, she says.
"Everyone is anxious to bring this long trial of the pandemic to an end, but relaxing safety protocols will only continue unnecessary and unwarranted loss of life, and further strains for our already overwhelmed frontline caregivers," Triunfo-Cortez said.
"We don’t need new metrics," she said. "We need dedicated public health leadership."
The final vote was tallied Monday at National Labor Relations Board (NLRB) offices in Boston, with 302 voting to keep the union and 133 voting to decertify.
With this vote, they'll keep their new contract, which they had ratified on January 3 following their strike, according to the MNA.
The vote was held after St. Vincent Hospital nurses filed a petition with the NLRB to decertify the nurses' union—a move backed by the National Right to Work Foundation and the hospital's CEO Carolyn Jackson.
"The honor and integrity of our union is strong, as the St. Vincent nurses have reaffirmed our right to maintain a powerful voice in our advocacy for our patients and our work life," said Marlena Pellegrino, RN, a longtime St. Vincent nurse and co-chair of the nurses local bargaining unit with the MNA. "We now look forward to working with all our colleagues to truly begin the healing process and to build a positive future for St. Vincent Hospital."
"We are proud of our union and the great contract we have built over the last 22 years—a contract that provides our nurses with a strong voice to ensure optimum patient care, and which protects and rewards all nurses at the hospital for the contributions they make to the success of, this, our community hospital," Pellegrino said.
The petition to decertify the union was filed with the NLRB shortly after the nurses reached a tentative agreement on their new contract on December 17.
Secret ballots were mailed to nurses by the NLRB on February 4, and the nurses had until Feb. 25 to return their ballots to the NLRB.
3 takeaways from a unique HealthLeaders Exchange study that examines COVID-19's unprecedented effects on nurse leaders.
Nearly 75% of hospital and 64% of health system-based chief nurse executives (CNEs) are "stressed, dissatisfied, or intend to leave their role," with staffing as the top challenge as CNEs lead their nurses through the interminable COVID-19 pandemic, reveals a unique recent study by HealthLeaders Exchange.
"We wanted to understand how chief nursing executives were faring during the pandemic, and we found that there was a gap," says Boston-Leary. "Most of what we've seen in literature was for nursing overall. We did not see any studies that pertained to or that explored how chief nursing officers or executives were faring during the pandemic."
Chief nurses are traditionally strong for their team, so the study, which was sponsored by Cipher Health, was an opportunity to "allow them to be vulnerable and share how they were actually doing," Boston-Leary says.
The top 3 takeaways illustrate the depth of those chief nurses' challenges:
1. The COVID-19 pandemic exacerbated existing stresses in the nursing workforce, resulting in unprecedented levels of burnout and turnover that threaten recovery and rebuilding.
Some 62.5% of the CNEs who responded to the survey did not have adequate nursing staff to care for COVID patients, with the most critical shortages in the intensive care unit (ICU), emergency department (ED), and Med/Surg, the study says.
And 79.1% of respondents experienced high nurse turnover and had to amend or create new care models:
The most-used models of care were team models and use of non-nursing personnel.
Staffing models most applied were nurse-to-patient ratio and patient acuity models.
The most-used scheduling practice was consecutive, staggered 12-hour shifts.
Some 81% of CNEs who responded to the survey named staffing as their biggest problem, followed by burnout (58%) and turnover (40%), according to the study. Other challenges addressed in the study included capacity (33%), workload (23%), new protocols (17%), and personal protection equipment (PPE) (15%).
Despite those hardships, nurse executives were reluctant to talk about themselves and their well-being.
"When we asked how they were faring, a number of them said they were okay," Boston-Leary says. "They would give maybe one sentence of response in terms of how they were, but then they would shift to talk about how their team was doing."
2. Nurse executives have felt a deep-seated personal impact from supporting and leading their teams through the pandemic.
This impact has resulted in a duality of increased loyalty to team and mission but also to stress, dissatisfaction, and thoughts of leaving their roles.
Asked how they were feeling, executive nurses answered:
Stressed (52%)
Satisfied/content (25%)
Intend to leave role (10%)
Dissatisfied (8%)
Other (4%)
But despite stress and difficulties, nurse executives are up to the challenges that COVID-19 has unleashed, says the second of the principal investigators, Linda Hofler, PhD, RN, clinical assistant professor at East Carolina University College of Nursing and former chief nurse executive of Vidant Health.
"We've got part of the population of nurse executives who have worked long in their careers, and they want to get to the point where they get past COVID-19 and have handoff to the next generation," Hofler says.
"And then there's this newer group we saw on our study who have said, 'If it's not me, then who?' and, "I still have a legacy to leave and I'm even more committed than ever,'" Hofler says.
"As long as they are managing their emotional and mental health and well-being, and they're getting nurtured to be their best, I think that the future can be bright for people in those senior leadership positions," she says.
When asked what the nurse executives need to do now to ensure they are prepared for future crises, many responses focused on ensuring a prepared workforce moving forward, says Michelle Messing, lead researcher for HealthLeaders Exchange.
"A lot of these people are going to retire or phase out of this part of their career and want to ensure there is playbook for a future crisis or the next pandemic," she says.
For example, some nurse executives kept journals of their COVID experience of how they responded to particular challenges, she says. They also saved all their communications and kept notes on their thought processes so they could provide a guide for future nurse leaders, Messing says.
3. Nurse representation in C-suite decisions and internal support for nurses is inadequate to address the workforce shortage, nurses’ well-being needs, or prepare for future pandemics.
The study's respondents barely mention support from other C-suite executives, which is not a surprise, Boston-Leary says.
Chief nurses typically are women in a mostly male C-suite, and they're usually the only nurse, Boston-Leary says. Additionally, she says, chief nurses of color may be the only minority in the room, as well.
"So those factors alone bring about some dynamic that has to be navigated for a lot of nurse executives, because it is a challenge," she says. "The pandemic really revealed that being in the room doesn't necessarily mean that you have a strong voice."
"[This takeaway] revealed what really feels like a gap or weakness or a link that needs to be strengthened in the chain," she says, "for nurses to be able to make the case for what they need and have some support around what they need."
Looking ahead
COVID-19 most definitely has impacted chief nurses, Messing says.
"Nurse executives have one of the toughest jobs in the world right now," she says. "They are leading an American nursing workforce through one of the most taxing challenges in modern day history, and they really had to pick themselves up by the bootstraps and figure out what needed to get done."
But despite the challenges faced by the largest workforce in the healthcare sector, its leaders are more than capable, Messing says.
"There's a lot of hope within this group," she says. "They shared different quotes like, 'If not us, who?' and 'I love my work and I love my team and I still have a legacy to leave,' so their love of nursing and their love of the profession will win at the end of the day."