Nurses, particularly RNs, and their role and work in health care is a subject of deep interest to me. My wife is a nurse, our daughter is a nurse, my mom was a nurse, and so was my aunt. One could say nursing and nurses (RNs in particular) “run in the family”.
I have written multiple articles and given multiple presentations on staffing across all provider levels. I have sounded the alarm (as best as I could) about how devastating COVID and COVID policies (from vaccination mandates to lockdowns to restricted patient visitation, etc.) adversely impacted bedside staff and RNs in particular. The impact, negative, was so profound, it pushed staff away from bedside nursing and in some cases, health care altogether. The labor landscape for nurses shifted, and not in a good way or in my opinion, in a way that is reversible anytime soon.
A recent survey of 18,226 Registered Nurses completed by AMN Healthcare (available at the end of the post) provides insight into the post-COVID status of nurses and the impacts COVID had on the profession. Among the 18,000 survey participants, 65% were direct care or staff nurses. A few snapshots are as follows.
- Nurse career satisfaction has been at 80-85% for a decade. By 2023, it dropped to 71%. The likelihood of younger nurses encouraging others to become a nurse is down 14 points from 2021.
- Only 15% of nurses employed in hospitals say they will “continue working as I am” in one year. 36% of hospital nurses say they will continue working as nurses but seek a new place of employment.
- 30% of nurses say they are likely to leave their career due to the pandemic, up 7 points since 2021.
- Four of five nurses say they experience a great deal or a lot of stress, up 16 points from 2021. 70% worry that their job is affecting their health is up 19 points. Often feeling emotionally drained rose 15 points.
- 94% of respondents agree there is a severe or moderate shortage of nurses in their area, with half of nurses saying the shortage is severe. 90% say the shortage is worse than five years ago.
- 80% of nurses expect the shortage to get much worse or somewhat worse in the next five years, with half of nurses saying the shortage will get much worse.
- Only 1/3rd report they have enough time to spend with patients and 64% reported being satisfied with the care that they provide (this means more than 1/3rd is unsatisfied with the care they provide).
These numbers/results did not shock me but did reaffirm what I already knew and have been saying…health care is in deep trouble with regards to its clinical labor pools. RNs are irreplaceable and their presence (or lack thereof), the difference between safe and effective care and the opposite, poor outcomes. I am just seeing within my work, litigation mounting that is encapsulating staffing deficiencies as a root cause for negative outcomes, including wrongful death. I don’t see this trend arresting.
The most disturbing statistic is the dwindling job satisfaction numbers followed by the younger nurses being unlikely to recommend nursing as a career. Historically, within my family and circle of nurses, this has been just the opposite. Nursing, kind of like teaching, was always a family career. If new nurses cannot be grown, the gap between supply and demand widens exponentially, already widening by COVID and the average age of RNs in the nursing profession (skewed older, nearer retirement).
The solutions highlighted in the report are,
- Reducing regulatory barriers
- Increase workforce flexibility to meet patient demand
- Expand nursing program capacities (i.e., schools of nursing)
Per the nurses surveyed, improving job satisfaction and reducing stress is a function of,
- Having more input into decision making
- Create a safer work environment
- Increase salaries
- Reduce patients per nurse
- Increase support staff
In closing, I’ll add a few more that I think are even more impactful and can immediately be accretive to the nursing profession.
- Create full 50 state license reciprocity. Lots of states have reciprocity but a few remain holdouts. This is crazy. RN licensure should be fully portable.
- Improve clinical and system administration-better management. I’ve worked with a few of the very best nursing leaders in health care and witnessed first-hand, little turnover and high satisfaction. Yes, COVID mucked things up, but bad management is like bad icing on a dry cake.
- Regulatory reforms that reduce the documentation burden and finally, creates interoperability (HIPAA and other legislation never has) among providers.
- A Federal govt. initiative to fund and put forth full effort, to expand the profession including adding real dollars to attract nurse educators to primarily, technical schools and increase the output of new nurses. Likewise, all of healthcare needs to get super serious about either full private funding for RN education or employment supports (tuition forgiveness, etc.) so that the supply increases.
The full AMN Healthcare RN survey is available here: amn-healthcare-rnsurvey-2023