As a registered nurse in New York who has worked in emergency rooms and critical care units across his 35-year career, Richard has seen his share of calamity, but never has he seen his profession as bad off as it is now.
“Our current nursing shortage is dire at present and careening toward catastrophe,” he related. (Richard is an alias WorkLife agreed to for this story.) He singled out patient volume, bad behavior on the part of patients and visitors, compensation, and long shifts as reasons for burnout and despair on the part of nurses, leading many to leave their jobs.
“Over the past few years I have been exposed to workplace conditions that have challenged my coping skills like nothing else,” he said. That can mean 12-hour (or longer) shifts without a break. “There is a huge physical component that often leaves us exhausted,” he related. “Being in constant motion for 12 or more hours takes its toll.”
There’s little wonder, then, that hospitals in the U.S. are averaging 100% employee turnover every five years, with the shortfall in nurses in particular reaching crisis levels, jeopardizing patient care, driving up costs for healthcare providers and consumers — and driving nurses to the brink.
As The Washington Post reported, 7,000 nurses, fed up with understaffing and burnout, went on strike this month in New York, while hundreds of healthcare workers across the U.S. protested HCA Healthcare, the largest hospital chain in the nation — including a staffer at a Texas facility who recently admitted herself into her own emergency room because of dehydration and exhaustion.
A recent report by the RN recruitment firm NSI Nursing Solutions, based on feedback from 272 healthcare organizations in the U.S., found that while nearly three-quarters of hospitals have a formal nurse retention strategy, fewer than half of those have measurable goals in place. Meanwhile, the average hospital loses $5.2 million to $9 million every year on RN turnover alone, according to the survey.
“Hemorrhaging is the word we’re hearing most often to describe the staffing crisis in many healthcare organizations — and if that’s the problem, stopping the bleeding must be leadership’s Number one strategy and priority,” said Burl Stamp, founder and president of Stamp & Chase, a healthcare industry consultancy. “That means reducing turnover and the number of new hires organizations have to find each month just to stay even.”
The inability to retain staff impacts organizational success in numerous ways, as Stamp sees it, including patient experience, operational efficiency, and meeting the community’s needs.
Many point to the pandemic as putting strain on the healthcare sector — and there’s no question it has. That said, Stamp believes the causes of turnover are more complex. “Research confirms that multiple aspects of the work environment itself, which can vary from department to department in the same organization, contribute to individuals wanting to stay or stray,” he said. “Many of these same characteristics are the root causes of burnout.”
Furthermore, industry hiring strategies that are designed to help may, in fact, be contributing to the problem, argued Stamp, who proposed that aggressive recruiting by healthcare systems and staffing agencies has led even those professionals who were not considering a job change to consider their options.
Multiple issues affect any employee’s level of satisfaction in his or her job, of course, but at the heart of loyalty and commitment in healthcare is the extent to which staffers feel a meaningful sense of connection to their organizations, supervisors and patients, Stamp explained. As with most any other field, variables like professional recognition, career opportunity and development, and compensation and benefits also play key roles in job satisfaction, he added.
The workplace environment dominated responses to the National Nurse Work Environment Survey, conducted by the American Association of Critical Care Nurses and encompassing feedback from 9,000 nurses in the U.S. It found that implementation of AACN’s standards for a healthy work environment — including variables like better communication, collaboration and recognition — may mitigate the pandemic’s negative impact on nurses and ease the current staffing crisis.
Promoting virtual patient visits is yet another answer to the nursing shortfall. Virtual care provider Omada Health and Komodo Health, a healthcare data and tech firm, found in their research that nearly one-third of care can be conducted virtually, which stands to lessen the load on in-person staff and opens opportunities for in-person care to focus on higher acuity patients, according to Omada Health president Wei-Li Shao.
He argued that virtual care can mitigate unforeseeable staffing shortages without putting the responsibility on providers to come up with solutions.
“People make decisions about their health each and every day, and aggregating these decisions makes health outcomes generally worse,” he said. “Specifically for chronic conditions, investing in care during the time between hospital visits is proven to improve health outcomes and, therefore, lessen the strain on nurses in the long term.”
For his part, Richard, the longtime RN working in New York, says proper compensation in the form of pay increases and/or bonuses, plus more humane schedules, would go a long way toward making work life better for nurses.
“Ending draconian attendance policies that are responsible for many nurses coming to work on days when they are ill or just need a break to regroup could help,” he said. “Really anything that enhances nurses’ work-life balance, and respect.”