By Rayna M Letourneau, University of South Florida
The fourth wave of COVID-19 is exacerbating the ongoing crisis for the nursing workforce and has led to burnout for many nurses. As a result, many are quitting their jobs in substantial numbers all across the country, with 62% of hospitals reporting a nurse vacancy rate higher than 7.5%, according to a 2021 NSI Nursing Solutions report.
But the global pandemic has only worsened problems that have long existed within the nursing profession – in particular, widespread stress and burnout, health and safety issues, depression and work-related post-traumatic stress disorder, and even increased risk of suicide.
In addition, nurses need to contend with growing workloads and inadequate staffing, or not having the right number of nurses on the right units to ensure that patients receive safe quality care. Mandatory overtime is another challenge and occurs when nurses must work extra hours beyond their shift because of staffing shortages. All of these issues can lead to low job satisfaction among nurses and are likely to contribute to nurses’ leaving the profession, a trend that began well before the current pandemic struck.
Despite more awareness of the challenges nurses currently face, nurse staffing and its impact on patient safety have been studied for more than 20 years. My role as a nurse researcher and assistant professor at the University of South Florida is to evaluate the needs of the nursing workforce and design and implement programs to address them.
Here’s why the pandemic has made the nursing shortage even worse, and why I think health care leaders need to make bold changes to address the well-being of nurses – for the sake of nurses and patient care in our country.
How some hospitals are addressing the shortage
Hospitals are desperate to fill nursing vacancies. One hospital system in South Dakota is offering incentives as large as US$40,000 sign-on bonuses to recruit nurses to work in the clinical areas that are in most need. This may be a great attempt to draw nurses to an institution, but sign-on bonuses and incentives might not be enough to persuade some nurses to work at the bedside and continue contending with the current workload of the pandemic.
Another strategy to fill vacancies is the use of travel nurses. Travel nurses work for agencies that assign them to hospitals that cannot fill vacancies with their own staff. Although this can be a successful short-term solution, the use of travel nurses is not sustainable over time and it does not help retain experienced staff nurses in an organization. Travel nurses make significantly more money than staff nurses, which may lure nurses away from permanent positions and in turn increase the staffing deficit for hospitals. The average salary for a travel nurse in the U.S. is $2,003 per week, with $13,750 in overtime per year. Some nurses even accept “crisis assignments,” which can pay as much as $10,000 per week. That is significantly higher than the average of $1,450 per week ($36.22 per hour) for a staff nurse.
Focus on nurses’ well-being
For the past 18 years, nursing has been identified as the most trusted profession. Nurses are caregivers, role models, educators, mentors and advocates and have a direct impact on the health and well-being of patients. The health of the nation’s nursing workforce is fundamental to our health care industry. As identified by a 2021 National Academy of Medicine report, nurse well-being and resilience are needed to ensure the delivery of high-quality care and to improve the health of the nation.
Research demonstrates that people with higher levels of well-being have lower levels of burnout and perform better at work. Therefore, some hospitals and unions are offering resources and programs to nurses during the COVID-19 pandemic that seek to reduce stress, promote resiliency and increase well-being. We have yet to see the long-term effectiveness of these programs on the health and wellness of nurses.
While nurses are responsible for prioritizing self-care, health care organizations are responsible for creating a workplace environment in which nurses can flourish. Nurses report fewer medical errors when their well-being is supported by their organizations and they are in better physical and mental health.
The long-term solution to the nursing shortage calls for systematic changes that value nurses and offer them a safe place to work. Examples include implementing appropriate salaries and flexible schedules, ensuring adequate nurse staffing, and creating jobs that allow aging nurses to continue working in direct patient care roles so they can remain in the workforce longer instead of retiring. The pandemic has made more people aware of the distressing conditions many nurses work in. But without systematic changes, the drain of nurses out of the profession – and its negative impact on patient care – will only continue.
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Rayna M Letourneau, Assistant Professor of Nursing, University of South Florida
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