Since the start of the Covid-19 pandemic, nurses and other healthcare workers have benefitted from an unprecedented outpouring of public support, and have been hailed as heroes by everyone from patients to the president. There’s also been widespread attention paid to their mental health, and the impact of watching so much death and devastation up close. In recent months, multiple studies have sounded the alarm about the toll that the pandemic has taken on our healthcare workers, painting a picture of a workforce that is burnt out and suffering from a variety of adverse mental and physical health effects.
And yet, the structural changes that would help address some of these issues seem to be lagging at best, and non-existent at worst. One poll found that one in five healthcare workers feel that they needed mental health services but haven’t been able to get them. For nurses, the result is a profession in crisis. According to a survey of more than 1,000 nurses conducted by my company, Trusted Health, nearly half of nurses are less committed to the profession than they were pre-pandemic. This finding was particularly pronounced amongst nurses under 40, who were 22 percent more likely than average to report that their commitment to the profession had decreased.
This data is particularly disturbing when you consider that the United States was already in the middle of a nursing shortage when the pandemic hit, and that tens of thousands of Baby Boomer nurses are likely to retire in the coming years. This means that we simply cannot afford to lose the nurses we already have, particularly those in the early stages of their careers. The situation is dire enough that the U.S. Senate met recently to discuss the issue and identify potential solutions.
While it’s gratifying to see that this issue is getting attention from Congress, we can’t rely on slow-moving legislative solutions to a problem in need of quick, decisive action. For the nurses who are on the fence about leaving and can still be won over, meaningful solutions delivered in the near term are the only option. Hospitals and healthcare administrators must come together to find ways to retain their nurses and to rethink how they manage their nursing workforce more generally. Below are four potential strategies.
Prioritize moving nurses in distress away from the bedside
From speaking with frontline nurses over the last year and reading the write-in responses to our survey, it’s clear to me that many of the nurses who reported a diminished commitment to the profession are deeply conflicted. Some will leave, but others are suffering from trauma and extreme distress, and simply need to be re-assigned. Nurse leaders need to meet with members of their staff individually and move nurses who are in periods of mental distress from the most demanding units into less acute roles or away from the bedside entirely.
Create career planning programs
Even prior to Covid-19 hit, the healthcare industry wasn’t particularly good at retaining nurses and nearly 20 percent left their first post within two years. One of the major drivers here is a feeling among nurses that they are treated as disposable by their facilities, and worked to the point of exhaustion without much concern for their well-being or career progression. Career planning — at the hospitals where it does exist — rarely gives much thought given to an individual’s preferences or career goals. Unlike their Baby Boomer counterparts, Millennial and Gen Z nurses are less interested in working at the same facility for years or even decades and choosing between the standard paths of advanced practice or management in order to grow their career. In order to retain these nurses and keep them engaged, hospitals need to create a structured approach to career planning that starts with helping nurses determine what kind path appeals to them — leadership, education, or clinical — and then working to develop timelines, identify opportunities, and provide mentorship.
Drop the “hero” label and focus on substantive culture changes. Since the start of the pandemic, many healthcare workers have spoken out against being referred to as heroes. Nurses specifically are ambivalent at best and see it as a manipulation at worst. In fact, less than one in four respondents in our study felt that this label was fitting, while 49 percent felt that the label was an oversimplification and asked them to sacrifice their health and well-being for others. Hospitals need to ditch the “Heroes Work Here” banners and other gestures like yoga classes and pizza parties, and focus on comprehensive mental health programs. This should include a variety of different options like crisis support, education and coping mechanisms for compassion fatigue and moral injury, and peer-to-peer counseling from other clinicians who understand the unique set of stressors that nurses face. One excellent program is MindStrong from The Ohio State University College of Nursing, which uses Cognitive Behavioral Therapy to build resilience and coping skills for clinicians.
Rethink nurse staffing. The healthcare industry’s thinking about staffing simply has not kept pace with the reality of work today. Younger nurses want the same flexibility that they see their peers enjoying in other sectors. Many of them tried travel nursing for the first time during the pandemic, and aren’t keen to move back into full-time roles even as COVID-19 wanes in the US.
To give these nurses the optionality they are looking for without paying the high fees typically associated with contingent labor, hospitals and health systems need to move from a reactive to a proactive approach to hiring and filling shifts. This means looking holistically at data around staff PTO, census, fill rate and more to identify the best fulfillment strategy, and then using smart technology to push extra shifts out to float pools, local per diem nurses and travel nurses. Forcing nurses to work overtime, or conversely, to beg for extra shift work, and chronic under-resourcing of teams will just push more nurses to consider leaving the organization or the profession.
The last year has shown the entire world what I have known for a long time: nurses are some of the most selfless, passionate and caring professionals out there. But even the most caring individuals can’t sustain that approach indefinitely and the pandemic has truly pushed nurses to their limit. While much of the recent data is disheartening, I truly believe that it is not too late to bring this profession back from the brink and start investing in nurses the way that they have always deserved.