A few months ago, I attended the CNO Exchange and one of the primary topics of discussion was nurse staffing. The leaders at the conference spoke about how hard it has been to keep basic requirements —supplies, staff, medicine, beds—available in their hospitals. Supply shortages of appropriate PPE and ventilators were an early problem, along with having enough patient beds available for the influx of COVID patients. Staffing shortages continue to grow the further into the pandemic we go. Hospitals have been forced to make difficult choices regarding elective procedures, life-saving treatments, and staff retention. With the newest COVID-19 Omicron variant wave surging (including the highest-ever national positivity rate), cold and flu season in full swing, and overflowing ED and ICU floors, the worsening staff shortage issue is a major concern for healthcare leaders across the country.
A recent McKinsey study of strategic and operational leaders at 100 large private-sector hospitals showed that the biggest ongoing COVID-19 challenge they were facing was nursing workforce coverage and/or attrition. In the same study, 60% reported challenges with broader clinical support staff coverage. Respondents also noted that nursing turnover and vacancy rates had increased on average 4-5 percentage points in the past year. The new Omicron variant is only exacerbating this problem nationwide with rising sick callout rates and changing guidelines for return to work highlighting the need for more staff.
The pandemic has poured gasoline on the burnout fire
Nurses are worn out, tired, overworked, and trying to figure out what comes next. Several nursing leaders at the conference spoke about staff burnout. At the start of the pandemic, everyone on the front lines rallied to do what was needed to respond to the crisis as it was unfolding. Now, exhausted clinicians and staff are dealing not only with the trauma of a deadly virus and its effects, but also with fundamental changes to their profession. One topic that surprised me during the conference was that COVID has even shifted how nursing leadership is talking about career management for their staff. What sort of growth path can they provide for veteran nurses, and how will they approach the large – and growing – shortage of nurses? In addition to the shrinking number of nurses across the country, programs to train new nurses are also in short supply.
The issue of nursing burnout existed long before COVID, although the past year of COVID has understandably contributed to an increase in the causes and symptoms of burnout. Last year, the ANA Enterprise’s Year One COVID Impact Assessment of more than 22,000 U.S. nurses found that 18% intend to leave their jobs in the next six months, and 21% are undecided about leaving. Nearly 50% noted that the decision to leave is a result of their work negatively affecting their health/well-being. Similarly, another study shows new levels of nurse burnout in the forms of trauma and PTSD. Of the more than 12,000 nurses who completed the survey, 13.3% reported trauma and 39.3% experienced post-traumatic symptoms.
Post-COVID: What really comes next?
Seeing the strain that the pandemic and the past 22 months put on the nursing profession, I personally wonder what comes next. Which pandemic-driven changes will actually stay once we are finally in a ‘post-COVID’ reality? The healthcare industry has changed and will remain changed by our COVID experience. The unprecedented financial challenges brought on by the pandemic continued through 2021. Hospitals and health systems are navigating high costs associated with COVID patient care, additional expenses due to supply chain and labor market disruptions, and lost revenue due to lower volumes of elective procedures and other non-emergent care services. Healthcare executives and leaders must balance the need to offset these pandemic-related impacts to their bottom-lines with the necessity of retaining the talent they have and to recruit new staff to fill the roles of those who have decided to leave. It is not a simple math problem.
I know this all may sound like doom and gloom, but I have to share that I was comforted by the tone of the very last session I attended at the conference. Not one of the leaders who spoke was throwing in the towel. Each one of them spoke at length about the weight of these challenges but no one was giving up. Resilience has always been (and still is) one of several nurse super-powers. Without a doubt, these leaders believe in the strength of their nursing workforce. The veteran nursing staff are bringing knowledge and experience to bear on the current set of problems, and the new nursing generation is viewing the changing field through an entirely different lens.
COVID is driving a reckoning throughout the healthcare industry. Positive changes are coming in the longer term. The pandemic has exposed some deep cracks and leaders are hopeful for the not-too-distant future changes coming on a scale we may not have seen otherwise. Lines of communication are opening in ways they haven’t before. Healthcare leadership sees that implementing more appropriate recognition of the demanding, emotional toll of the workload and embedding more meaningful support and flexibility in the operating model can help retain talent on a broader level.
Another solution is automating and simplifying administrative tasks through technology. Intuitive technology solutions, like clinical communication platforms, can help address some of the contributors to burnout for nurses by simplifying information-driven workflows. Implementing communication solutions can help minimize miscommunications, reduce alarm fatigue, and maximize available time for each patient, all which are more important now than ever before.
Nurses demonstrate their resilience, day in and day out, no matter the situation, even in a pandemic that can sometimes feel like it might never end. Hospitals and health systems aren’t throwing in the towel and neither are the nurses. The challenges brought on by the pandemic can be solved, and I am so impressed by how my nursing colleagues are already making changes to reshape the profession to meet those challenges head-on.