THE NURSING CRISIS:  A PLEA FOR THE PROFESSION

THE NURSING CRISIS:  A PLEA FOR THE PROFESSION

BONUS:  A List of Articles on New Treatments and the Future of Healthcare

By Pat Stricker, RN, MEd, Former Senior Vice President, TCS Healthcare Technologies

The COVID-19 pandemic caused numerous challenges for healthcare workers: chaos in work processes and procedures; lowered staff morale; increased, unrealistic workloads; long hours and increased weekly work hours; a feeling of a lack of respect and autonomy, and the feeling of despair in not being able to do enough to “save” their patients. The overwhelming loss of life was devastating and adding all these events together led to staff burnout and employees deciding they needed to leave their jobs.

A survey conducted in 2021 with more than 200 nurses found that 90% of them said they are considering leaving the nursing profession this year and 71% said they were planning to do so within a few months of the survey. Those are devastating and very frightening numbers. In addition, we also have a large number of baby boomers who are at the age of retirement now, so we will be losing them over the next 5-10 years and we do not have enough new nurses being graduated each year to replace the normal attrition of nurses, much less all the others who are leaving. According to the U.S. Bureau of Labor Statistics, healthcare also experienced a reduction of 460,000 workers in the past two years.

These statistics are unbelievable and scary. However, we need to stay positive and assume that 90% of the nurse respondents to these surveys will not decide to leave the profession, but we still may be heading towards a drastic reduction in the number of nurses over the next decade and we need to start to prepare for that.   

STATISTICS

Let’s take a look at some of the alarming statistics related to nurses and other healthcare workers leaving their positions. Recent reports show that about 20% of nurses have quit their jobs. Some of the following statistics vary depending on what was happening with the pandemic at the time they were done. Remember too that these numbers are a small slice of the nursing profession. They include mostly inpatient and nurses involved with face-to-face nursing, so they may not be as reflective of the case management nurses.

• According to a study from February 2022, COVID-19 has caused 1 in 5 healthcare workers (21%) to consider leaving their jobs.
• A report from October 2021 found that 18% of workers quit their jobs and 12% were laid off during the pandemic. Another 31% were considering leaving, and if they do, that would mean a total loss of 61%. If that is indicative of all healthcare workers, that is scary!  
• A study from May 2021 showed that 20-30% of front-line U.S. healthcare workers said they were considering leaving the profession.
• An April 2021 study found that four in 10 (43%) nurses are considering leaving their role in 2021. (This occurred right after the largest peaks in the pandemic.) 
• Another report from August 2020 found that more than 50% of the nurse respondents thought about quitting their job, yet on a more promising note, 90% of the nurses said they like their job and feel it is more important than ever. (This was taken at the time when the pandemic was moving into very high numbers of cases and deaths.) 

Hospital IQ conducted a survey in late 2021 with over 200 registered nurses working in hospitals. While the number of respondents is low, it shows some rather alarming results, including that 90% of the nurses surveyed are considering leaving the nursing profession in the next year!

Job security was also a concern for some nurses who had their hours or those of team members reduced during the pandemic due to: 

• Fewer patients coming in for office/hospital visits (65%)
• Fewer scheduled elective surgeries/traumas (42%)
• Their workplace being closed or scheduling fewer patients (36%)
• Their employer having financial problems (15%)

The reduction in hours made them question whether they should stay in their position or start to look for another job with better job security. 

A survey of physicians conducted in 2018, prior to the pandemic, found that almost half (48%) said they planned on changing careers due to extreme workloads (80%), burnout (78%) and pessimism about the future of medicine (62%). Virtually half (49%) said they would not recommend medicine as a career for their own children. This is very alarming!  A study done in the summer of 2021 found that physicians are leaving their practices at four times the rate compared to years before the pandemic.

However, there is some encouraging news as well. A recent study done by the American Medical Colleges found that even as the pandemic turned some people away from the medical profession, it also attracted others. They saw enrollments rise by 1.7% in 2020. It is encouraging to see that the pandemic may have attracted some people to pursue a career in medicine.   

Unfortunately, it is not just the staff nurses who are burned out and ready to leave their positions. There is also a dramatic change occurring at the nursing management level. A report indicated that the rate of managers leaving has increased dramatically, resulting in an entire generation of leadership that is suddenly “gone.” These are senior nurses who have years of experience, but they do not feel they can work with that level of responsibility and stress anymore. The manager position is a very difficult one. They are caught between the needs of the staff and the expectations of senior management, yet they are often not able to satisfy either of them. Senior management feels that teamwork and team performance are the manager’s top responsibilities, while managers spend most of their time dealing with operational and employee issues. Burnout and retention are key problem areas. The report suggested that leaders should support and reward their managers, who will, in turn, feel better about their role and pass that on by being more effective with their staff.

BURNOUT

Burnout is described as a feeling of exhaustion, cynicism, and disassociation from work that results from being chronically exposed to stress. During the pandemic, it was caused by the fear of contracting COVID-19, work overload, and the lack of time to relax and refresh oneself from the ongoing pressure. Burnout causes anxiety, irritability, fatigue, exhaustion, insomnia, and depression among other things. People may also turn to drugs or alcohol to get through this challenging time. For those who are still managing to work, their patient care may be affected by making mistakes or giving less than exceptional care. 

A 2021 survey of more than 20,000 U.S. healthcare workers by the American Medical Association showed that 49% reported at least one symptom of burnout, while another 43% experienced work overload. While the workload has been overwhelming, it is becoming even worse as more and more workers are retiring or quitting, resulting in an even smaller group of workers able to care for patients.

A Harris Poll survey taken in the summer of 2020 found that nearly one-third of the 300 nurse respondents at that point in the pandemic said they were able to maintain their mental health, while more than one-half of them said they felt their mental health had suffered.  

To address burnout, the management team and the employees both need to work together. Management needs to help reduce the effects of burnout by improving how work is done, but even more importantly how people are treated. Demonstrating this type of respect for the employees provides them with a sense of increased morale, engagement, incentive, empowerment, and pride in their work. Employees who feel respected and empowered can respond to a crisis like COVID-19 with energy and resourcefulness rather than fatigue and despair.

To ensure this type of respect in the workplace, specific behaviors need to be practiced in all interactions every day to make sure all workers can be successful. It lets the staff know what they can expect.

Leaders need to nurture this type of environment by:

• Providing an environment of respect and teamwork to encourage engagement and satisfaction
• Encouraging a culture of respect and autonomy and embedding these into processes and workflows
• Talking openly about and demonstrating respectful behaviors
• Setting clear expectations about how team members and patients should be treated
• Asking for input and feedback from the staff (people with less seniority)
• Allowing staff to have a voice in how they do their work, which creates a feeling of being valued, connected, and invested in their job
• Empowering staff to identify issues and resolve them on their own rather than wait to be asked for solutions or told what to do by management 
• Letting the staff know how much they are appreciated and how meaningful their work is to the organization
• Making tasks and processes that support overall goals more efficient and effective
• Helping employees to be successful by providing them with the right culture, tools and processes

In addition, employees who are experiencing burnout need to do everything they can to be positive, optimistic, connected and invigorated. Employees need to:

• Focus on taking care of themselves. Self-care is critical. They need to make an effort to stay close to family and friends, as their support is needed. 
• Seek the help of a therapist if work seems overwhelming or they become depressed.   
• Continue to learn. Things change quickly and there is always something new to learn. Attend conferences and workshops whenever possible. It is also good to learn new skills that make the employee up-to-date and therefore more valuable as a candidate for different career opportunities.
• Be realistic about what can be done. They need to realize they are not “superwoman” or superman” and sometimes goals will not be able to be met. They just need to make sure they do their best.
• Work on developing a sense of purpose and fulfillment – the antidote for burnout! 

NURSING: A VALUED PROFESSION

Once again, the nursing profession has been ranked as the #1 trusted profession in the U.S. for the 20th year in a row by the Gallup Honesty and Ethics Poll. Nursing received an 81% ranking followed by the #2 ranking profession (Medical Doctors) at 67%. 

I know I am biased, but I think nursing is one of the best professions anyone could have. There have been many days in my 56-year career when I was thankful that I chose nursing over my first choice – teaching. After all, teachers have shorter workdays and summers/holidays off, instead of working 12-hour night shifts, weekends and every other holiday as a nurse. However, I realize now that it was the best decision I ever made.

I would have been a teacher if my best friend had not invited me to attend a “Future Nurses” group meeting at our high school with her because she did not want to go alone. That meeting piqued my interest in nursing and the two of us decided to go to our local hospital school of nursing and room together. We were friends from the first grade and going to nursing school together just made our friendship even closer. Throughout the years we have been like sisters, rather than friends. I owe my whole nursing career to her for “forcing” me to go with her.

I cannot think of another career that offers so much variety as far as the type of nursing positions you can choose. In my career, I have worked as a nurse in an office, a visiting nurse service, a labor & delivery room, an emergency department, a national nurse advice service, two medical management companies offering CM/DM/UM services, a technology company, and consulting companies with assignments both here in the U.S. and abroad. My roles have included staff nurse, educator, content developer, management roles (manager, director, vice-president), consultant, subject matter expert, project manager, and “whatever other role was needed.” I was also able to have positions that offered a variety of shifts (days or nights – I never liked the evening shift) and to work weekends or not, depending on what fit into my family life at the time. Where else can you work in a career that gives you all these options and allows you move to another career area, while continuing to do what you love  – NURSING? 

For anyone reading this that is thinking of leaving the nursing profession, I would urge you not to give up. If your current position is not working for you, find another specialty area of nursing that you might like better or another type of role, e.g. teacher, quality management, call center advice nurse, technology subject-matter-expert, etc.  You worked too hard to get where you are today. Do not throw all that away. Think of the difference you are making in your patients’ lives. You may think what you are doing is just routine, but the patient and their family think what you are doing is far from “routine.” They value your assistance and support and depend on you to help them through their medical issues. 

So no matter how frustrated you may be, remember this is not the norm for healthcare. Take a step back and consider other areas of nursing you can work in. Things will get better and you will be able to find a nursing role that you enjoy.  

And for those of you who are retired or are ready to retire, consider continuing to work part-time in an area that you enjoy or volunteer in a nursing role at a school, church, community organization, or other agency. It will benefit you, the organization, and the patient. I have been retired for 8 years now, but I still consider myself a nurse and continue to volunteer for things that I feel make a difference. Nursing is a personal identity. It is who I am! I just cannot give that up.  

And if none of this rings true to you and you are perfectly happy in your nursing career – TERRIFIC! That is the way it should be. I would assume that most case managers are not as dissatisfied with their positions and were not as affected by the workloads and stresses of the pandemic as other hospital-based nurses may have been. But there is something I would like to request that you do. Encourage others to consider a career in nursing. Volunteer to speak to other groups, schools, or organizations about nursing and encourage high school students to look into a nursing career. If I had not gone to that meeting, I would not have had 55+ wonderful years in this profession.  

I am deeply concerned though about the impact the pandemic has had on the mental health and well-being of nurses who worked tirelessly to care for patients. The pandemic has had a significant impact on the nursing shortage and therefore on the nursing profession as a whole. I hope that we will be able to resolve these issues and solve this impending crisis. However, I am very hopeful because we are nurses and we can do anything we put our minds to!

ADDED BONUS:

In researching articles on healthcare trends over the past two months I found other articles related to new innovative treatments and the future direction of healthcare. I know you probably do not have a lot of extra time to research future technologies or treatments, given the amount of time you work, care for your family and try to fit in “private time” for you, so I included these on the next page for your review, if you have time. Enjoy!

A List of Interesting Articles on New Treatments and the Future of Healthcare

“Mark Cuban’s Pharmacy Started with a Cold Call”

“27 Medications with the Biggest Price Cuts on Mark Cuban's Online Pharmacy”

Have you been waiting for someone to do something about the cost of pharmaceuticals? Mark Cuban is doing just that. He says he is not interested in making money – he has enough- so he has set up a company that sells medications at extremely low prices. The savings range from $100 - $6,100 per prescription on 27 drugs and the consumer is the winner here! Hopefully this business model will succeed. 

 

“A Woman Was Cured of HIV Using Stem Cells From Cord Blood: How It Works”

This news was just released in February. She is only the third person to be cured of HIV and the first who received cord blood instead of receiving an intense bone marrow transplant.

 

“Paralyzed Man with Severed Spine Walks Thanks to Implant”

“3 Paralyzed Men Can Walk Again After Getting Electrode Implant”

This revolutionary technology gives patients with spinal cord injuries the ability to walk again, even those with a severed spinal cord. It is amazing how this could change the lives of it patients like these.  

 

“A Fall Shattered his Body. These Medical Marvels Pieced him Back Together.”

After a fall that nearly cost him his life, cutting-edge surgeries repaired his legs and pelvis, while virtual reality helped him deal with the pain during surgery.

 

“The State of Exoskeletons in 2022” from the Medical Futurist. 

Science Fiction is becoming a reality. Exoskeleton robots have been around for years, being used in movies and as robots to assist humans to perform tasks in factories. Now this technology is being used to allow paralyzed patients to move, walk, and live near-normal lives again. These examples are amazing!  Think how this can transform a life!

 

“The “Next Frontier” for Pioneering Cancer Therapies”

Cancer treatments that modify a patient's immune cells to attack cancer cells is not new, as they are being used to treat blood cancers and multiple myelomas. In this process, a patient’s T cells are reprogrammed with an antigen that binds to the surface of the cancer cell. The cells are re-infused into the patient so they can attack the cancer cells. The treatments have been approved by the FDA and they are showing success for some blood cancers and multiple myeloma.

 

“CAR T Cells: Engineering Patients’ Immune Cells to Treat Their Cancers”

Researchers are also working on trying to duplicate the above process for solid organ tumors, which account for up to 90% of the adult cancers. Clinical trials are now being conducted on cervical cancer patients. Work on solid organ tumors is more challenging, but has a very promising future.

 

“How The Metaverse Could (Or Could Not) Transform Healthcare”

I am sure you have heard the term “Metaverse” and its new direction for Facebook, but do you know what it really entails? I know I did not. It has innovative implications for changing processes in healthcare.