COVID: The Straw That Broke the Nurse's Back

AnneD.RN

You probably recall watching the frightening and surreal news stories unfold in the Spring of 2020. Hospitals were overflowing with patients infected with COVID, medical facilities were clamoring to obtain supplies that were formally considered basic necessities and the general population depleted grocery stores of toilet paper and Clorox wipes. The COVID pandemic brought the attention of the media to the inside of hospitals. News teams covered the terrifying scenarios of ventilators being shared between patients, patients being boarded in hallways because there were no rooms available and healthcare providers struggling to stabilize patients who were deteriorating from a virus that they did not yet understand. Worldwide, cities started to open their doors at night to applaud and cheer on hospital workers as those workers continued to head to work to face a day of unknowns. Over the next two years, the world would watch the pandemic unfold and the struggles that accompanied each new step in its journey. The public expressed empathy for nurses that were leaving the workforce and nodded their heads in an understanding of being overwhelmed by the pandemic. The truth is that nurses were already overwhelmed long before the pandemic and that COVID was simply the last straw that broke the camel’s back for nurses.

Most nurses that I have known went into nursing out of a desire to improve the lives of others. One study showed that reasons people decided to enter nursing school included “being able to help and care for people, job security, the ability to enter tertiary education, and the enjoyment or love of nursing"¹. Although nursing school provides the tools needed to care for patients, it is challenging to prepare nurses for the physical, emotional and mental struggles of their day-to-day job. It is more challenging to teach nurses how to care for themselves. One of my nursing colleagues shared with me that in her first year as a nurse, she did not have time to use the restroom during her 12-hour shifts. As a result, she developed multiple UTI’s in that first year. My colleagues and I incurred injuries related to repositioning patients and needle sticks within the first 1-3 years.

Although most new graduate nurses receive a 3-month orientation with a precepting nurse, realistically 12 months is required to become proficient in administering various medications, utilizing medical devices, conducting wound care, and navigating the psychosocial issues that are affecting patients. This first stage of nursing is often overwhelming. You can ask any nurse and they can tell you which supply closet or bathroom they would go hide in so that they could cry at some point during those first 12 months. After surviving that first year as a nurse, tasks become more second nature. However, nurses are still expected to prioritize the needs of others or the hospital over their own basic needs. If you conduct an internet search including keywords such as “lawsuits nurses meal breaks”, you will discover page after page of class action lawsuits taken by nurses against hospitals due to being unable to take a lunch break during their shift. Nurses have been expected to neglect their own basic needs in a very physically demanding job. This type of repetitive neglectful behavior easily leads to symptoms of burnout.

Burnout is not a new topic in the field of nursing. A 2018 survey of nurses revealed that 31.5% of those who left their jobs attributed the reason for leaving to burnout. Those who were leaving or considering leaving because of burnout specifically attributed their burnout to “stressful work environment” and “inadequate staffing”². By 2020, 62% of nurses were experiencing burnout symptoms³. With the COVID pandemic, a new set of burdens had been added to the nursing field. Nurses were attempting to deal with a virus, for which they did not have a standard protocol of treatment. There was a shortage of PPE (personal protective equipment), which meant that nurses and staff had to use makeshift PPE at times, including garbage bags for gowns and reusing days-old N95 masks. Prior to COVID, using this type of makeshift PPE would warrant a nurse being written up for incorrect and unsafe practice. Nurses would often isolate themselves from their own family members at home out of fear of passing the virus to a loved one. In 2021, hospitals and states started to mandate that all staff receive the COVID vaccine. Nurses that had once been hailed as heroes for going into work without any protection, were now having their jobs terminated solely based on the fact they declined the new vaccine. A 2021 survey attributed feelings of burnout among nurses to low staffing, emotional exhaustion and high workload demands as the top 3 factors⁴. With nurses leaving due to burnout and nurses being terminated due to refusal to receive the COVID vaccine, hospitals were left with a significant nursing staff shortage.

Hospitals realized that they needed to find ways to hire nurses and retain them. In order to temporarily fill the gaps, hospitals offered an unprecedented amount of money for travel nurses. Depending on what part of the country a nurse lived in, they could make their annual salary in one 13-week travel assignment. However, these contracts would only serve as temporary solutions for hospitals. Hospitals realized that they need to find ways to retain nurses. Soon, hospitals were offering to hire nurses with sign-on bonuses, which had not been commonly seen for well over 10 years. Parkland Health and Hospital in Dallas, TX has been offering its employees a temporary contract that pays close to what a travel nurse contract would pay, in order to provide them with a financial motivation to stay⁵. Many hospitals have been exploring how to reduce staffing shortages even prior to the pandemic. American Sentinel offered strategies including reducing overtime and eliminating mandatory overtime, supporting acuity-based staffing tools, and recognizing nurses’ needs for work-life balance⁶. The Mayo Clinic instituted a stress management program to educate staff on how to recognize stress and techniques to deal with stress⁷. Many of the most nursing-friendly hospitals have received ANCC Magnet recognition and have innovative perks such as weekend shift differential and even financial support for nursery care⁸. Ultimately, if hospitals plan to find a way to retain their nurses, they need to look at what nurses need as full human beings, not just as a name filling a staffing vacancy.

Prior to the pandemic, nurses were already experiencing symptoms of burnout due to stress and understaffing. The COVID pandemic brought additional aggravating factors that only heightened stress and understaffing. If hospitals and medical facilities wish to retain their nurses, they need to reassess the needs of their nursing staff. Nurses need to know that when they come to work, they will be assigned a safe and appropriate workload. Nurses need to have a say in how their shifts are chosen. Nurses need to be compensated for additional work that they are asked to take on, whether it be financially or with additional benefits. Nurses need to be provided tools to safely deal with the physically and emotionally challenging work that they are tasked with.

FACT: Ultimately, if hospital leaders want their nurses to stay, they need to ask their nurses what they need, listen to their responses and act on these requests.

References

¹The reasons students choose to undertake a nursing degree

²Prevalence of and Factors Associated With Nurse Burnout in the US

³We need to talk about burnout the same way we talk about benefits

⁴Nursing CE Central: Nurse Burnout Study 2021

⁵Hospitals innovate amid dire nursing shortages

⁶Nursing Turnover: Why it Happens and Retention Strategies

⁷Hospitals Explore Innovative Nurse Retention Strategies

⁸30 Most Nurse Friendly Hospitals in the US