Nurses are stressed out and burned out – putting your health at risk
About 15,000 Minnesota nurses recently went on strike over concerns regarding staffing, pay and patient safety. According to the Minnesota Nurses Association, it was the largest ever strike of private-sector nurses in the United States.
Nursing strikes happen from time to time and don’t get much notice. This spring and summer, when nurses in California walked out of hospitals, there was little national attention.
While disruptive to patients – appointments and elective surgeries need to be rescheduled – the latest labor actions have more significance because of the current health care landscape, especially as it relates to the diminishing number of nurses.
More than 1 million new nurses needed
The Government Affairs Committee of the American Nurses Association predicts that the United States will need to produce more than 1 million additional nurses to fill both new nursing jobs and replace the ever-increasing wave of retiring nurses.
This isn't the first time we've experienced nursing shortages. These crises come in waves, cresting then eventually abating. The difference this time though is, in the past, we were always able to restock the supply with nursing school graduates. Not this time.
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One reason is that there are not enough experienced nurses available to teach in nursing schools, leaving more qualified nursing school candidates competing for spots than are available.
Exacerbating this trend is the fact that the average age of nurses continues to rise, meaning more nurses are set to retire each year. Today, the average nurse is 43.7 years old, up from 38.9 years old in 1978, and the proportion of nurses over age 55 has increased from 13% to 23% over the same period
Why are we not attracting – and retaining – new people to the field?
Part of the answer came from a recent Hospital IQ survey of more than 200 registered nurses working in U.S. hospitals. The results were alarming – not just for the health care industry but also for patients, who are directly affected by nurses’ work conditions:
►90% of respondents considered leaving nursing in the next year.
►71% of nurses who have more than 15 years of experience considered leaving within the next few months.
►72% of respondents said they experienced burnout long before the pandemic.
►43% revealed that due to a shortage of technicians in their hospitals, nurses are now tasked with non-nursing duties such as cleaning hospital rooms, procuring supplies and completing clerical duties.
Patient-to-nurse ratios are alarming
As always, patient-to-nurse staffing ratios are a primary concern: 84% of emergency room nurses and 96% of critical care nurses have a 4-1 ratio, which is double the optimal target of 2 to 1.
Due to increased job demands, 39% of nurses who responded to the survey said they were experiencing serious mental health issues, like anxiety or depression.
Poor staffing ratios don’t just mean nurses have to work harder – though they do. The greater concern is that when nurses are required to care for more patients, beyond the capacity of any one person regardless of skill or experience level, medical errors increase and patients are the loser.
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Do you want your nurse, after you’ve had cardiac surgery, to care for too many patients and be forced to go too fast to get everything done? Or your child cared for by an emergency department nurse who is stretched thin, administering potentially harmful drugs like opioids for a leg fracture on the soccer field, medications that are easier to dose incorrectly than one might think.
As it is, up to 251,000 deaths in this country occur each year due to medical error. This number won’t get better with extra strain on the nurses – and might get quite a bit worse.
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Much has been (rightly) written about the impact of physician burnout, a significant problem for society because many doctors are looking to exit the field, especially due to the pandemic. But I would argue that the nursing shortage, due primarily to work conditions imposed by the hospitals, has the potential to be far more damaging.
As much as I would like to think that during my career I personally helped many patients, I believe that nurses have a larger role in day-to-day, minute-by-minute care of patients, because their contact time is so much greater. Doctors are in and out of a patient’s room, often with just a few moments of face time. In contrast, nurses are there for 12 hours, sometimes longer. Who do you think has the greater ability to either make or break a patient’s hospital experience?
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In spite of this, nursing staffs are a constant target for hospital cost cuts. A New York Times report found that at least 36 of the top 60 hospital chains in America laid off, furloughed or cut the pay of nurses to save money during the pandemic – despite receiving government bailout money to help avoid such cuts. This is exactly the wrong move, if hospitals are interested in achieving high-quality care and containing costs.
A report from the Healthcare Financial Management Association concluded that having enough nurses saves money, because there are fewer medical errors, patient falls, hospital-acquired infections and patient deaths.
Yet, nearly every time hospitals want to reduce costs and improve efficiency, firing nurses seems to be the preferred strategy. Nurses being viewed as replaceable commodities led author and nurse advocate Theresa Brown to conclude that “knowing the system cared more about money than patients ruined nursing for me.”
Which brings us back to Minnesota. The nurses there are requesting a 27% pay bump over three years, the union said. The hospital system, Essentia Health, said it is offering a 10% wage increase over three years and an immediate 1% bonus. I am no economist, but this appears to be a wage increase below the expected rate of inflation.
Although the nurses in Minnesota have now returned to work as negotiations continue, it doesn't feel like the end but rather a signal of more to come.
And neither nurses nor hospitals will be the main losers – patients will be.
Dr. David Weill is the former director of the heart and lung transplant program at Stanford University. He’s also the author of “Exhale: Hope, Healing, and a Life in Transplant.”
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This article originally appeared on USA TODAY: US nursing strikes mean burnout, shortage about to get worse
