As an emergency room nurse, Terry Foster has cared for people on their worst days. He loves his work, and as president of the Emergency Nurses Association, a group that represents about 50,000 nurses, he’s met countless others who share a similar commitment to helping others. But he’s concerned about the future of his profession.
“I’ve worked in the emergency department 45 years, and you’re not going to hear people say that again. I don’t think you’re going to see that kind of tenure anymore,” he said.
Something changed with the Covid-19 pandemic, Foster said. That change is among the many captured in the 2023 Survey of Registered Nurses from AMN Healthcare, a nurse staffing company.
The biannual survey of 18,000 nurses, published Monday, points to what AMN Chief Clinical Officer Dr. Cole Edmonson called a “perfect storm” of problems for the profession that could leave the US health care industry without the nurses it needs.
The survey, which was conducted in January, shows a group of professionals who care very much about their work, but it also shows a significant decline in work satisfaction and a significant increase in stress levels. Many are thinking about leaving the profession.
“A crisis in nursing is upon us,” Edmonson says in the survey.
Nurses typically like their profession, surveys have found over the years. For more than a decade, their career satisfaction was around 80% to 85%. Yet when they were asked in the new poll whether they were extremely satisfied or somewhat satisfied with their choice of nursing as a career, the number dropped a full 10 percentage points from the most recent AMN survey, done in 2021.
If 71% of nurses say they are satisfied with their work in 2023, that’s still a lot of people, but the drop is concerning, said Christin Stanford, vice president of client solutions for AMN Healthcare.
“I don’t think any of us were prepared to see just how drastic the drop was in career job satisfaction, mental health and well-being, and what the overall feeling of the nurse profession today was,” she said.
Another troubling sign, she said, is that younger nurses seem less satisfied with their careers than older professionals.
Research has shown that nurses who are satisfied with their work typically stay on the job. But only 63% of millennials and 62% of Gen Zers said they were satisfied with their career choice, as opposed to 78% of baby boomers.
“The overall data is very concerning. But if you segment out and look at a few different splices or populations within the survey data, it is even more distressing,” Stanford said.
The survey found that many nurses are thinking about leaving their jobs.
Hospitals could face the most instability. Only 15% of hospital nurses say they will continue in the same job in one year, the survey found.
Nearly a third of all the nurses surveyed said they are likely to leave the profession, up 7 points from the 2021 survey.
Only 40% said they will stay in the same job in one year, a 5 percentage-point drop since 2021. The rest said they will look for work as a travel nurse, move to part-time or per diem work, take a job outside of nursing or patient care, or return to school.
Foster, who works as an emergency room nurse in Northern Kentucky and was not involved in the AMN survey, in part faults typical burnout. About 100,000 registered nurses in the US left the workplace due to the stresses of the Covid-19 pandemic, according to the results of a survey published this month by the National Council of State Boards of Nursing.
Foster says patients and their families have also changed in recent years.
“There’s just a new level of incivility from the public,” he said.
The same violence seen in social media videos of people attacking flight attendants or fast food workers is happening more and more in health care settings, he said. Health care workers are five times more likely to experience workplace violence than employees in all other industries, government surveys have found.
“We’re just trying to take care of people, and they’re lashing out at us,” Foster said. “It’s patients who don’t want to wait, or they act out or are very dramatic or violent. And sometimes our patients are fine, but their families will lash out at us and threaten us.”
This new survey showed that 4 out of 5 nurses said they experienced “a great deal” or “a lot of stress” in their work, an increase of 16 points since 2021.
More nurses said they worried that their job was taking a toll on their health, and they often felt emotionally drained.
Nearly 40% of nurses surveyed said they felt burnt out. Nearly a third said they felt misunderstood or underappreciated, and about the same number felt that they were not getting what they needed out of their job.
Another part of the problem is a lack of adequate staffing.
Only a third of those surveyed said they had the ideal time they needed with patients, a 10-point decrease from 2021. The percentage of nurses who were satisfied with the quality of care that they were able to provide fell 11 points, from 75% in 2021 to 64% in 2023.
Stanford said that in just a couple of years, the profession will be 1 million nurses short, partially because of a demographic change.
Baby boomers are reaching the age of retirement, and there will be more demand for nurses because boomers are also reaching the age when they need more medical care.
Another problem is education. While the number of candidates who passed the nursing licensure exam has steadily grown over the years, according to the union National Nurses United, there are still many more people who want to become nurses than there are classes. Schools just don’t have enough people to teach, Stanford said.
There may also be a lack of interest in doing the work in today’s environment.
There are about a million registered nurses with active licenses who are not employed as nurses, according to a National Nurses United analysis of Bureau of Labor Statistics data from 2021.
Coming out of the pandemic, far too many hospitals cut corners on staffing and allowed a higher nurse-to-patient ratio, said Kristine Kittelson, an RN in Austin and a National Nurses United member. Essentially, that’s placed nurses in a moral dilemma, she said, where they can’t completely help their patients even if they want to.
“We are being put in these challenging work environments that really forced us to feel like we, as nurses, aren’t providing the best care that we can,” said Kittelson. who also was not involved in the new survey. “We’re just not being given the resources that we need and the staffing that we need.”
More flexibility in schedules could help, Stanford said. Do nurses have enough flexibility to take time off and take care of themselves?
Nearly every nurse who participated in the new survey said they wanted increased staff support, a reduction in the number of patients per nurse, an increase in salary, a safer working environment and more opportunities to share their input with decision-making.
“This is a great profession, and it’s very rewarding, but I think that the pandemic has really shown how undervalued we are,” Kittelson said. “We should just be able to put in a position to give patients what they deserve and not feel stressed.”
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