Work is Really Difficult for Nurses Right Now. We Can’t Just Return to the Old Normal.

Despite the horrible darkness of COVID, it has shined a very bright light on the courage, dedication and loving care for patients (and each other) that nurses have always possessed. They’ve been called “super-heroes,” “angels,” and “warriors,” and nursing remains one of the most respected professions in the U.S. 

Yet, the toll on nurses has been heavy, and even deadly. 

Two recent articles discuss the toll nurses bear, sharing different paths to lighten that load. The first article we’ll discuss here, in the New York Times (Aug. 12, 2021), is “Nurses Deserve Better. So Do Their Patients.” The second article is, “Why it’s so hard to be a nurse in America, according to two nurses,” which appeared in Vox.com (Aug. 16, 2021). 

Nurses Deserve Better. So Do Their Patients.

The author of this guest essay is Dr. Linda Aiken, a professor of nursing and sociology and the founding director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing. 

She notes, “More nurses died of job-related Covid than any other type of health care worker. The more than 1,140 U.S. nurses who lost their lives in the first year of the pandemic knew the risks to themselves and their families. And yet they stayed in harm’s way. They cared for their fallen co-workers.”

“But if we value their sacrifices and want them to be there when we need them, we must prevent a return to the poor prepandemic working conditions that led to high nurse burnout and turnover rates even before Covid.”

Dr. Aiken says that, despite a “robust supply of nurses” in the U.S., “we find ourselves too often with a shortage of nursing care. Many decades of research reveal two major reasons: 

First, poor working conditions, including not enough permanent employer-funded positions for nurses in hospitals, nursing homes and schools. 

And second, the failure of states to enact policies that establish and enforce safe nurse staffing; enable nurses to practice where they are needed, which is often across state borders; and modernize nurse licensing rules so that nurses can use their full education and expertise.”

Further, “… More responsible management practices in health care, along with better state policies, could [solve these problems].

Not only are states not requiring safe nurse staffing, but individuals also do not have the information and tools they need to pick hospitals and nursing homes based on nurse staffing or to advocate better staffing at their hospitals and nursing homes.”

Dr. Aiken proposes potential solutions:

• States, under their authority to set occupational licensing and facilities requirements, should “set meaningful safe nurse staffing standards” (these limit the number of patients one nurse is responsible for at a time);

• States should waive rules that restrict a nurse’s practice to just the state in which the nurse is licensed (Governors waived such restrictions on an emergency basis, there’s no reason to reinstate these restrictions);

• The federal government “should require hospitals to report patient-to-nurse staffing ratios on the Medicare Hospital Compare website, because transparency motivates improvement)”;

• The federal government could “incentivize the states to pass model nurse practice acts.”

Dr. Aiken concludes:

“While we long to go back to pre-Covid life, returning to chronic nurse understaffing in hospitals, nursing homes and schools would be a big mistake. We owe nurses and ourselves better health care resources. The so-called nurse shortage has become an excuse for not doing more to make health care safe, effective and patient-centered.”

Why It’s So Hard to Be a Nurse in America, According to Two Nurses

Katherine Harmon Courage, the author of this article on vox.com, begins with a quote from an ICU nurse from the Seattle area:

“No amount of money could convince me to stay on as a bedside ICU nurse right now. I can’t continue to live with the toll on my body and mind. Even weekly therapy has not been enough to dilute the horrors I carry with me from this past year and a half.”

This nurse, identified only as Sara, further noted, “We’re not soldiers. We’re not the saviors of humanity. We’re humans who have families and the need to take care of ourselves.”

The mental health issues of the nearly 3 million registered nurses in the U.S. are, at best, only barely known or understood. Nurses are leaving the profession “at a staggering rate,” and a “perpetuating a cycle of burnout and likely worsening the quality of care for patients.”

“The mental health of nurses was taxed even before the Covid-19 pandemic. Female nurses in particular were at twice the risk of dying by suicide as women in the general population, according to research published earlier this year. And that’s only ‘the tip of the iceberg,’ said Christopher Friese, a professor of nursing at the University of Michigan and a co-author of the study. ‘What I worry about is the large number of nurses that we can’t even quantify, that are suffering in silence.’”

Friese, who has practiced as a registered nurse for 27 years, spoke with Vox about the toll nursing can take on mental health, and what has to change for nurses to get the support they need.

When asked what some of the biggest strains were on nurses prepandemic, Friese broke the stresses into two buckets:  the role of caregiver for their families; and, the workplace. 

“We’ve known for over a decade that nurses have been concerned about their workloads. They’ve been concerned about the resources that they have to take care of patients or communities. And they are often the group that we add new tasks on to. So adding the electronic health record has placed that very heavy burden on nurses because nurses are sort of a catchall for all of that work. And we haven’t taken anything away from nurses. The only thing we’ve done is continued to pile on to their work.”

Friese added another major strain: the hostility nurses face at work. Increasingly, patients, families and fellow staff members are verbally and physically abusive: “We have not created a safe environment to work.” 

“We have not created a safe environment to work.” 

Discussing how COVID is impacting nurses and their mental health, Friese said that, in addition to PPE concerns and worry about their colleagues and their own safety, “There is also a unique combination of their personal health at risk, their loved ones’ safety, and then the societal split in our approach to this public health crisis, which you’re seeing right now. We have really good tools to protect our population — we have really effective and very safe vaccines. We’ve learned in this pandemic that masking and staying out of crowds is effective. And yet we have a swath of the population who is not doing that. And they’re in our ICU and they’re in our hospital beds, and nurses have to live with that duality.”

Regarding access to good mental health care, many nurses have “reasonably good” health insurance, so access is likely there. However, Friese said, “it’s very difficult for health care professionals — and especially nurses — to seek out mental health services because of the stigma we have in place. Nurses might be concerned that if they seek out mental health services and undergo treatment, that might jeopardize their employment.”

How Can We Take Better Care of Nurses?

Replying to the question of how we can help nurses, Friese said:

“We all have a family member or a loved one who’s a nurse. And I think oftentimes we don’t necessarily check in with them and ask them how they’re doing, how their day was. We know their work is difficult…. But checking in with loved ones who are nurses, making sure they know they’re valued. If a family member is struggling, making sure they know that is a normal thing and that seeking help is perfectly okay.

I think we also need to have a conversation as a nation about how we value nurses — and how we structure health care so that they can actually be the best nurse they can be for our patients and for our loved ones. Right now, it’s very transactional. We really need to think carefully, particularly after this pandemic: Can we redesign their work so that we take full advantage of their clinical skill? I think right now we’re not doing that.

The last thing would be to advocate for research on nurses. That has not been valued. Just like we want better understanding of diabetes and cancer, we want to have a better understanding of: Are nurses at risk, and what can we do to help them? We have the tools to do this.”

How Do We Make Meaningful Progress to Help Nurses?

I think the best way to address that question is to quote questions, and a warning, Christopher Friese posed:

“Do we as a society want to put value on this? Do we want to try to better understand how we can have a healthy, safe nursing workforce? I think, for our loved ones, that’s the question. Because if we don’t, we’re going to be in big trouble.”