Home Organisation Tips Health Nurse – Nurses aren’t doing well: Why they’re quitting and what it means for the future of healthcare
After more than eight years working in the intensive care unit of a big city hospital, Michelle Toney has seen a lot: drug overdoses, trauma victims, violently assaulted patients. It was tough, but she loved it: “That constant stress and adrenaline is something I got over.”
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Now, two years after the pandemic, he’s thinking about something he hadn’t before: leaving the intensive care unit. “I can’t do this anymore,” said Toney (who is using a pseudonym to protect his privacy).
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Across the country, nurses are leaving their bedside jobs at an alarming rate — both mentally and physically exhausted from dealing with the number of sick COVID patients, fearing for their lives, and people refusing or even refusing Covid vaccines. the virus is dangerous. The remaining nurses are left to care for more people with fewer resources, worsening a fragile system and harming patients and healthcare providers.
Nursing has always been hard work. A wave of hospital consolidation in recent decades has helped drive down nurses’ wages and contributed to staff shortages. However, Covid has turned the problem into a crisis. More than a third of nurses plan to leave their current job by the end of the year, according to a survey by nurse staffing firm Incredible Health. The American Association of Critical Care Nurses (AACN) recently found that 66 percent of acute and critical care nurses have considered leaving the profession.
And in the wake of the pandemic, there are signs that fewer new nurses are entering the profession, creating problems that could outlast the virus. Without systemic changes that address the forces driving the current shortage, many hospitals will lack the nursing staff needed to provide good patient care.
“Treating so many patients and not getting the treatment they need is a huge moral stress,” said AACN President Beth Wathen. “Nurses have borne a collective and profound burden over the past two years, witnessing the deaths of hundreds of thousands … the exhaustion right now is overwhelming.”
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Before the pandemic, 17 to 38 percent of nurses had some form of depression, and female nurses, who dominate the profession, died by suicide twice as often as non-nursing women. But “the pandemic has really increased the burden on nurses to an unbearable level,” Wathen said.
Toney has vivid memories of his hospital’s first covid outbreak in November 2020. “I would go to work and see death all day,” he said. Patients in the intensive care unit are the sickest in the hospital, but the hospitalized covid patients required a higher level of care than the department’s normal patient load. Nurses began to leave with each new wave of infection, and the unit struggled under a workload that sometimes tripled.
Eventually, Toney began taking anti-depressants, and he and his co-workers asked senior management for mental health help, including help paying for therapy sessions. But nothing changed. “If there was more help when we called for help, I might have seen myself stop,” he said. “It’s too late now. I don’t have it in me anymore.”
Lack of personnel is one of the main causes of moral stress and burnout. “Both increase nurses’ workload, which in turn makes them less valued by [employers],” said Jane Muir, a nurse and nurse researcher at the University of Virginia.
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For most hospital settings, “four or fewer patients per nurse is associated with increased well-being and decreased burnout,” Muir said. Hospitals often violated this ratio before the pandemic, but many have fared well during the rise of the coronavirus.
After hearing horror stories from other nurses, Kentucky nurse Daniel Potter launched HospitalRatios.com in late February. With her 2-year-old son in her arms, Potter created a grassroots website where nurses could share information about working conditions. Over 300 nurses submitted information on the site’s first day. Only about 16 percent said their facilities were adequately staffed.
“The longest [during the pandemic] was working behind the scenes, the signs in front, the pizza parties … the first six months,” Potter said. “But after that, no one ever wanted to do any kind of raise, like a real long-term raise to keep people.”
In some cases, nurses were laid off or asked to take pay cuts as hospitals canceled elective surgeries and outpatient clinics, usually their main sources of revenue, to cope with the influx of Covid patients.
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Laura Stambach, a nurse who began her career at a New Jersey hospital during the pandemic, often saw eight patients in the emergency room, sometimes 12. “You were always suffocating. We had no help,” she said. He collected the toll. During that time, “more patients died than lived, and I’m eliminating that now,” he said. “At a certain point, you become almost immune because you have no other way to protect your emotions.”
Caring for unvaccinated COVID patients after the shots became widely available added another layer of anxiety. “Now that we have a vaccine, it’s harder to see people die because you know it could have been prevented,” he said. After a year and three months, Stambach left to take a more lucrative job as a travel nurse, working short-term jobs for higher pay that gives her more time and money to care for her mental health.
As the patient load increases, many hospitals have placed new responsibilities on nurses, such as conducting outpatient covid tests for staff. “I would have to go potty in the middle of the workday, every couple of hours,” said Clare Hourihan, an emergency room nurse in Buffalo, New York. Because the staff is already reduced, you can’t go [as often] to do the COVID amount,” he said.
Increasing hospital staff shortages and pandemic restrictions on access to patient rooms have also led to many nurses taking on tasks that others did before covid hit, including delivering food trays, mopping floors and opening toilets. When family members were prohibited from visiting patients, nurses often let the sick and dying hold an iPad to say goodbye to their loved ones.
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In the early days of the pandemic, nurses and other healthcare workers were attracted by a grateful public. But that support has waned and in some cases turned hostile as the covid response has become a politically polarized issue. “I was salivating at nursing,” said Vicki Good, chief nursing officer at Mercy Hospital in Springfield, Missouri. “Suddenly we’re going from heroes to villains…physical and emotional violence against healthcare workers is on the rise like never before.”
According to the Bureau of Labor Statistics, between 2011 and 2018, the number of fatal incidents of violence against health care workers increased by about 60 percent. According to a recent study, in the first months of the pandemic, 44 percent of nurses reported experiencing physical abuse (including hitting, biting, choking, and hair pulling), and 67 percent reported being verbally abused by patients. Nurses caring for Covid patients were more likely to experience both types of abuse.
These increasingly cramped work environments can rob nurses of the very thing that called them to the profession: compassion. “Compassion fatigue beats burnout,” said Robin Cogan, a school nurse in the New Jersey Camden City School District. “You feel like you have nothing left to give. It creates this distancing, like a defense mechanism,” he said, to protect you from the trauma of others. “It’s a terrible feeling, especially if you’re a nurse and you believe in the power of compassion.”
Burnout, moral stress, and compassion fatigue are naturally horrendous for nurses, affecting heart disease and gastrointestinal disease as common as insomnia and depression. This stress is not limited to nurses.
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“In hospitals, everything that touches the patient goes through the hands of the nurse,” said Karen Lasater, a nurse researcher at the University of Pennsylvania. “When nursing is depleted, there is no quality of care.”
Research confirms this. Burned-out nurses are less likely to administer medications to patients on time and are more likely to lose control of infections and report patient falls. Hospitals with more burned nurses have a higher mortality rate. Burnout also has to do with employers wanting to leave, Lasater said, depleting units from the deep knowledge bank that helps train and support new nurses.
Without major changes, this downward spiral of deteriorating working conditions and increased burnout will only continue. It takes more than pizza parties and yard signs to stop. “We need system-wide changes,” Wathen said. “This is not an individual problem; To deal with these things, we need fundamental systemic changes
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