They're exhausted. They dread going to work. Others are retiring early and quitting. Nurses all over the country are burned out. Three years into the pandemic, the toll of working short-staffed, without enough supplies and in crowded hospitals is overwhelming. Many nurses are simply not OK.
A new study shows more than one third of nurses plan to leave their jobs at the end of this year because of their high-stress work environments, pay and benefits. Another alarming study this month says female nurses are twice as likely to commit suicide as other women from the stress of long hours and constant exposure to severely ill and deceased patients. The study also found female nurses are 70% more likely to take their own lives than female doctors. On March 21, President Biden signed the Dr. Lorna Breen Health Care Provider Protection Act to support and protect healthcare workers from mental and behavioral health issues, including suicide, stemming from high levels of burnout during the pandemic.
So, what can be done to relieve the pressure? We’ve asked two experts at the University of Colorado College of Nursing to weigh in on this subject.
About Our Expert
Priscilla Nodine, PhD, CNM, FACNMA. She’s an associate professor of Clinical Teaching at CU College of Nursing and co-chair of the Nurse-Midwifery program.
Dr. Nodine is ardent about improving pregnancy outcomes through maternal health behavior change and nurse-midwifery education. Her teaching, research, practice, and service focus on these two areas of interest.
Nodine is currently the PI on two projects, Intrapartum Nitrous Oxide, a national database, and Graduate Student Stressors during COVID-19, a mixed-methods study.
Since 2009, Nodine has taught graduate-level courses at CU College of Nursing. She joined as full-time faculty in 2015. She works to include methods for different learning styles, to tap into critical thinking skills, and to feed students’ educational passions.
First, we spoke with Priscilla Nodine, PhD, CNM, FACNM. She’s an associate professor of Clinical Teaching at CU College of Nursing, faculty in the nurse-midwifery program, and the primary investigator on a study of nurses in graduate nursing programs during the onset of COVID-19 that included mental health.
Dr. Nodine, what surprised you in your study about burnout?
Nursing burnout is not new. It is a term coined in the 1970s and 80s describing the mental, emotional, and physical stress found in helping professions. But the onset of COVID-19 was a perfect storm, which brought more burnout.
From talking with colleagues and students, I hear that most are at a tipping point toward being burned out or are already there, and trying to hold on. Our study found:
- They don’t feel valued.
- Poor staffing.
- Exposure to suffering, pain, sadness, death.
- Burnout is “contagious” between nurses on a unit.
For those not in the profession, can you describe what it has been like for nurse-midwives during the past three years, especially compared to before COVID-19?
We have a large nurse-midwifery faculty at University of Colorado. For three years, we have been wearing masks at work. We weren’t on the COVID units, but took care of COVID (+) patients in the outpatient setting and inpatient (on labor and delivery) before we knew much about the disease, how best to protect ourselves and how infectious it was. We were with women in labor who could not have any family present. There was a lot of uncertainty around the disease, what to tell pregnant women about how it might affect their fetus, etc. Now, we know more and this makes it easier to talk with our patients. We haven’t had any severe staffing issues.
It is harder for the staff nurses in the hospital with staffing issues and rotating to other floors, COVID floors, when necessary.
The pandemic is still here and with evolving viruses, the pressure is unlikely to let up on healthcare workers. What is the solution here?
I have a theory that nurse burnout is associated with nurses not being able to practice to their full-scope. Nursing is a caring profession, which means we do for our patients what they cannot do for themselves and we help them to reach their best health. And it is about the interpersonal relationship with the patient and education of the patient. With understaffing and without institutional support for these activities, nurses are unable to do their job as they were taught. Institutions need to support nurses to practice full-scope nursing, not just going room to room putting out fires, so to speak, and doing tasks.
What steps can nurses take to care for themselves?
They should first have a strong support system at work and at home. They should take time to care for themselves when at work and also when off work. They should eat well and get good sleep.
As a professor, what do you tell your students about entering this profession knowing other infectious diseases will spread?
I tell them they are needed. The health care system is broken, and that they can make a difference one patient at a time or by advocating for the nursing role. We need to change how we care for patients and nurses should lead the cause. It is still a good profession. There are so many ways to be a nurse: focus on all sorts of areas, neuro, surgery, childbirth. One can work outpatient M-F or in the hospital doing shift work in many different areas. One can do hospice work at peoples’ homes. You get to be a part of others’ lives in ways that other professions cannot. It can be so rewarding. Difficult, but rewarding.
We also spoke with Laura Rosenthal, DNP, ACNP, FAANP who is associate professor of Clinical Teaching, an assistant dean of the DNP program and the president of the Colorado Nurses Association.
About Our Expert
Laura Rosenthal, DNP, ACNP, FAANP. associate professor of Clinical Teaching and assistant dean of the DNP program at the College of Nursing. Dr. Rosenthal is also president of the Colorado Nurses Association.
Rosenthal has been a registered nurse since graduating with her BSN in 2000. Her background includes practice in acute care and inpatient medicine.
While working as a nurse practitioner at the University of Colorado Hospital, she assisted in developing one of the first fellowships for advanced practice clinicians in hospital medicine. Her interests focus on quality improvement in the clinical setting as well as the education of DNP students.
As the president of the Colorado Nurses Association, what are members saying about the past three years?
The stress and the burnout have increased significantly. I hear from nurses all the time they have too many patients to take care of, they don't feel like they're able to provide safe care, that they're not being listened to, and they don't feel valued.
I did hear from one of our nurse managers that things are loosening up a little bit because the wave of COVID is going down. So, I think that's a big relief. But she had six nurses resign last week from her floor.
There have been two new studies about this subject. What did they find?
The American Nurses Association came out with their second-year study. Fifty-seven percent of nurses say they feel like they can't provide quality care to their patients, which I think is very scary and frightening. It doesn't feel good to go to work all day and try and do the job that you really want to do and you're not able to do it. That doesn't feel good when you go home. About 77% of nurses in that study said that the number one reason that they would leave their job in the next year is because of short staffing.
We did a large survey from CNA, the Colorado Nurses Association. Those stories are anonymous and some of them are absolutely horrific. We, as the association, can help advocate for nurses who are in danger of retaliation.
What concerns you about those findings?
I’m concerned about the trauma and the mental health for a lot of our healthcare providers. Having taken care of COVID patients myself, I feel like I have trauma. There are some things that will trigger that. All of a sudden, I'll realize I'm traumatized by this. And it's not just me, it's everybody out there. I'm concerned about that. I'm also concerned about the trust between frontline workers and leadership within our healthcare facilities, as well as our legislators who don’t seem to be listening to us.
What are the solutions?
There is not a magic bullet. There have to be several solutions proposed including:
- More money for nurses.
- Limit the number of patients that nurses take care of. We know that you should probably only be taking care of three really sick patients, not six. So, we need legislation that says we're going to protect you and limit the number of patients.
- Bridge the gap between our leadership within our healthcare facilities and the frontline workers. Again, there's some disconnect there. I think we all need to come to the table.
- Figure out how to bring back the nurses who have left. They’re already trained and have experience. So, how do we get them to come back from the job, or a job that they already left and to resume that trust and say, “We value you, we listen to you?”
I would also encourage nurses to advocate for themselves and the nursing profession. I think a lot of nurses are frightened or uncomfortable with meeting with their legislator or going to the capitol. But if they get familiar with that side, they'll realize how easy it is. We are the experts in our own profession and our legislators want to hear from us and hear the stories. Nurses have to be brave and say, “I am a nurse and here's what I'm experiencing.”
How to Manage Burnout in the Nursing Profession with Tips from Dr. Priscilla Nodine
Nursing burnout is nothing new, according to Priscilla Nodine, PhD, CNM, FACNM, associate professor of Clinical Teaching at CU College of Nursing. So, there are strategies already in place to help nurses struggling with exhaustion, stress, and burnout from working long hours, chronic short-staffing, and limited supplies during the pandemic.
Dr. Nodine and other faculty conducted a study of nursing graduate students in June 2020 about their mental health during COVID-19. The study found the students were facing a new level of stress while helping treat people with the infectious disease.
“The stress was emotional, physical, and even moral. That’s because nurses weren’t able to do what they’ve been taught or what they want to do with patients because of the staffing issues,” says Dr. Nodine. “The overall sense is that they’re feeling underappreciated and overworked and really worried about their patients and their patient care.”
She has tips for nurses to combat burnout including: