The COVID-19 pandemic has pushed the topic of burnout and mental health amongst clinicians into the national conversation as stories of healthcare workers reaching their breaking points have saturated the media. In 2020, as part of our overall mission to better support nurses -- the backbone of our healthcare system -- Trusted Health set out to understand the impacts of COVID-19 through a study of frontline nurses. This year, we’ve revisited and expanded the survey to look at the specific impact of the pandemic on nurses’ physical and mental health and how their experiences over the last year have impacted their career plans.
What we found is a profession in crisis. Not only are nurses reporting significant declines in their mental health; high levels of depression, stress and PTSD; moral injuries, and bouts of compassion fatigue, but nearly half of the respondents in our survey reported feeling less committed to the profession than they were before the pandemic. This finding was particularly pronounced amongst nurses under 40, who were 22 percent more likely than average to report that their commitment to nursing had decreased. At a time when the US Bureau of Labor Statistics projects that demand for nurses is growing faster than any other occupation and that we need 1.1 million additional nurses in order to avoid a further shortage, we simply cannot afford to lose the nurses we already have -- and particularly those in the early stages of their careers.
Our hope is that this report serves as a warning and rallying cry for healthcare leaders, and a step towards coming together to find meaningful solutions to address these issues. Over the last year, nurses have made unimaginable sacrifices, working in conditions they never thought possible when they joined this profession. It’s time for our industry to step up and take care of them the same way they have taken care of us.
The data in this study is gathered from survey responses from more than 1,000 nurses, 80 percent of whom reported that they were providing direct care to COVID-19 patients in their current role. The survey was conducted online in March of 2021. Eighty-nine percent of respondents were female, 9 percent were male and 2 percent were either gender non-confirming or preferred not to say.
For the second year in a row, nurses reported steep declines in their mental health as a result of the COVID-19 pandemic. On a scale of 1-10, nurses rated their current mental health and well-being an average of 5.7, compared to an average of 7.9 prior to the COVID-19 crisis, representing a decline of 28 percent.
Nurses continue to feel that their health and well-being aren’t being prioritized or supported. On a scale of 1-10, nurses rated their current facility an average of 4.6 in terms of the support it has provided related to their mental health and well-being, a slight decline from 2020’s rating of 4.8. More than one in five nurses rated their current facility a 1.
Nurses also report feeling unsupported at a systemic level. When asked how they think that the healthcare industry prioritizes and supports nurses’ mental health and well-being, 95 percent said they felt that it was either not a priority or that it was a priority, but that there were inadequate measures in place to support it. This finding is consistent with last year’s report, but is notable given the level of discourse and reporting in the mainstream media about the issue of clinicians’ mental health in the wake of several high-profile incidents.
Nurses have experienced a variety of negative outcomes on their physical and mental health as a result of the pandemic. In this year’s study, we wanted to dig into the specific impact that the pandemic has had on nurses’ well-being. Nearly two-thirds of respondents reported feelings of depression, declines in their physical health and compassion fatigue towards their patients. While nearly 1 in 5 nurses tested positive for COVID-19 over the last year, it’s clear that the knock-on negative effects on mental health were significantly more widespread than actual COVID-19 infections amongst the nursing workforce.
Nursing can take a toll on you under the best of circumstances. After a year-long global public health crisis, I feel completely drained -- mentally, physically and spiritually. - Jeri, Pediatric Nurse
Nurses are ambivalent about being called heroes. Healthcare workers of all kinds have been referred to as heroes throughout the pandemic, but less than 1 in 4 respondents in our study felt that this label was fitting. Forty-nine percent felt that the label was an oversimplification and asked them to sacrifice their health and well-being for others.
I know this whole sentiment of ‘health care heroes’ is well-intentioned, but it's damaging. It sets us up for feelings of guilt and sets the tone that we can or should sacrifice ourselves for others. - Tayler, ICU Nurse
Over the course of the COVID-19 pandemic, nurses and other healthcare workers have frequently been referred to as "heroes." Please select the answer below that best describeds your response.
Nearly half of nurses are less committed to the profession than they were before the pandemic, and many are considering leaving the workforce. This finding was particularly pronounced amongst nurses under 40. Nurses between the ages of 20 and 29 and 30 to 39 were 24 percent and 15 percent more likely to report that their commitment to nursing had decreased, respectively. Looking across specialties, nurses who work in acute care, emergency, critical care and pediatrics were the most likely to report that their commitment had decreased.
We asked a follow-up question to the respondents who said they were less committed to the profession, and found that nearly 1 in 4 are actively looking for a job outside of nursing or planning to retire. The most common write-in responses under “other” were from nurses who were looking for a job away from the bedside or in a less acute care setting.
The fact that more than half of nurses under the age of 40 feel less committed to the profession than they did a year ago is alarming, particularly at a time when Baby Boomer nurses are retiring in record numbers. In the coming months and years, retention of the nursing workforce has to be the industry’s number one priority. Here are three ways to achieve that goal.
Focus on culture over messaging. While the campaigns referring to nurses and other healthcare workers are well-intentioned, the respondents in our survey have made it clear that this label is harmful. Moreover, when held up next to the finding that the overwhelming majority of nurses feel that their mental health isn’t supported by their facility or the industry at large, it can feel hollow. Hospitals who focus on gestures like yoga classes or pizza parties over substantive workplace changes risk making nurses feel that they are simply being placated, rather than truly supported. Culture changes should be informed by listening that starts at the top of the organization and might include strategies meant to address bullying and incivility, education and coping mechanisms for compassion fatigue and moral injury, and comprehensive support for nurses who are experiencing acute mental health issues.
Rethink nurse staffing. The industry’s thinking about nurse staffing ossified years ago, and hasn’t evolved in response to more widespread generational changes in attitudes about work. Millennial and Gen Z nurses want more flexibility around their careers, and the ability to try different things. New technology is being built that will allow hospitals to push out extra shifts to full-time nurses and local per diem nurses so that they can easily take on additional work when they want it and get the experience that comes from floating to other units. The industry also needs to stop treating contingent labor like second-class citizens, and focus on creating a work environment that leverages travel nurses’ unique experience and expertise, and keeps them coming back. Fifty-seven percent of the nurses in our study said that the number of roles available to them had increased over the last year, which means that hospitals can’t afford to treat any of their staff -- full-time or contingent -- as disposable.
Create new opportunities for nurses. The write-in responses from nurses who reported feeling less committed to the profession indicated that many are simply looking for a new role within the field. This should be a clear signal to hospitals that they need to identify opportunities in less acute settings or away from the bedside for those who want it. Technological advances like telehealth, remote patient monitoring and eICUs can help us better leverage the skills of each nurse while still delivering a high standard of care. Career planning also needs to be a priority and focus less on simply moving nurses up the career ladder, and more towards tailored programs that map to each individual’s career goals and preferences.