High labor costs continue to stress health system leaders.
In 2023, for example, the average turnover cost for one staff RN grew to $56,300, up from $52,350 in 2022. The financial stakes are high — with each 1% percent change in RN turnover estimated to cost or save the average hospital $262,500 per year. In response, healthcare leaders are looking at new ways to attract and retain the next generation of nurses.
Becker’s Healthcare and Works recently conducted a brief survey of chief nursing officers to learn more about the qualities, skills and certifications that are top of mind in their searches for future employees; the current challenges and successes that organizations are experiencing with nurse recruiting; and investments that hospitals and health systems are making to advance nurse recruitment and retention efforts.
More than three-quarters of the 115 survey respondents work at hospitals or health systems, and close to two-thirds (63.4%) work at organizations with more than 250 beds.
Please select the most accurate description of your organization.
Flexibility is an important retention tool and strategic differentiator
Interestingly, 42% of the CNOs surveyed indicated that “reducing nurse workload” was one of the top-three most difficult things to offer or change as part of their organization’s nurse retention strategy.
Although it may be difficult for hospitals and health systems to reduce nurse workloads, many recognize the value of flexibility to employees and are leveraging it in their nurse retention strategies.
More than half (60.9%) of CNOs who participated in the survey indicated that flexible work schedules and arrangements are very important to their nurse retention strategies. For 48% of respondents, “flexible work arrangements” ranked as one of the top-three most necessary changes or updates to attract and retain the younger generation of nurses.
Flexible work arrangements take a variety of forms. While the most popular option among survey participants is self-scheduling, only 31.3% of respondents said their organizations offer that to employees. Interest is strong, however; among the 68.7% of organizations that don’t offer self-scheduling, 88.7% of CNOs said they were considering technology that would allow nurses to pick their own shifts.
“Clinicians are no longer tolerating pre-pandemic working conditions, and the next generation of nurses expects flexibility. We’re starting to see hospitals optimize their current workforce by leveraging digital tools to track talent data. At Mercy, we partnered with Trusted’s Works platform to create Mercy Works On Demand.”
Betty Jo Rocchio, DNP, CRNA, CENP, Senior Vice President & Chief Nurse Executive, Mercy
Other popular types of flexible work arrangements cited by the survey participants include the ability to pick up extra shifts according to preferences, part- time work with hour requirements and the ability to work across different care settings.
What types of flexible work arrangements does your organization offer?
Self-scheduling
31.3%
Ability to pickup extra shifts, according to preferences
29.6%
Part-time work with hour requirements
28.7%
Ability to work across different care settings
28.7%
Choosing which weekends to work
26.1%
Schedules to accommodate new mothers
25.2%
Hybrid shift lengths
24.3%
Hybrid roles
23.5%
Gig work without hour requirements
23.5%
Virtual nursing
22.6%
9 a.m. to 5 p.m. schedules
22.6%
Four-day work weeks
21.7%
12-hour shifts starting at anytime
21.7%
Figure 2: Types of flexible work arrangements offered by survey respondents’ organizations
High demand for nurses with compassion, empathy, and strong communication skills
When asked to identify the most important characteristics or skills they look for in potential nursing recruits, CNO survey respondents rated compassion and empathy highest, followed by strong communication skills. CNOs prioritized these qualities above characteristics like attention to detail and clinical competence.
While many nurses may be innately compassionate and empathetic people, it’s important to keep in mind that without sufficient bandwidth on the job, it’s difficult to display these traits to patients and peers.
What are the most important characteristics or skills you look for in potential nursing recruits?
0%
10%
20%
30%
40%
50%
60%
70%
80%
Compassion and Empathy
27%
18%
25%
Strong Communication Skills
23%
26%
17%
Critical Thinking and Problem-Solving Abilities
18%
20%
17%
Attention to Detail and Clinical Competence
12%
24%
18%
Adaptability and Flexibility
19%
11%
23%
1
2
3
Figure 3: Survey respondents’ most important characteristics or skills in potential nursing recruits
Embracing technology is essential to recruit the next generation of nurses
When asked what aspect of their organization’s nurse retention strategy was most difficult to offer or change, CNOs ranked “embracing new technologies meant to alleviate burdens” as the least difficult.
When it comes to leveraging technology as a differentiator, more than one-third of CNOs (39.1%) indicated that digital recruitment platforms are an effective recruitment strategy to attract the next generation of nurses.
Nearly half (48%) of the CNO survey respondents ranked “embracing technology” as one of the top- three most necessary changes or updates to attract and retain the younger generation of nurses.
“Leveraging technology for staffing and scheduling decisions in healthcare settings offers numerous advantages, primarily enhancing efficiency and introducing flexibility to scheduling systems. Automated algorithms can swiftly analyze vast amounts of data to generate optimized schedules that meet staffing requirements and individual preferences.”
Brian Weirich, DHA, MHA, RN, CENP, Chief Nurse Innovation Officer, Bon Secours Mercy Health
In your organization’s nurse retention strategy, which of the following have been the most difficult to offer or change?
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Reducing nurse workload
17%
11%
14%
Reducing nurse stress and burnout
17%
5%
17%
Recognizing nurse contributions
5%
20%
13%
Offering work-life balance/flexible options
11%
11%
15%
Fostering a healthy workplace culture
14%
8%
14%
Offering career advancement opportunities
12%
13%
10%
Offering competitive compensation and benefits
9%
17%
3%
Addressing staffing shortages
6%
11%
9%
Embracing new technologies meant to alleviate burdens
10%
3%
6%
1
2
3
Figure 4: Most difficult aspects to offer/change in nurse retention strategies, per survey respondents
What changes or updates do you believe are necessary within the nursing profession to attract and retain younger generations?
0%
10%
20%
30%
40%
50%
60%
Embracing Technology
23%
10%
15%
Flexible Work Arrangements
14%
23%
11%
Focus on Diversity and Inclusion
11%
17%
19%
Enhanced Benefits Packages
16%
11%
18%
Professional Development and Career Advancement
16%
12%
14%
Emphasis on Work Environment and Culture
12%
16%
10%
Holistic Well-Being Initiatives
9%
11%
13%
1
2
3
Figure 5: Changes or updates survey respondents believe are necessary to attract and retain younger nurses
Ready to get introduced to works?
As hospitals and health systems compete to attract nursing talent, technology and flexible work arrangements are key pathways to success. Works offers an industry-pioneering workforce management platform that helps healthcare organizations bolster nurse retention through a centralized staffing model, while driving clinical cost savings.
Works drives clinical cost savings and bolsters nurse retention through flexibility and workforce optimization. With Works, clinicians move across units and hospitals and you fill more shifts with your own labor resources.
2022 Frontline Nurse Mental Health & Well-being Survey
2022 Frontline Nurse Mental Health & Well-being Survey
2022 Frontline Nurse Mental Health & Well-being Survey
For the third year in a row, the Trusted Health team has set out to gauge the mental health & well-being of our nursing workforce. Explore our insights.
Trusted Health
2022 Frontline Nurse Mental Health & Well-being Survey
2022 Frontline Nurse Mental Health & Well-being Survey
By Trusted Health
INTRO
For the third year in a row, the team at Trusted Health has set out to gauge the mental health and well-being of our nursing workforce as part of our overall mission to support the individuals who make up the backbone of our healthcare system. This year we expanded our focus to better understand the relationship between nurses, their employers and the healthcare industry at large when it comes to helping nurses manage their mental health.
The picture that emerges is worrisome. Nurse mental health has not rebounded to anywhere near its pre-COVID levels, even as we enter a new and less destructive phase of the pandemic. Nurses are continuing to struggle with high levels of burnout, trauma, depression and experience suicidal thoughts at twice the rate of the average American adult, but are reluctant to seek help, both in and outside of work. As was first highlighted in last year’s survey, nurses do not feel supported at the facility level, nor do they feel that the industry’s stance on nurse mental health has evolved, despite widespread attention given to the issue.
We’ve tried as much as possible to focus on solutions in this report, including identifying the specific benefits that nurses would find most valuable, the culture changes that will facilitate discussions around mental health and the perceptions that hospitals and health systems need to address. But one thing is clear: many nurses do not see this as a profession that is compatible with mental health, and swift, decisive action is needed to stem the tide of departures. These departures are likely to increase, given that fully 64% of nurses say they are less committed to the profession than they were pre-pandemic, a 39% increase from our 2021 survey.
The pandemic has revealed the broken nature of many aspects of our healthcare system, but this moment can actually offer a chance to start fresh and rebuild nursing from the ground up to ensure nurses are supported with the right policies and infrastructure that make nursing not only a viable long-term career option but a desirable one. We think that this is an excellent place to start.
METHODOLOGY & DEMOGRAPHICS
The data in this study is gathered from responses from more than 2,500 nurses to an online survey conducted by email in May of 2022.
What is your gender?
What is your age?
What department do you work in?
Eighty-eight percent of respondents were female, 11% were male and 1% were either gender non-binary or preferred not to say.
Nearly 40% of respondents were in their thirties, and roughly two-thirds were under the age of 40.
KEY FINDINGS
Nurses’ mental health has not rebounded to its pre-pandemic levels.
On a scale of 1-10, nurses rated their current mental health and well-being at an average of 5.8, compared to an average of 7.8 prior to the COVID-19 crisis, representing a decline of 26%. The findings indicate a very modest improvement over previous years’ studies, which found decreases of 28% and 29% respectively. Still, this finding indicates that nurses’ mental health and well-being have not come close to reaching their pre-COVID levels, even as the most acute phase of the pandemic has subsided.
Please rate your state of mental health.
One in ten nurses have experienced suicidal thoughts as a result of the pandemic.
Nurses reported a variety of negative outcomes on their physical and mental health as a result of the pandemic, including burnout (75%), compassion fatigue (66%), depression (64%), declines in their physical health (64%) and extreme feelings of trauma, extreme stress and/or PTSD (50%). Half of all nurses also report being the subject of an attack, intimidation or assault by a patient or his or her family, echoing wide-scale reports that violence against healthcare professionals has been on the rise.1 Perhaps most disturbing is that one in ten nurses reported that they had had suicidal thoughts since the start of the pandemic, more than twice the incidence of such thoughts amongst the adult population in the U.S. as a whole.2
Since the COVID-19 pandemic began, which of the following statements apply to you?
Nearly 40% of nurses don’t know what mental health benefits their current facility offers.
For those who do know, access to a mental health hotline or crisis line (39%); education around mindfulness, meditation or other stress reduction techniques (29%) and one-to-one counseling or therapy (18%) were the most common resources made available by their facility. Notably, none of these resources were among the top three that nurses said they would find most beneficial, which included a wellness or fitness stipend (74%); access to a gym, yoga studio or group fitness classes (67%) and flexible scheduling (64%).
Which of the following benefits does your current facility offer? Which of the following benefits would you find most beneficial?
More than half of nurses are dissatisfied with the level of support their current facility provides related to their mental health and well-being.
Fifty-three percent of respondents ranked themselves either “somewhat dissatisfied,” “dissatisfied” or “very dissatisfied.”
How satisfied are you with the level of support your current facility provides related to your mental health and well-being?
Nurses are unlikely to seek support at work for mental health issues that could negatively impact their ability to do their jobs.
Nearly 60% of respondents said that they were either “very unlikely” or “somewhat unlikely” to share feelings of acute depression, suicidal thoughts or mental health issues with their manager or another individual at their facility. When asked why, the leading reasons were concerns about confidentiality (72%), job security (69%) and a lack of effort to address the issue (64%). This finding is consistent with previous reports that have found a high degree of stigma around issues of mental health among healthcare workers.³ Nurses were somewhat more likely to seek support outside of work, with 35% reporting that they had sought care from a mental health professional.
If you were experiencing acute depression, suicidal thoughts or mental health issues that you felt could negatively impact your ability to perform your job, how likely would you be to share this with your manager or other individual at your facility?
Why would you be unlikely to report these issues?
Have you sought care from a mental health professional like a therapist, psychologist, or psychiatrist?
Despite widespread attention paid to the issue of clinician mental health over the last few years, the majority of nurses feel that the industry’s stance hasn’t evolved.
Consistent with our surveys from 2020 and 2021, the majority of nurses feel unsupported at the systemic level when it comes to their mental health. Two-thirds said that the healthcare industry's stance on nurse mental health has not changed since the start of the pandemic and an overwhelming 95% said that their mental health was either not a priority or that it was a priority, but that there were inadequate measures in place to support it.
How well do you think the healthcare industry prioritizes and supports nurses’ mental health and well-being?
How do you think that the healthcare industry’s stance on nurse mental health has evolved since the start of the pandemic?
The number of nurses who said that their commitment to the profession has decreased has skyrocketed.
The percentage of nurses who report that they are less committed to nursing as a result of the COVID-19 pandemic jumped from 46% in 2021 to 64% in 2022, an increase of 39%. This was particularly pronounced among nurses ages 20-29 (72%) and 30-39 (69%).
How has the COVID-19 pandemic affected your commitment to nursing?
When asked about their future career plans, 58% of all respondents reported that they were either actively looking for a job away from the bedside or outside of nursing completely, had plans to do so within the next year or were planning to retire from the workforce entirely.
What are your future career plans?
When asked what about their current role kept them committed to nursing, compensation was the top response (49%), followed by commitment to patients (26%).
What about your current situation or role is keeping you committed to nursing?
RECOMMENDATIONS
Focus on benefits that make nursing a more sustainable career choice.
As COVID-19 transitions from a pandemic to an endemic phase, the stresses that nurses face on the job are shifting and so must the mental health and wellness benefits that we offer them. Substantive mental health programs like crisis hotlines, one-to-one counseling and therapy were critical during the pandemic’s peaks, and will continue to be so for nurses in periods of acute dis-tress. However, this year’s respondents have made it clear that they want benefits that support their physical and mental well-be-ing over the long-term: access to fitness facilities and/or classes, wellness stipends and flexible scheduling. The desire for new and innovative scheduling options echoes previous Trusted research, which found that nearly three-quarters of nurses (71%) say their experience as a nurse would improve if they had more control over their schedule, and more than half (52%) say that the way scheduling is done currently lowers their job satisfaction. As nurses see their peers in other highly skilled industries adopt new ways of working like flexible hours, a four-day work week and remote work, hospitals and health systems will need to find ways to offer them the same.
Destigmatize mental health issues.
Even given the well-documented issues around stigmatization of mental health within the healthcare industry, the fact that only one in three nurses have sought care from a mental health professional and 60% wouldn’t disclose potential job-impairing issues to their employer despite high levels of depression, trauma, stress and suicidal thoughts is disquieting. Hospitals and health systems need to create a culture in which nurses feel comfortable being open and honest about the issues they are facing, particularly when those struggles are a direct result of the demands of the job. When mental health programs are marketed internally – which also needs to be a point of investment given the widespread lack of awareness of available options – it should be packaged with strong messaging around confidentiality and job and license security.
Move from transactional to transformational engagement.
The fact that compensation – rather than their relationship with their managers or facility leadership – is keeping the vast majority of nurses on the job points to a weak, transactional relationship between nurses and their employers. And it’s no wonder: studies have found that the average nurse manager has between 85-90 direct reports, leaving little time for mentorship, rapport building or creating the kind of psychological safety that would be necessary for nurses to come forward with concerns about their mental health.⁴ This relationship is ripe for an overhaul in most organizations, particularly given its importance in nurse satisfaction and retention.⁵ Hospitals need to better train their nurse managers, find ways to free them from the tedium of tasks like staffing and scheduling and help equip them to lead from a place of transformation, rather than of transaction. This includes encouraging and facilitating substantive discussions about a nurse’s career aspirations, well-being and contribution to the larger profession, rather than simply compensation, scheduling and day-to-day tasks.
“Spat at, abused, attacked: healthcare staff face rising violence during Covid,” Sarah Johnson, The Guardian. June 7, 2021: https://www.theguardian.com/global-development/2021/jun/07/spat-at-abused-attacked-healthcare-staff-face-rising-violence-during-covid
“Suicidal Thoughts and Behaviors Among Adults Aged ≥18 Years — United States, 2015–2019,” Centers for Disease Control & Prevention. January 2022: https://www.cdc.gov/mmwr/volumes/71/ss/ss7101a1.htm
“It Is Time To Stop Stigmatizing Mental Health Among Healthcare Workers,” Jessica Gold, Forbes. July 13, 2020: https://www.forbes.com/sites/jessicagold/2020/07/13/it-is-time-to-stop-stigmatizing-mental-health-among-healthcare-workers/?sh=7372fb717709
Solutions for the Modern Nurse Manager, Laudio Whitepaper. April 2020: https://www.laudio.com/wp-content/uploads/2020/04/White-Paper-Laudio-Solutions-for-the-Modern-Nurse-Manager.pdf
“The Nurse Leader’s Pivotal Role in Retaining Millennial Nurses,” Kate Ulep, JONA: The Journal of Nursing Administration. December 2018: https://journals.lww.com/jonajournal/Abstract/2018/12000/The_Nurse_Leader_s_Pivotal_Role_in_Retaining.7.aspx “The Relationship Between Effective Nurse Managers and Nursing Retention,” Mary VanOyen Force, JONA: The Journal of Nursing Administration. July 2005: https://journals.lww.com/jonajournal/Abstract/2005/07000/The_Relationship_Between_Effective_Nurse_Managers.5.aspx
