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.
2023 Frontline Nurse Mental Health and Well-being Survey
2023 Frontline Nurse Mental Health and Well-being Survey
2023 Frontline Nurse Mental Health and Well-being Survey
For the 4th year, we gauged the mental health & well-being of our nursing workforce to support the people who make up the backbone of our healthcare system.
Trusted Health
2023 Frontline Nurse Mental Health and Well-being Survey
2023 Frontline Nurse Mental Health and Well-being Survey
By Trusted Health
Introduction
For the fourth 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’s data offers reason for measured optimism. Nurses’ self-reported mental health ratings continued to improve since the darkest days of the pandemic, and the incidence of negative outcomes associated with mental health declined across every category year over year, with notable improvements in the prevalence of moral injury, compassion fatigue and suicidal thoughts.
Still, nurses don’t think that their facilities or the industry at large prioritize and offer adequate support for their mental health. Every year since we launched this survey, 95% of respondents have said that their mental health was either not a priority for the healthcare industry or that it was a priority, but that there were inadequate measures in place to support it. This year, more than half said that they had some level of dissatisfaction with the level of support their current facility provides. Notably, nurses who rated their overall mental health as positive were two and a half times more likely to be satisfied with the level of support their hospital provides relative to those who rated their mental health as negative.
The number of nurses who are planning to leave the profession within the next year dipped slightly from 2022, but still remains worryingly high. More than half of all nurses say that they are 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.
Taken together, there are some encouraging signs in this year’s findings, but we as an industry still have work to do in order to stem the tide of departures. We must pursue an evidence-based approach to offering benefits that support nurses’ mental health and overall well-being. We must provide more support to the new nurses who are taking on responsibilities earlier and earlier in their careers. We must train managers and free up their time to better support their direct reports. We must find solutions to chronic staffing shortages. In short, we must better support our nurses, who do so much to support us.
Methodology & Demographics
The data in this study is gathered from responses from more than 1,900 nurses to an online survey conducted by email in April of 2023.
Eighty-seven percent of respondents were female, 12% were male and 1% were either gender non-binary, other or preferred not to say.
The majority of respondents (72%) were under the age of 44. The top specialties were critical care (20%), acute care (19%) and surgical (19%).
WHAT IS YOUR GENDER?
WHAT IS YOUR AGE?
WHAT IS YOUR CURRENT NURSING SPECIALTY?
HOW MANY YEARS HAVE YOU BEEN IN THE NURSING FIELD?
Key Findings
Nurses’ mental health has shown modest improvements each year since 2020.
Nurses’ mental health as self-rated on a scale of 1-10 has slowly ticked up each year since we started this survey during the early days of the pandemic.
The average rating for 2023 was 6.6, compared to an average of 5.8 in 2022, 5.7 in 2021 and 5.4 in 2020.
PLEASE RATE THE STATE OF YOUR MENTAL HEALTH AND WELL-BEING RIGHT NOW.
WHICH OF THE FOLLOWING DESCRIBES YOUR OVERALL MENTAL HEALTH AND WELL-BEING?
Negative outcomes associated with mental health have declined across every category over the last year.
While the incidence of things like burnout and depression is still worryingly high, we saw year-over-year improvements across every single category.
The biggest decreases were in moral injury (-28%), compassion fatigue (-27%) and suicidal thoughts (-25%). Taken with the findings in the previous section, this suggests that overall nurse mental health may continue to improve as COVID-19 further subsides.
EXPERIENCE
Staffing shortages top the list of things negatively impacting nurses’ mental health.
This year we dug into the specific variables that nurses said both positively and negatively impacted their mental health. Topping the list of positive impacts were pay and salary changes (39%), the atmosphere in a respondent’s unit or department (36%) and how prepared they felt to do their job (35%). The most-cited negative impacts included nurse staffing levels or shortages (80%), patient assignments (55%) and the atmosphere in a respondent’s unit or department (53%).Notably, nurses who graduated from nursing school pre-pandemic are twice as likely to say changes in institutional knowledge in the nursing field have had a negative impact on their mental health than nurses who graduated post-pandemic.
OVER THE PAST YEAR, HAVE ANY OF THE FOLLOWING COMMON NURSING EXPERIENCES AFFECTED YOUR MENTAL HEALTH?
Nurses who reported that their mental health was positive are more than twice as likely to say they have a positive relationship with nurse leadership than those who reported negative mental health.
HOW DO EACH OF THE FOLLOWING GROUPS WITHIN YOUR HOSPITAL/ORGANIZATION AFFECT YOUR MENTAL HEALTH?
Nurse dissatisfaction with support for their mental health and well-being at both the facility and the industry level remains high.
Consistent with our previous surveys, the vast majority of nurses feel unsupported at the systemic level when it comes to their mental health and dissatisfied with the offerings at their facility. For the fourth year in a row, 95% of respondents said that their mental health was either not a priority for the healthcare industry 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 OVERALL PRIORITIZES AND SUPPORTS NURSES' MENTAL HEALTH AND WELL-BEING?
HOW SATISFIED ARE YOU WITH THE LEVEL OF SUPPORT YOUR HOSPITAL/ORGANIZATION PROVIDES RELATED TO YOUR PERSONAL MENTAL HEALTH AND WELL-BEING?
Fifty-five percent of respondents ranked themselves either “somewhat dissatisfied,” “dissatisfied” or “very dissatisfied” with the level of support their current facility provides, a slight increase from 2022. Nurses who rated their overall mental health as positive were two and a half times more likely to be satisfied with the level of support their hospital provides relative to those who rated their mental health as negative.
Peer support programs have a significant positive impact on nurse mental health.
This year we looked at the relationship between nurses’ self-reported mental health with the dedicated mental health benefits and programs that their facilities offer, as well as general workplace initiatives in order to better understand their impact. We found the strongest correlation with peer support programs: nurses who report positive overall mental health are twice as likely to work at a hospital with a peer support program compared to those who rated their mental health as negative. Notably, nurses who report overall negative mental health are almost twice as likely (92%) to say their hospital doesn’t offer any benefits at all.
WHICH OF THE FOLLOWING MENTAL HEALTH AND WELL-BEING BENEFITS DOES YOUR CURRENT HOSPITAL/ORGANIZATION OFFER?
WHICH OF THE FOLLOWING WORKPLACE BENEFITS DOES YOUR HOSPITAL OFFER?
Seventy percent of nurses have never had their direct manager ask them about their mental health.
Just one in five nurses have been asked about their mental health in the last year, and just one in ten have been offered any kind of coaching or support.
Nurses have pursued a variety of measures – both healthy and unhealthy – to manage their mental health.
In the past year, one-third (33%) of nurses have personally sought care from a mental health professional such as a therapist, psychologist, psychiatrist or primary care provider. This figure rises to 51% when looking specifically at respondents who ranked their mental health as negative, indicating that nurses who are struggling are taking a more proactive approach to their mental health.
IN THE PAST YEAR, HAVE YOU PERSONALLY SOUGH CARE FROM A MENTAL HEALTH PROFESSIONAL SUCH AS A THERAPIST, PSYCHOLOGIST, OR PSYCHIATRIST?
When asked about other actions that nurses have taken to manage their mental health in the past year, the top responses were largely positive: spending time in nature / going outside (64%), exercising, team sports or other physical activity (63%) and taking leave or an extended period of time away from their job (45%). However, more than a quarter of respondents said that they had increased their alcohol consumption or turned to recreational drugs. Moreover, nurses who reported that their mental health was negative were 77% more likely to be on prescription medication for depression or anxiety than those who reported that their mental health was positive.
IN THE PAST YEAR, WHICH OF THE FOLLOWING ACTIVITIES HAVE YOU ENGAGED IN AS A WAY OF COPING WITH OR MANAGING YOUR MENTAL HEALTH? SELECT ALL THAT APPLY.
Nurses are taking on more responsibility earlier in their careers, and it’s having a negative impact on their mental health.
Nurses who graduated from nursing school post-pandemic are 61% more likely to have become a preceptor in their first year than those who graduated pre-pandemic. Similarly, almost a quarter (24%) of nurses who have ever been a charge nurse reported taking on that role less than one year into their career. Of those nurses who reported that they had taken on an advanced responsibility one year or less into their careers, 38% reported that it had had a negative impact on their mental health.
AT WHAT POINT IN YOU NURSING CAREER DID YOU FIRST TAKE ON EACH OF THE FOLLOWING RESPONSIBILITIES?
The number of nurses who are planning to leave the profession within the next year dipped slightly, but still remains worryingly high.
When asked about their future career plans, 54% 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. This was compared with 58% in 2022.
When we asked the nurses who were considering leaving the profession what the drivers were, the top reasons were feelings of underappreciation (60%), the job’s negative impact on their mental health (55%) and a desire to work from home or remotely (45%).
WHICH OF THE FOLLOWING BEST DESCRIBES YOUR FUTURE CAREER PLANS?
WHICH OF THE FOLLOWING ARE REASONS YOU ARE CONSIDERING LEAVING BEDSIDE NURSING OR NURSING AS A PROFESSION? SELECT ALL THAT APPLY:
Recommendations
Empower nurse managers to support their direct reports’ mental health.
One of the more dispiriting findings from this year’s survey is that the vast majority (70%) of all nurses have never had their direct manager ask them about their mental health, and just one in ten have been offered any kind of coaching or support. And yet, this isn’t surprising: studies have found that the average nurse manager has between 85-90 direct reports, creating a workload that leaves little time for non-transactional engagement or leadership. Nurse managers with a large team of direct reports should have the support of assistant nurse managers, educators, schedulers to help lessen the administrative burden of things like staffing and scheduling so they can focus on team building and development. Mental health support should also be a key component of training for nurse managers, with modules dedicated to recognizing signs of mental distress or crisis, and making mental health a part of informal check-ins and formal reviews.
Evolve your approach to staffing.
We all know that staffing continues to be one of the biggest – if not the biggest – challenges facing the healthcare industry, and this year’s survey highlights its negative impact on nurse mental health. Much of the industry’s thinking about nurse staffing stagnated 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 and autonomy around their careers, and the ability to choose how they work. Health systems need to remove rigid rules around scheduling and traditional roles for work, and provide flexible offerings such as self-scheduling, different shift lengths, flexible benefit packages, and the option to work on a full-time, part-time or gig basis. Technology like Works that provides dynamic staffing technology can help health systems be more agile and meet nurses’ desire for flexibility, while still achieving cost-effective safe staffing to support the front-line. Most importantly, evaluating staffing practices and making operational changes will have a positive impact on nurses’ work experience and well being.
Do more to support new nurses with increased responsibilities.
Due to the vast number of nurses who have left the profession in the last few years, new nurses are being asked to take on additional responsibilities like being a charge nurse or a preceptor earlier and earlier in their careers. And for more than a third (38%), it’s having a negative impact on their mental health. Educational and mentorship support should be baked into training for nurses who are taking on new roles as managers or preceptors, and regular check-ins should be a core part of their experience for a minimum of six months. Moreover, these kinds of advanced responsibilities should always be voluntary, never forced upon nurses who aren’t ready or aren’t interested.
Final Thoughts
The journey to supporting nurse mental health is ongoing, but hopefully this year’s survey offers some encouragement, both in the form of data that shows we’re moving the needle, however slowly, and ideas for how to better support the profession. In addition to the recommendations listed above, the data points to specific, concrete initiatives that work: peer support programs, employee recognition programs, self-scheduling, and one-to-one counseling or therapy. Concerted focus and effort are required, but in the end, our nurses are worth it.
