Can the Hospital Nursing Workforce Bounce Back After COVID?
NEW Column in Cancer Nursing Today
Hi All,
A new column from Cancer Nursing Today, on whether nurse staffing in hospitals will recover from the ravages of the pandemic. As you’ll see, that question relates to hospital staffing in all fields, but nursing is my focus.
You can read the column below, but I’m sharing a thought before you get to it. I shopped this piece around to other outlets because the study the column addresses got a fair amount of media attention and I wanted to point out problems with the research. I could not get anyone interested, which typifies my experience of trying to get national media coverage of health care post-Covid to focus on ongoing issues plaguing nurses in hospitals. I hear people resignedly describe bad health care experiences in terms of, “You know, with all the staffing issues…,” which makes me really sad. This is a serious and eminently solvable problem, but there seems to be little appetite to talk about the problem or fix it.
Health care Bizarro World?
With two wars going on, our forever elections, and a former President who craves and receives constant media attention, there’s less room for other stories no matter how important they are, but I have developed a bizarre sense of inhabiting two separate health care worlds. In one, mainstream media coverage of health care only rarely talks about staffing or burnout (or Covid), and in the other darker Bizarro world I get constant google alerts from national health care outlets and local media about nurses striking, being assaulted on the job, and caring for patients amid dangerous levels of unsafe staffing.
This sense of bifurcated realities makes me sometimes worry that I have become the Chicken Little of health care, squawking about how hard nurses (and other health care workers) have it, when I’m really only projecting my own burnout and everything is fine. But then I talk to working nurses and everything is absolutely not fine. If you have thoughts on what I’m talking about here or in the column, or on what health care is like overall, please share them in the comments. I am interested and it’s important to keep the complete and true story going. You can also tell me if I am being Chicken Little—but please only speak from your own expertise or personal knowledge.
Can the Hospital Nursing Workforce Bounce Back After COVID?
You may have seen or read about the recent paper in JAMA Health Forumthat forecast a full recovery for nursing through 2035. The authors predict no lasting ill effects on nurse employment from the 100,000 nurses who quit their clinical jobs during COVID, and the challenges nurses faced during that difficult time. A nurse myself, I would like to believe this prognostication, but nurses’ well-known struggles during the pandemic—inadequate staffing, crippling levels of burnout, and feeling generally unsupported on the job—have not only continued, but show little sign of being effectively addressed, particularly for hospital nurses. Despite the rosiness of the JAMA prediction, other nursing employment data suggests that hospital nursing is not going to smoothly bounce back from COVID—a concern for nurses and anyone who cares about patients.
The JAMA paper by Auerbach et al, is a serious work of scholarship by health care statisticians who have done previous analyses of trends in the nursing workforce. The authors use data on nurse employment from the Census Population Survey to extrapolate into the post-pandemic future.
Total Eclipse of the Sun
In other news, it was of course eclipse Monday, and we traveled to Erie, PA to enjoy it with the parents of one of Miranda’s friends, whose backyard offered a great view. The day began cloudy, but cleared up and we saw the whole eclipse, which I found awe-inspiring, similar to watching sunlight slowly descend into Grand Canyon when we camped at the bottom last Spring. Nature can be cruel, but also beautiful and breath-taking. It also helps to be married to an astrophysicist—Arthur explained how eclipses work and the different kinds of eclipses that can happen. It was a lovely day.
More next time. Spring is slooooowly springing, more slowly than I would like, but I have faith that it will come.
Hugs to all,
Theresa
Unfortunately, staffing has been an issue for as long as I can remember. You and I have both been lobbying for safe staffing legislation for years. It started to go south when hospitals became health care systems. COVID-19 just threw it south of the border!
I have been at the bedside for 37 years. I just recently went part- time. We continue to be over ratio, even with union contracted ratio, which are violated daily. I work on a surgical telemetry unit where we take care of fresh transplants and receive patients, often prematurely out of the Trauma and surgical ICU. They expect new nurses fresh off of orientation to navigate these assignments with up to 4 to 5 other patients. They expect senior nurses like myself, to take on the physicality of these assignments with little to no ancillary. But there is a new factor to this equation that has made staffing and health care subpar. The new nurses are not standing for it. They are leaving the bedside, either to travel for more pay and a better work life balance or furthering their education to get away from the bedside. I do not blame them one bit. However, the down side is nurses that have mastered a clinical area, will no longer exist. This leaves many things undone. For instance, many of our colorectal patients are being discharged without any education on ostomy care. This is because traveling nurses as well as the countless number of nurses
pulled to units they are unfamiliar with, do not know how to educate lest take care of an ostomy. When you do not feel a sense of professional growth, satisfaction and appreciation in your work, why stay? This is the general consensus today. It is why I took a step back. I just worry about who will be taking care of me?
Theresa, your message is appropriate. The sky really is falling but hospital administrators aren't interested. As long as hospitals' make decisions based on whether nurse requirements appear to be fiscally realistic to non-nurse administrators, then nurses will be demonized as wrongfully demanding and will not taken seriously by hospital administration. Post-Covid is worse than pre-Covid. Pre-Covid was bad enough, with 17% to 49% of new graduate nurses leaving acute care in their first year, depending on the study and setting. My 2019 acute care ratio of 1:5 felt unsafe already, even more so because we were perpetually short CNAs. I left acute care when they implemented 1:6, 2.5 years after I had graduated from nursing school. Nursing school taught me to think like a nurse, to prioritize based on patient safety in ways that do not make sense to non-nurses. Hospital administration has not been taught to think like a nurse and is not qualified in terms of schooling to prioritize patient safety. Hospitals should be run by people who have been taught to think like a nurse and who have recent acute nursing care experience. Hospitals are so for-profit that I don't understand how they can say that they can't afford to pay nurses for the essential, uniquely skilled patient-safety work that they do and to hire enough nurses to keep patients safe.