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Editorial

The Nursing Crisis in Acute Care

Kennedy, Maureen Shawn MA, RN, FAAN

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AJN, American Journal of Nursing: September 2021 - Volume 121 - Issue 9 - p 7
doi: 10.1097/01.NAJ.0000790552.23197.1d
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Abstract

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Figure:
Maureen Shawn Kennedy

I'm worried about nurses who work in hospitals and the patients who look to them for care. Even prior to the COVID-19 pandemic, it was so apparent that clinician stress and burnout in acute care was untenable that in 2018 the National Academy of Medicine convened a committee to study and issue recommendations to address it. And then came COVID-19, and a year of unprecedented physical and emotional demands on already stressed clinicians.

Throughout the pandemic, the media has been replete with reports of hospitals facing departures of nursing staff. For some nurses, the pandemic was the last straw as they tried to provide care without sufficient resources or protections; for others, it spurred retirement earlier than planned. Nurse executives saw nursing staff leave their jobs to work as travel nurses, lured by large sign-on bonuses, higher pay, and their choice of assignments—and many are not returning.

Most hospitals—especially those in rural areas—are unable or reluctant to increase pay as they try to recoup huge financial losses caused by the pandemic. The American Hospital Association estimated that in just one four-month period at the height of the pandemic, American hospitals lost $202 billion from unanticipated costs (for example, for purchasing personal protective equipment and other supplies needed to care for seriously ill patients, hiring more staff, and paying for staff overtime). At the same time, hospitals lost revenue from the cancellation of all but emergency surgeries, curtailed elective ambulatory procedures, and a decrease in ED visits, as frightened patients stayed away from hospitals. To save on costs, hospitals furloughed many health care workers, including nurses, and now they're seeking to rehire them as they reinstate elective surgeries and procedures. But either nurses aren't returning or they're leaving.

The American Nurses Foundation conducted a survey of 22,316 U.S. nurses between January and February on the one-year impact of COVID-19, and the responses from the 8,524 nurses in acute care are sobering. When asked if they thought their employers cared about their mental health, 37% disagreed; 38% felt employers did not value them. More than half (52%) indicated that work negatively affected their health and well-being. And when asked if they planned to leave their position within six months, 21% said yes and 22% were undecided.

At the virtual conference of the American Organization for Nursing Leadership (AONL) in July, researcher Peter Buerhaus reported preliminary findings of his study on the impact of the pandemic on the nursing workforce. He noted that nurses over age 55 seem to be leaving the profession more quickly now than before the pandemic. He also reported that a phone survey of over 800 AONL members conducted in May revealed that more than 50% of hospital chief nurse officers were seeing “increased retirements, sick leave, and early exits, including among younger nurses.”

As I write this in late July, the Centers for Disease Control and Prevention recently reported a 46.7% increase in the seven-day average of daily new cases from the previous week. Hospitalizations are also rising, largely from the transmission of the highly contagious Delta variant in unvaccinated individuals. This bodes poorly for hospitals that are still understaffed. A nurse colleague told me that in the fully occupied 24-bed ICU at her hospital, there were only six RNs and no aides on a weekend shift, making for a 1:4 nurse–patient ratio—a ratio most would agree is not safe for high acuity patients. If there is another prolonged surge of admissions in understaffed hospitals, it will only intensify the burden on nurses already struggling to cope with accumulated exhaustion and stress.

The pandemic has exacerbated acute care nurses' feelings of being unsupported and not valued by their institutions. They watch colleagues leaving to pursue other roles that offer a chance for professional practice, more prestige, and better working conditions. They see no relief from increasing workloads, unhelpful technology, and lack of support. Is it any wonder many nurses have lost faith that working conditions in hospitals will ever improve?

On October 20, AJN will host a webinar to explore the crisis in acute care nursing. Information will be forthcoming. We hope you will join us.

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