Nursing for me is about making a difference — and every day I’m making a difference in the lives of the people I care for. Take a Monday earlier this month. A patient of mine living with cerebral palsy was struggling to complete her therapeutic exercises. Her mother, clearly frustrated, feared her daughter wasn’t making sufficient progress. Dedicated and caring, the mother also worried that she wasn’t doing enough to help her daughter improve and succeed.
But this young woman was improving — slowly, surely, in ways imperceptible to the untrained eye. “Your daughter can now open both of her hands; all of our hard work is clearly paying off,” I explained, as the mother’s face transformed from hopeless to full of hope. “Your daughter just wants to be independent,” I continued, “and she obviously gets this spirit from you.”
Independence – as much as making a difference – is becoming a bigger focus for me in my career. The freedom to control my schedule. The freedom to control my income. The freedom to care for my three children. The freedom to care for me.
Until recently, I didn’t really have that choice.
For too long nurses have been treated like afterthoughts. We’re burned out and stressed out – from Covid, from our home lives, from feeling like our needs are always considered last. And this not only impacts our ability to perform, it threatens the effectiveness of the entire healthcare systems we’re so passionately committed to supporting. Yet, the working conditions and rigid schedules have not changed with the world around us.
Over my six-year career in nursing, I’ve witnessed both the indifference and abuse that has become too common in our industry. As a result, our community is suffering. Less than half of the 12,000 nurses recently polled by the American Nurses Association (ANA), for instance, believe that their employers care about them – a mere 19 percent for nurses 35 and under. More than 50 percent of all nurses are also thinking about leaving nursing; a figure that rises to 63 percent for nurses under 35. The latter numbers particularly worry me; with so many of my younger brothers and sisters ready to give up on nursing – and a national nursing shortage only expected to get worse – the future of the profession I love has never felt grimmer.
I know what it’s like to be undervalued in the workplace. I’ve been told by nursing agencies to wait in the cold if my patients are running late. Then when they finally do arrive, I’ve been expected to wash their clothes – even though I’m a nurse, not a housekeeper. I’ve been berated by patients for “moving too slowly” and battled with administrators for adequate PPE safety gear during the height of the pandemic. I’ve been made to feel like a number – a body – by nursing agencies just focused on profits and disrespected by patients and family members aggressively insistent I could just “do more.”
But more must be done to consider our needs, too – both by the nursing industry and the community of nurses to whom we all belong. What we seek is to be seen, valued, and supported in ways that matter. To be listened to if we are struggling during a hard shift. To hear “thank you” instead of being ignored. To give us tools and resources to take care of our mental health because after the past two years, we need it.
I experienced this kind of support unexpectedly when I found connectRN, a new platform that matches nurses with health care facilities that need our services. The ability to work when I want, where I want has given me the independence I was seeking, and an opportunity to step away if I need to recharge. As a mother, this flexibility is more important than ever. I can take on shifts that work with my child-care needs, eliminating the stress that usually occurs when making money and being a Mom collide. This should become an industry standard, rather than a perk from a digital start-up.
One of the things I value most about connectRN is that they are nurse-first and care as much about our community as the shifts they post. When I joined the platform, I was given access to The Beat, a private community of nurses who also work with connectRN. It is a safe space to chat with your peers about the things only nurses can truly understand – without the fear of reprisal or retribution. We share stories about hard shifts, give each other support to keep going, and often find “work buddies” in the places we work often. As debates rage around the role of nursing unions, hospitals and agencies must understand that a united nursing community is a better nursing community – better equipped, better prepared, and far better focused on the needs of our patients. With my life far more than just nursing – kids (both teens and a toddler), my extended family, a bit of me time – I feel lucky to be part of this community
For me, personally, The Beat proved particularly helpful when dealing with mental health concerns. At the height of Covid, the community offered telehealth therapy sessions through a partnership to use at our discretion. To be honest, I never considered I might need this kind of help — no one had ever asked me. But the death of a colleague — a young mother who passed away shortly after giving birth — hit me harder than I’d initially expected. I needed help to process how I was feeling and I took advantage of the offer. To have that support – for free – made me feel worthy and valued.
Over the past two years, I’ve been struck by a newfound respect for nurses as the Covid crisis continues unabated. Patients and families recognize our role at the frontlines of the pandemic and understand the risks taken daily to help their loved ones survive. What’s needed now is a parallel boost in understanding and appreciation from the hospitals and nursing agencies that power our profession. Because fairer pay, added flexibility, stress reduction, and self-care won’t just improve the lives of nurses, they’ll help ensure the positive patient outcomes we all desire. As nurses, we intuitively understand the necessity of these demands; it’s time for staffing agencies and health facilities to embrace this mindset with equally open hearts and minds.
Nurses inevitably encounter situations that cause moral distress. At the height of the Covid-19 pandemic, though—when there was no vaccine, and it was still assumed that for at least two years there would be no protection beyond masking and social distancing—moral distress became a daily ordeal for many frontline nurses.
Among those hardest hit by moral distress were the nurses of color working through a pandemic that exacted a disproportionate toll on Black, Filipino, Latino, and Native American minorities. Their experiences during the early days of Covid are at the core of a new study from researchers at DePaul University’s School of Nursing. In interviews with a diverse group of nurses located across the US, investigators found that moral distress was an almost inevitable affliction when lack of support made it impossible for nurses to provide high-quality care based on their training.
Nurses on the frontlines faced unrivaled psychological and physical demands during the pandemic, noted researchers. Voices of nurses from this moment in history could help inform policies and laws to improve retention and reduce burnout among nurses in the U.S. “People need to listen to nurses more, and nurses need to feel empowered to share their experiences at every level of leadership,” said principal investigator Shannon Simonovich, PhD, RN, an assistant professor of nursing at DePaul.
“Diverse nurses caring for a diverse patient population”
In 2020, many news stories about health care heroes featured white, female nurses, Simonovich said. In reality, nurses from many personal, ethnic and geographic backgrounds with a varying levels of education were caring for COVID-19 patients.
Simonovich recruited a diverse group of DePaul nurse researchers to conduct the study, which in turn helped recruit a diverse group of 100 nurses to be interviewed, according to assistant professor and coauthor Kashica Webber-Ritchey. “We captured the voices of diverse nurses caring for a diverse patient population that was being disproportionately impacted by COVID-19,” Webber-Ritchey said. In the DePaul sample, 65% of the nurses identified as a member of a racial, ethnic, or gender minority group.
Many nurses from these represented populations have lost their lives to COVID-19. Researchers at DePaul cite a tally that more than 3,300 U.S. nurses, doctors, social workers and physical therapists died of COVID-19 between February 2020 and February 2021.
DePaul researchers conducted interviews between May and September 2020, asking nurses to describe their emotions. Nurses reported moral distress related to knowing how to treat patients and protect themselves, but not having the staff, equipment or information they needed. As a result, they reported feeling fear, frustration, powerlessness and guilt.
The toll of frustration, stress, and guilt
This qualitative study is believed to be the largest of its kind from this period—a time of great uncertainty about the virus that causes COVID-19 before the development of vaccines. Highlights include:
Study participants described many forms of frustration while providing patient care, including frustration with healthcare leadership being out of touch with those on the frontlines.
Nurses felt powerless to protect themselves and others from contracting COVID-19.
Nurses described being placed in difficult patient care experiences that resulted in guilt around letting down patients and their families, as well as fellow members of the healthcare team.
““We are a largely female profession, and we don’t complain enough when things are tough.”
The burden nurses have shouldered during the COVID-19 global pandemic calls for research that describes and examines the emotional well-being of nurses during this unprecedented time in contemporary history, write the researchers. As the media coverage of nurse heroes fades, the narratives in this study should be a call to action, says Kim Amer, an associate professor with 40 years of nursing experience.
“Nurses need to come together as a profession and make our standards and our demands clear,” Amer said. “We are a largely female profession, and we don’t complain enough when things are tough. As a faculty member, we teach students that it’s OK to refuse an assignment if it’s not safe. We need to stand by that.”
The DePaul research team calls for clear, safe standards for nurses that will be legally binding and hold hospitals and health care agencies accountable. “We go into nursing with the intention of saving lives and helping people to be healthy,” said Simonovich. “Ultimately, nurses want to feel good about the work they do for individuals, families and communities.”
Investments by healthcare organizations and policymakers in mental health resources could help promote psychological resilience in nurses, noted Webber-Ritchey. “Taking time to speak to nurses to understand their needs and provide support would help with addressing moral distress,” she said.
Believe it or not, during the COVID-19 pandemic, some nurses have been spreading misinformation about the virus and all its variants. Doing so, however, isn’t a small thing. In fact, you can lose your job over it.
Georgia Reiner, MS, CPHRM, Senior Risk Specialist with the Nurses Service Organization (NSO), took time to answer our questions about this bizarre phenomenon.
Spreading misinformation about COVID is wrong, no doubt. But nurses may not be thinking of the consequences that face them if they do it. Why can nurses face disciplinary action by their State Board of Nursing? How do they determine if information is incorrect?
Holding a nursing license means upholding the standards of the profession and the principles of the ANA Code of Ethics for Nurses. Spreading misinformation about COVID-19 vaccines, treatment, and masking—either verbally or on public forums or social media—can be harmful to public health and the nursing profession. When nurses identify themselves by their profession, The National Council of State Board of Nursing (NCSBN) says that they are accountable for the information they share with the public. Using nursing credentials to discuss medical information can be considered nursing practice because the public views nursing credentials as evidence of a nurse’s knowledge and trustworthiness. As such, the NCSBN says that nurses who disseminate COVID misinformation can face disciplinary action from their State Board of Nursing, which can jeopardize their license and career.
The NCSBN defines misinformation as “distorted facts, inaccurate or misleading information not grounded in the peer-reviewed scientific literature and counter to information being disseminated by the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA).”
What are some tips that can help nurses spot misinformation online?
It can be difficult to differentiate between factual information and news that comes from legitimate sources from rumors, opinions, falsehoods, and conspiracy.
Here are some tips to help nurses spot misinformation online:
Analyze both the content and the source.
Does anything seem too good to be true? Does information seem dramatic or overblown? If something seems outrageous, check with reputable news sources and fact checkers to confirm what may have really happened.
Does the author use sensationalistic language or lack specific evidence? Opinion and news commentary represent a point of view, while fact-based writing or analysis represent facts that are framed in appropriate context. Examine supporting evidence to see if the cited sources are reputable and if they support the claims being made.
Is the source of this information fake news or satire? In today’s world, sometimes satire can seem somewhat plausible. When you’re checking sources, visit the “About” or “Contact Us” section of its website. If it is satire, it should say so on the site, and illegitimate sources won’t share information about their mission, staff, physical location, or a way to contact the organization.
Examine the author
What other content have they produced in the past? Reviewing an author’s past work can reveal an agenda or point of view if they have repeatedly published content on the same topic.
Try to identify the intent behind the post or information. Information can be deliberately altered to push an agenda, such as damaging someone’s reputation, endorsing a belief system, or getting users to click on or share an article to help drive advertising revenue.
Engage in self-reflection
Evaluate how the information fits into your pre-existing beliefs. People often rely on their personal beliefs to understand evidence, and confirmation bias leads people to seek out information that supports their pre-existing beliefs.
Check to see if there are any articles refuting what you read. Oftentimes, when a piece of misinformation becomes mainstream, reputable authors will provide evidence that explains why a particular claim is false.
How can nurses address incorrect information or misperceptions with their patients? With the public? What can/should they do in either case?
Nurses and other health professionals play a critical role in proactively engaging with people to help counter COVID misinformation. One of the most effective strategies is to use personalized, individual communication.
When nurses speak with their patients and the public, they should understand that using shame or embarrassment can often lead to the opposite intended effect. Fact-checking to prove a point can also shut down a conversation. It’s important to be patient, caring, understanding, and empathic. People have different needs, backgrounds, and experiences that shape their fears and beliefs. Nurses should try to focus on the bigger issue and the person’s feelings about the issue, rather than the false claims they may support. Asking questions and listening with empathy are great ways to understand perspective.
It’s critical for nurses to acknowledge that finding credible information online is challenging. If they’re open to assistance, nurses can help people identify reliable sources for accurate information or connect them with another health professional who can help them make informed decisions on their own.
In our highly polarized political environment, some nurses may believe it is effective to use their nursing credentials online to validate the opinions they share. However, the internet is written in ink, not pencil. You can have conservative privacy settings in place, and you can try to delete posts after the fact, but the best defense against allegations of unprofessional behavior online is to exercise caution before posting anything related to your nursing practice or health care in the first place.
Staffing shortages in hospitals have been a concern for some time, owing to the country’s aging population—but COVID-19 has only worsened the situation. In reaction to the pandemic, many of these institutions spent months stockpiling medical equipment and protective clothing, but the supplies are useless without staff. So, how do we handle the hospital staffing crisis?
Despite recent decreases in coronavirus infections across the country, many hospitals are still facing staffing shortages, and may continue to do so in the coming months. Healthcare workers are still under a lot of pressure, experiencing deplorable working conditions. Many of them are unable to take much-needed breaks due to severe personnel shortages, and suffer burnout as a result. The stress levels are so high that some are even considering leaving their professions entirely.
Adequate staffing levels in healthcare institutions ensure a safe work environment for healthcare workers and quality care for patients. Hospitals must be ready for potential personnel deficits and must have contingency plans and workforce management tools in place to deal with them.
COVID-19’s Impact on Healthcare Staffing
In 1999, the state of California enacted and implemented the first and only comprehensive U.S. legislation limiting the number of patients that nurses may care for at a time. Although several studies show how better staffing leads to improved patient outcomes, no other states have adopted this type of legislation.
There are many reasons why efforts to pass legislation governing hospital nurse staffing fail to get universal support from influential groups. The first impediment is a lack of local and timely evidence to support such laws. Another is the misconception that the country lacks nurses. Meanwhile, registered nurse graduations have more than doubled in the last 15 years.
The COVID-19 pandemic served as a stark reminder of the significance of adequately staffed health systems in delivering high-quality patient care, as well as the toll that under-resourced facilities have on workers’ well-being. The rising patient demand and diseases among healthcare professionals, particularly those of ethnic minorities, significantly impacted staffing in healthcare, worsening the staffing crisis even further.
Many hospitals responded to the surge in patient demand by canceling elective treatments and shutting down non-essential outpatient clinics, but dealing with the shortage of personnel was more difficult. Healthcare workers were repurposed, and students were onboarded at the worst-affected hospitals. Some states provided temporary allowances that permitted nurses licensed in one jurisdiction to practice in another during the heat of the crisis. Nurses were allowed to work across state borders and in areas with severe shortages.
What Can be Done About the Recent Healthcare Staffing Crisis?
While no one has the one-size-fits-all solution to staffing shortages, it’s fair to presume that healthcare providers would benefit from being more proactive than reactive in their staffing strategies.
The absence of flexible workforce management is now the most common cause for nurses leaving their first year of employment. Clinicians must sign up for shifts eight weeks in advance, and there is little leeway to readjust the schedule once it has been completed. Shift allocation is inefficient and largely reliant on manual systems, which undoubtedly isn’t suited to any last-minute changes.
Nurses and other clinicians prefer to specialize, but with further training and development, nurses may cover shifts in various departments and situations. While tenure in a department is frequently used to determine a schedule, this strategy results in nurses concentrating in one specialty and limits multidisciplinary training. It’s possible that tenure isn’t an excellent criterion for scheduling.
Pipelines for candidates
Though the number of registered nurses graduating yearly is at an all-time high, there is room for more. Other healthcare fields are still producing fewer professionals than there are jobs available. To recruit future healthcare workers, healthcare companies must be future-focused in their workforce planning, building stronger relationships with high schools, colleges, and training centers.
One of the most effective methods to guarantee that patients receive the treatment they require is to lower the likelihood of healthcare workers being sick. Infection prevention teams must make a concerted effort to offer timely and complete information to employees so that they can protect themselves.
Hospital executives must also change their workplace culture by encouraging employees and managers to speak out when they observe colleagues missing a chance to improve safety. It’s critical to reinforce the idea that everyone has the right to contribute to a workplace that is safer for other employees and patients.
Employing Digital Tools
One of the numerous advantages of telehealth adoption is that nurses, doctors, and other hospital personnel may care for patients online, while quarantined or recuperating from sickness. Furthermore, hospitals may centrally control all elements of their treatment operations thanks to digital health care delivery.
Staff can also use digital technologies to communicate between hospitals, e.g. during surges, to lend support at all levels. Critical care teams, in particular, can cross-cover patient spikes.
The staffing crisis in healthcare may continue for some time due to the ongoing COVID-19 pandemic, poor workforce management, and low adoption of digital transformation in the sector. The government also has a role to play in enacting legislation that regulates patient-to-health worker ratios. With adequate adjustments, the deficits can be filled and care delivery optimized.
While the worst of the COVID-19 pandemic seems to be behind us, the spread of the Delta variant indicates that it’s not completely over yet. During the height of the pandemic, nurses worked on the frontlines all over the country, and some are just now sharing their experiences working in the ER during the height of COVID-19.
Rastisha Smikle, RN, works in an ER at a hospital in central Florida. Having worked as a nurse for more than 10 years, she answered our questions about what it was like in the ER during COVID-19.
As a nurse in the ER in Florida, what has it been like working there during COVID-19? How has it changed over the last year or so?
It was very challenging to work during the pandemic. In the ER, we are a patient’s first point of contact, and because of that, our staff is considered at a higher risk of being exposed to the virus. Although safety and infection control elements have always taken priority in our roles, the unknown factors of the virus’ transmission, ever-changing symptomatology, and treatment contributed to our challenges because of all the unknowns.
Patients were more fearful than ever; they often came in anxiety-ridden wanting testing because of recent exposures, which added additional challenges because the critical emergencies also relied on our care.
In some ways, things have gotten better. As we have learned more about the virus and therapeutic treatments, patients are being cared for more efficiently so that they can recover at home. Unfortunately, hospitals nationwide are busier than ever right now. The volume that we are seeing is higher now than we saw during the pandemic. It’s tough to say what that is.
Did your duties change during COVID-19?
My duties didn’t change per se, but the way we cared for patients did.
Before the pandemic, PPE like N-95 masks were not permanently a part of my uniform. Now, I wear an N-95 and face shield with every patient encounter. Because of the wide range of symptoms, we have to be extra diligent in caring for patients just in case they have the virus and aren’t aware of it yet. In addition, minimizing my exposure time with known Covid-19 patients is also an element that I have had to implement in my care. For the safety of myself and the other patients, swift patient care must be implemented with these patients when appropriate.
Employing the use of hospital phones has been a way that I try to fill in the gap. Throughout this time, I have learned how fearful patients are after they get the diagnosis. With these talks, I can extend some reassurance, listen to their concerns, and figure out thoughtful and effective ways to help them with the emotional challenges that often accompany the diagnosis and isolation.
Was it scary to work there in the beginning of the pandemic? Why?
There was a level of fear when it came to the unknowns. I had worries about getting the virus. But primarily because of my level of exposure in the ER, I was mainly concerned about others being around me. I isolated myself from family and friends, and my life was work and home.
There were times when we would care for patients with no known symptoms and later, we’d find out that they were positive for Covid-19. I would have mounting thoughts of whether I wore the correct PPE or if I was exposed in those moments.
We also had staff members contract the virus, which was scary. Thankfully, most of them recovered well, but seeing how careful other staff members were and finding out that they still contracted the virus was nerve-wracking. Every minor allergy symptom or cough would cause concern and anxiety about whether I was next. To combat those fears, I had to reshape my focus. Instead of being hyper-focused on getting sick, I began to fix my focus on doing my job well and providing the optimal patient care that I was used to. With this newfound focus, my anxieties slowly began to dissipate.
How do you keep yourself from bringing the stress of the job home? What do you do to relieve your stress?
Sometimes it can be challenging, especially after losing a patient. My go-to stress reliever is prayer. I have a solid spiritual foundation, and thankfully the organization I work for also provides spiritual support, if needed. As nurses, we are fortunate enough to work three shifts per week. I try not to take my days off for granted; I use that time to refuel. Therapy, exercise, and self-care activities have been essential to my mental well-being.
What are the biggest challenges of your job—especially during COVID-19?
One of the biggest challenges of my job is knowing that I have to be on my A-game at all times because the safety of myself and others depends on it. The unknowns that came along with COVID-19 made it challenging to do and be our best. For example, we didn’t always know the best course of action when treating some patients because everyone would respond so differently, which posed one of the biggest challenges. Thankfully, as time went on, we learned more about the virus, the treatment options that worked for others, and we eventually adapted very well.
What have been your greatest rewards during this time?
My greatest rewards have been seeing how the nursing and healthcare community banded together during the most challenging times. The support from our community members was also very inspiring. We often came into work with goodies from companies that wanted to encourage and thank us for our continued work.