Nursing is more than a profession. It’s a calling. And those who answer the call become the backbone of a high-functioning, compassionate health care system. People who become nurses are capable, compassionate, and strong scientists and clinicians who have worked hard to start their careers. Their expertise, patient care delivery, and commitment to the profession contribute a distinct perspective on how health care should be managed and delivered.
While nurses are strong and resilient, they can’t fix their biggest problem: a dire nursing shortage. A decade in the making, our national nursing shortage threatens our already struggling health care infrastructure. Studies have long predicted that the demand for nurses would intensify as the U.S. population aged. And just like the trends in general higher education, nursing schools have become less accessible, as many face faculty shortages, limits on enrollment, and limited space for clinical training at teaching hospitals.
And, of course, the COVID-19 pandemic only accelerated these trends. Nurses came under incredible pressure from the increase in patient numbers and acuity, and public distrust surrounding politicized vaccines and treatments, with a large number of their peers opting to leave the field due to these pandemic stressors. The nurses who remain find themselves in professional limbo, looking for ways to squeeze in continued education and professional development, manage work demands and challenges, and find a healthy work-life balance.
And that is if they chose to stay. A staggering number of nurses have decided to leave. The total number of registered nurses in the workplace decreased by more than 100,000 in 2021, the most significant drop observed in four decades. The largest group to depart was nurses under 35.
We need to do everything in our power to create sustainable solutions that don’t simply “put nurses on floors” but will provide our nurses with the best possible experience, one that allows them to practice at the top of their license. The circumstances are challenging, and there’s no quick fix, but our patients, our communities, our health systems––health care itself can’t afford to continue in this direction.
At Trinity Health, we started developing solutions well before the pandemic and have seen first-hand how thoughtful solutions, informed and led by nurses, impact job satisfaction most. Programs that give nurses greater flexibility and options based on where they are in their career and what they want to do, innovative care delivery models that support their work and provide opportunities for professional development, continuing education, and alternative career pathways work.
Supporting Education and Career Advancement
Starting a career in nursing is no simple endeavor. So, when entry-level nurses are just beginning, it’s critical to jump on the moment’s excitement and encourage them to dive as deep into their new role as possible. In 2014 we collaborated with Vizient, the country’s largest member-owned health care services company, to create our Nurse Residency Program. This program helps orient entry-level nurses as they transition into practice. The evidence-based curriculum incorporates three key areas: patient outcomes, leadership, and professional development.
For experienced nurses, we provide a robust system-wide learning platform for those interested in advancing their skills in various areas of practice specialization. Obtaining the highest level of education doesn’t just support their careers and livelihoods, but it helps us ensure we provide the best patient care possible.
Opportunity must be equitable, and we are committed to living Trinity Health’s values of equity, diversity, and inclusion in everything we do. Unequal access to education, specifically for underrepresented communities, is a well-documented barrier for students who wish to pursue a nursing degree. To that end, we provide tuition assistance, flexible online programming through our nursing schools and seven academic partner schools, scholarships, on-the-job training, and career advancement programs to help level the playing field for nurses from diverse backgrounds. This is crucial for delivering health care that is representative of the populations we serve.
Multiple Options to Support Work-Life Balance
Nurses especially need work-life balance. Options for flexibility and roles that match their needs and goals are essential to increasing the longevity of a fulfilling and meaningful career.
Nurses at Trinity Health led the development of FirstChoice, our internal staffing agency that offers flexible scheduling and travel opportunities for nurses and clinical staff. Having our pool of travel nurses helps prevent colleague burnout and maintains continuity in patient care. In addition to FirstChoice, we’ve introduced a new care delivery model to improve patient care, experience, and nurse satisfaction. The delivery model has been well-received by nurses who are early in their careers and benefit from the unique mentoring experience and from more tenured nurses who can continue to work in a less physically demanding but gratifying capacity.
Beyond flexibility, we must provide other ways to support nurses’ well-being and resilience. A recent study reports that a quarter to half of the nurses reported feeling emotionally drained (50.8%), used up (56.4%), fatigued (49.7%), burned out (45.1%), or at the end of the rope (29.4%) multiple times a week. Mental health benefits are an essential requirement once considered a luxury perk or not considered at all. We began offering Colleague Care Resiliency Rounding, a real-time, one-on-one, human connection for colleagues in high-volume, highly demanding areas within the hospital setting. The program’s goal is to address mental health proactively and sustain their mental well-being in the face of the inevitable stress of the job.
To ensure that there are no barriers to mental health support, we offer six free therapy sessions and six free coaching sessions per calendar year, as well as options for personalized care, access to diverse providers, self-guided wellness exercises, personal medication management training, substance use support, work-life services, and more.
When someone is a nurse, their career can easily become their identity. Nurses love their job, and we love them for that. But we must recognize that every nurse is more than the exceptional care they give to patients. They are whole humans with lives away from the bedside. They need support that is designed with that in mind.
Nurses have long been renowned for confidently taking control of situations many shy away from. While I firmly believe it’s up to administrators and health systems to provide the essential support nurses need to thrive, I also know nurses must have a hand shaping their work lives. From my 40 years of experience as a nurse, with nearly 30 of those as a chief administrator, here is my advice to nurses searching for a career that will meet their personal and professional needs and goals.
Find an organization that shares your values. Look at the organization’s mission, vision, and values. Does it align with your own? Can you see evidence of their commitment to these values? Make sure the operational structure meets your needs. Does flexibility matter? Ask about shift offerings, virtual opportunities, or options to work in multiple locations. Do you care about mental health access? See what benefits they offer from day one.
Make sure the organization will truly see you and hear you. Your input is key to creating improved work environments and patient care. You must feel nothing less than supported in asking questions and contributing your voice to the conversation.
Whatever stage of your career––recently graduated or 20 years in––make sure an employer is willing to support your professional development. Opportunities for a new nurse should look vastly different than those for someone who has spent decades in a specialized unit. Ensure you can access individualized educational opportunities that impact your career trajectory and help you meet your goals.
I can only speak for myself and my team, but until all nurses feel adequately supported, I won’t rest my case that urgent action needs to be taken. Patients’ lives depend on our ability to care for and empower the people who care for them.
I am encouraged by my colleagues who have taken notice and have started to make meaningful changes. Nurses have been through a lot in the past few years, and we never know what awaits around the corner. But a positive shift is coming. The momentum we’ve built so far must continue so that the next generation of nurses feels more supported, better equipped, and more passionate about their calling than they ever dreamed possible.
Nurses face various challenges in their day-to-day activities, and one of the most prominent currently is the ongoing healthcare staff shortage. The shortage creates greater stress for nurses but can also affect patient outcomes, workplace safety, and meaningful career growth.
Administrators and industry leaders must commit to meaningful systemic changes to address the issue. However, nurses’ commitment to helping one another throughout this crisis is also essential. By offering support, guidance, and insights in key areas, nurses can empower one another to thrive throughout these challenges.
Communicate About the Causes
It is likely to be clear to all nurses that there are significant staff shortages in the healthcare industry across a range of roles. There are various reasons, including aging populations living longer, which has increased the demand for services. Many professionals are aging out of the industry. Toxic workplace cultures – resulting from stress, insufficient pay, and patient abuse – can also contribute to a lack of new nurses.
Nurses must understand these causes and what is causing specific staffing shortages in their area. With a clear idea of the root problem, it can be easier to have clarity on how to find solutions.
Perhaps most importantly, nurses should communicate with each other about staffing problems. Nurses representing traditionally marginalized demographics or interacting with minority communities can also highlight specific challenges. The better insights everyone can gain about the shortage causes, the more empowered everyone can be when navigating them.
A recent National Council of State Boards of Nursing survey found that 45.1% of nurses reported feeling burned out, contributing to many professionals leaving the industry. While burnout isn’t a diagnosable illness, it does have physical and psychological symptoms that can have long-term negative impacts. Relentless workplace stress and toxic working environments can lead to sleep loss, weight fluctuations, anxiety, and suicidal behavior. It’s no wonder nurses are leaving the profession rather than risk continued burnout.
Certainly, some of the root causes of burnout are related to systemic issues that administrators must address. However, from the perspective of nurses supporting nurses, one of the key contributions professionals can make is encouraging one another to prioritize self-care.
Prioritizing self-care is challenging, particularly given how busy working life as a nurse can be. This only emphasizes the importance of keeping colleagues accountable for taking care of themselves. Nurses must encourage one another to take breaks, eat healthy meals, and engage in hobbies. Committing to looking out for signs of exhaustion and stress in one another can open up conversations leading to effective resources.
Another key form of self-care as a nurse is advocating against inequalities and toxic environments contributing to burnout. Particularly among nurses from marginalized populations, the cumulative effect of microaggressions can be disruptive. One study found that 80% of nurses have witnessed workplace or nursing school discrimination. It is important to talk to one another about the presence of these elements and present a united front in highlighting the problem to administrators and demanding change in the workplace.
Influence Inclusive Recruitment
There are certainly recruitment issues that contribute to the healthcare shortage. It’s important to recognize that one of the most positive ways nurses can help one another address this is to be meaningfully involved in influencing recruitment. After all, no one has better insights into the challenges, benefits, and needs of the nursing industry than those who are a part of it. Importantly, nurses from minority backgrounds can ensure recruitment approaches are more accessible and welcoming to a wider proportion of the population. This can help bridge the labor gap and bring much-needed diverse cultural perspectives into the industry.
It can be helpful to encourage administrators to engage in meaningful community outreach. This may involve arranging formal opportunities for experienced nurses from various backgrounds to visit schools or community organizations. They can then discuss the options and provide practical advice on pursuing the path.
During outreach, it’s vital to share nurses’ experiences that have made later life career switches to the industry or pursued educational courses despite tough socioeconomic conditions. Nurses can also act as much-needed mentors among still under-represented minority communities. One recent study found that only 19.4% of registered nurses are from minority backgrounds. These outreach efforts give community members a sense that people with similar challenges can thrive in the industry, which may prompt engagement.
It can also be wise for nurses to have frank discussions with human resources (HR) personnel about facilities’ current recruitment processes. It’s common for systemic biases to result in recruiters overlooking ways to reach more diverse candidates. There can also be cultural hurdles that HR staff must be aware of. Providing these insights and suggesting solutions can help more potential nurses enter the sector.
Nurses committing to supporting one another through the healthcare staff shortage is essential. Communicating with one another about the causes of the shortages can aid well-informed approaches to addressing the issues. Promoting mutual self-care – including advocating against toxic workplaces – can help mitigate the potential for burnout. Engaging in more inclusive community recruitment can also positively impact greater nursing numbers and more diverse professionals in the field.
Though nurses’ contributions can be invaluable, it’s also important to take only part of the responsibility for meaningful change on their shoulders. Nurses are already overworked and face significant career stress. Recognizing personal limitations, setting strong boundaries, and seeking solid resources are essential for navigating this difficult time.
With all the talk about a nursing shortage, nurse satisfaction is a key priority in healthcare, and uncovering and addressing issues for nurses is more critical than ever.
Minority Nurse recently launched a Nursing Satisfaction Surveyto learn more about nursing education and career topics beneficial to our readers and help boost talent retention and create a more productive workforce.
Preliminary results of our Nursing Satisfaction Survey indicate that 81% of nurses are at least somewhat satisfied in their nursing jobs, and those nurses not satisfied cite burnout and lack of recognition as the top reasons above compensation.
Eighty-three percent of nurses considering changing jobs say they plan to stay in nursing, with 29% of nurses surveyed saying they have a second job. Only 9% of nurses surveyed have a second job outside of nursing, with the top side gig being a nanny.
Nurses say the top three characteristics when choosing a new employer include compensation, work-life balance, and career advancement.
Lend Your Voice to Our Survey
These are preliminary results from our Nursing Satisfaction Survey, and with a few days left until the survey closes, we’d love for you to lend your voice.
Complete our Nursing Satisfaction Survey to win one of five $50 FIGS gift certificates
Every nurse’s voice matters, and with just seven minutes of your time, Minority Nurse can uncover and address issues important to you. Once you complete the survey, you will be enrolled for a chance to win one of five $50 FIGS gift certificates. Please note survey responses must be entered by July 1, 2023, to be considered for the raffle.
Thanks in advance for your input and for sharing your voice on this important issue.
Hospitals serving more patients at risk for complications during childbirth are less likely to have enough nurses to care for patients during labor, delivery, and recovery, according to a new study in Nursing Outlook.
The findings reveal one of many factors that may contribute to poor maternal health outcomes in the U.S. for the most vulnerable childbearing populations, including Black mothers and those insured by Medicaid.
Nurses play a central role in the 3.6 million births in U.S. hospitals each year. The Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) issues guidelines on nurse staffing levels for maternity units; its 2010 guidelines call for one nurse to one birthing person during many parts of labor, two nurses at birth, one nurse for each mother-newborn pair during the first few hours after birth, and one nurse for every three pairs of mothers and babies after that period. These same nurse-to-patient ratios were included in the AWHONN nurse staffing standards published in 2022.
Recent data show that patients at high risk for severe maternal complications are more likely to give birth in teaching hospitals and have Medicaid as their insurer. In addition, teaching hospitals—often safety-net hospitals providing a significant amount of care to low-income and uninsured patients—are also more likely to have high volumes of births. In this study, the researchers aimed to determine nurse staffing levels at hospitals with vulnerable maternity patients, using high-birth volume and teaching status as proxies for high-risk patients.
The researchers surveyed 3,471 registered nurses from 271 hospitals across the country. Nurses were asked about staffing levels on their maternity units during labor, delivery, and recovery using AWHONN guidelines. The researchers compared nurses’ responses on staffing with hospital characteristics from the American Hospital Association Annual Survey.
Overall, nurses reported strong adherence to AWHONN staffing guidelines in their hospitals, with more than 80% of respondents saying that their unit frequently or always met the staffing guidelines. Adherence to guidelines was particularly high for specific stages of labor, including a nurse being continuously present at the bedside during second-stage labor (93.3%) and one-on-one care during epidural initiation (84.1%). However, adherence was lower for having a dedicated nurse for postpartum recovery in the two hours right after delivery (71.8%), one-on-one care for mothers with high-risk conditions (72.6%), a nurse dedicated to fetal heart rate monitoring (61.3-77.2%), and one-on-one care during oxytocin administration in labor (54.6%).
Analyzing hospital characteristics, the researchers found that teaching hospitals and hospitals with higher birth volumes, neonatal intensive care units, and higher percentages of births paid by Medicaid were associated with lower staffing guideline adherence—all of which have been shown to serve high-risk maternity patients.
“These gaps in staffing are particularly troubling for our most at-risk patients,” added Lyndon. “Many maternal complications can be prevented or quickly addressed through timely recognition of risk factors and clinical warning signs, and, when issues are identified, the escalation of care and coordination with the care team—but this is only possible when there are enough nurses monitoring patients.”
The researchers note that one possible cause of nurses in these types of hospitals having more patients than recommended may be poor reimbursement from Medicaid for childbirth services.
“Studies show that Medicaid pays hospitals less than half of what commercial insurers pay for a birth. This inequity in reimbursement creates a fiscal challenge in hospitals with a high percentage of maternity patients insured by Medicaid,” says Kathleen Rice Simpson, PhD, RNC, FAAN, a perinatal clinical nurse specialist in St. Louis, MO, and the study’s lead author. “Better funding for teaching and safety-net hospitals caring for high-risk maternity patients could support better nurse staffing.”
In addition, the researchers encourage the Centers for Medicare and Medicaid Services (CMS) and the Joint Commission to consider safe staffing requirements for inpatient maternity care, similar to CMS working to establish minimum staffing regulations for nursing homes to promote patient safety.
In conversations with nurses around the country, I hear from older nurses who feel their age is a significant liability in today’s nursing job market. While age discrimination can be a valid concern to remember, older nurses can also leverage their professional history and life experience as a plus for employers seeking accomplished nurses with much to contribute as highly skilled healthcare professionals.
Age and the Nursing Shortage
According to the National Council of State Boards of Nursing 2020 National Nursing Workforce Survey conducted in partnership with The National Forum of State Nursing Workforce Centers (the 2022 study results will be released sometime in 2023), the median age of RNs is 52, up from 51 in 2017.
With an ongoing nursing shortage projected through 2030 by the American Association of Colleges of Nursing and numerous others, employers are not in the position to look a gift horse in the mouth when an older nurse applies.
When it comes to the numbers, there are so many nursing jobs in need of qualified candidates, and, more often than we would like, there need to be more nurses in the market. This is worrisome. As Auerbach et al stated in their April 2022 article in the journal Health Affairs, the total supply of RNs dropped by 100,000 in 2021, the most significant single-year drop in four decades. This is a universal cause for concern.
Enter: The Older Nurse
Despite older nurses’ understandable concerns that employers will pass them by for younger applicants, there may not be enough 20- and 30-something nurses to go around. There’s something to be said for length of experience, and a nurse with several decades behind them has something unique to bring to the table. Unfortunately, while younger nurses just out of school or with less than ten years of experience have fresh perspectives and energy, employers ignore older nurses’ gifts and potential contributions at their peril.
We can attest that age discrimination can cut both ways. For example, some hiring managers or HR professionals may have an inherent bias against younger, less experienced nurses, just as others may look askance at those with more years under their belts.
Truly, nurses of all ages and levels of expertise and experience have unique qualities, and this variety is healthy for the profession, the healthcare system, and employing institutions. With four generations of nurses active in the workforce (i.e., Baby Boomers, Gen X’ers, Millennials, and Gen Z’ers), each cohort can be avidly embraced, especially with a significant nursing shortage with no end in sight.
The Argument for the Older Nurse
If you’re an older nurse (e.g., 40s, 50s, or beyond), there are many arguments to make for your continued relevance. Of course, you don’t want to unnecessarily make your age an issue on your resume, cover letter, or job interview. Still, there are subtle ways in which you can leverage your status as an older, more experienced nurse in your favor.
Experience: Let’s face it — experience counts a lot in most cases. An L&D nurse with 22 years of experience has seen a thing or two. Their ability to contribute to patient safety, the delivery of high-quality care, positive outcomes, and patient education should be considered. If you’ve cared for hundreds of laboring moms and attended hundreds of births, you have valuable experience to draw upon. On your resume, in your cover letter, and during interviews, you can tout your volume of experience as a big plus for why hiring you would be smart.
Maturity and life experience: Maturity isn’t always proportional to age (I’ve known teenagers who are significantly more mature than most 30- or 40-somethings), but we can, by and large, figure that experience and exposure to the slings and arrows of life hold some value. Without explicitly drawing attention to your chronological age, you can communicate how your life experience (e.g., as a parent, a nurse, a citizen, etc.) gives you an edge.
Longevity of employment: A clear bias exists (at least in the media) that Millennials and Gen Z’ers are likelier to ditch an employer when they feel their current position has outlived its usefulness for their careers. Like any bias, its validity is highly debatable; however, what’s not debatable is that older nurses can be very clear when describing their track record of employer loyalty (if that’s the verifiable case, of course), and their desire for a new professional home where they plan to stay for a significant amount of time.
Keep Your Head Held High
You can walk into an interview with your head high as an older nurse. Professional experience, life experience, and relative maturity are factors that any prudent employer will consider.
During an interview, the older nurse can point out that, with onboarding new employees costing tens of thousands of dollars, hiring well is essential, not to mention nurse retention. With a clear demonstration of past workplace loyalty, you can verbalize how you plan to stick around, become a valued employee, and deliver a significant return on investment.
We need newer and more experienced nurses in the nursing workforce, and older nurses can leverage the ongoing nursing shortage to their advantage. However, your value should not be questioned, so make your case loud and clear.
Minority Nurse is thrilled to feature Keith Carlson, “Nurse Keith,” a well-known nurse career coach and podcaster of The Nurse Keith Show as a guest columnist. Check back every other Thursday for Keith’s column.