1. Kennedy, Maureen Shawn MA, RN, FAAN


Weak institutional support hampers nursing's recovery from COVID.


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It's no surprise that the top nursing news story of the year is the ongoing workforce crisis. Not enough experienced nurses choosing to work in acute care combined with insufficient faculty to prepare new nurses suggests there will be no quick fix for the nursing pipeline. Perhaps nothing exemplifies the crisis more than the widely reported incident in which an ED charge nurse at a community hospital in Washington State, seeing her staff overwhelmed with patients, called 911 for paramedics to help.

Figure. Photo courte... - Click to enlarge in new windowFigure. Photo courtesy of National Nurses United.

Although COVID-19 vaccines proved effective in preventing the hospitalizations that overwhelmed the health care system early in the pandemic, the past year did little to improve nurses' lot. Hospitals have had difficulty attracting staff to replace those who retired, quit, or left to take better-paying travel nurse jobs or work in other settings. A recent McKinsey and Company report on its November 2021 survey of 710 nurses noted that "the strongest drivers of intent to leave included insufficient staffing levels, seeking higher pay, not feeling listened to or supported at work, and the emotional toll of the job."


Of concern is that many of those who left the profession are experienced nurses, and newer nurses-especially those who entered the workforce at the beginning of the pandemic-did not receive sufficient orientation nor did they bring real-world clinical experience. Jean Ross, copresident of National Nurses United (NNU), told AJN, "Retaining experienced nurses is critical to ensuring that the next generation of nurses have all the help they need to learn and grow in their careers. It is common at hospitals across the country to see nurses with only a year's experience acting as preceptors to newly graduated nurses, something that would have been unthinkable just a few years ago."


Observers say workplace violence is another factor that may make nurses hesitant to work in direct patient care. Citing an April 2022 NNU survey, Ross noted that nearly half (48%) of the responding RNs "reported a recent increase in workplace violence" and identified short staffing as "the biggest contributing factor." Safe levels of staffing, she said, "ensures that nurses have more time to recognize and deescalate potentially violent behavior from a patient or a family member." Statistical evidence supports these observations. An analysis by the health care data collection firm Press Ganey found that, on average, two nurses were assaulted every hour in the second quarter of 2022. The attacks ranged from verbal harassment to physical violence, which can turn deadly. In October, two nurses-a labor and delivery nurse in Texas and a mental health NP in North Carolina-were killed while on duty.


Nursing homes, schools, and nursing faculties are also suffering from workforce shortages that intensified during the pandemic:


* Only 40% of U.S. schools have a full-time school nurse; 25% have no nurse at all. In a March survey of 7,900 school nurses by the National Association of School Nurses, 45% of respondents said they suffered an adverse mental health condition in the previous two weeks, and 48% said they had experienced pandemic-related work stressors (bullying, threats, or harassment).


* Nursing homes fared worse than hospitals, losing over 15% of their workforce, according to a June report in U.S. News and World Report, and a survey by the American Health Care Association found that 61% of facilities have restricted new admissions, which may leave many elders without care.


* A survey by the American Association of Colleges of Nursing shows 2,166 full-time faculty vacancies in the 2022-23 academic year, with more than one-third at the baccalaureate level.



According to Marilyn Oermann, Thelma M. Ingles Professor of Nursing at Duke University, there are not enough faculty and clinical sites, nor enough faculty and preceptors trained as educators. She added: "While there's certainly a need to prepare students for primary care, we can't lose sight of the need for nurses in acute care."-Maureen Shawn Kennedy, MA, RN, FAAN

Box 1 - Click to enlarge in new windowBox 1. Nurses Appointed to Key Leadership Positions