‘Return nurses to being nurses’: A call to address burnout and shortages

The nursing shortage didn’t start with the arrival of COVID-19, but the pandemic has pushed an already problematic situation to a critical point.

Vicki Good, executive director of nursing for Mercy Springfield, Missouri, has seen the shortage vividly. A national leader in the nursing field, Good is a former president of the American Association of Critical-Care Nurses board of directors.

Good talked with Chief Healthcare Executive about the shortage of nursing, the stress on nurses, and how healthcare leaders are going to have to think differently to retain nurses.

When asked for the biggest problem facing the industry, Good said, “Nurses don’t want to work at the hospital bedside, and that’s where we need nurses the most."

“How do we make bedside nursing attractive once more and get people to stay at the bedside?” (The story continues after the video.)

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Many nurses have left the field due to the stress of the COVID-19 pandemic. Studies show many nurses plan to get out over the next two years. Some nurses have moved away from bedside positions to other jobs with better hours, such as roles in outpatient clinics.

The industry is seeing “an unprecedented number of nurses leaving the profession,” Good said.

Nurses who are still working in hospitals and taking care of patients have said they’ve been overworked and under-staffed. Some say they don’t feel safe because they don’t have enough nurses on staff and are managing too many patients.

Some areas are facing more severe staffing crunches than others, but in the midwest, where Good is based, she said, “It’s gone from a difficult situation to a crisis situation."

Helping nurses focus on patients

With nurses being overworked, healthcare leaders need to find a way to take some tasks off of their plate, Good said.

“We’ve got to return nurses to being nurses and actually performing nursing duties,” Good said.

“We’ve got to look at all these things over the last 20 years, we’ve asked nurses just to assume and really pull that stuff off them, so they can truly be the nurse and drive quality outcomes that a nurse can drive.”

Over the years, as healthcare organizations have reduced some support positions to address financial challenges, nurses in hospitals have assumed more duties, Good said.

“When I started as a nurse, 30+ years ago, I wasn’t having to clean my rooms …. I wasn’t having to pass my meal trays,” Good said. “Those things were done by support personnel.

“As we have made cuts in healthcare to accommodate the financial constraints, a lot of those items have been added to the nurses’ plate,” she continued. “And so when you’ve got a lot of things added to your plate that aren’t within the scope of a nurse, then you get the stress of this pandemic bearing down on you, it makes a poor environment that’s very difficult."

She explained that it’s not a question of certain chores such as emptying trash baskets as being “beneath” nurses. Good said the question is what is the best use of their time and skills when nurses are “trying to drive outcomes and drive quality and decrease length of stay.”

“As nursing leaders, we have to start looking at what is truly within the scope of your nurse and what do we need to give back to other people to help us with,” Good said. “Doing patient care can’t fall solely on the heels of a nurse.”

Keeping nurses

To keep nurses with experience, hospitals also need to take another look at compensation, Good said.

Some hospitals have offered bonuses to recruit new nurses, and some providers are also offering retention bonuses to keep nurses to stay.

At Mercy Hospital, Good said the system instituted a loyalty plan adding to hourly wages for nurses, based on their years of service. “We have to start looking at those kinds of things,” she said.

At the same time, some hospitals are also struggling to keep younger nurses. Good has seen some young nurses leave after only 6 months, even after studying to be a nurse for four years, “because they couldn’t handle the pressures.”

Some nurses, including young nurses, are leaving hospitals for higher paying jobs as travel nurses, where they can earn two to four times as much as hospital staff nurses. Good said that’s become an attractive proposition for some nurses who have just finished college.

As Good said, some young nurses are saying, “‘I can go do this for 6 months and pay off all my college debt.’ And who could blame them?”

Health leaders are going to have to look at pay and more flexible scheduling, Good said.

“It’s forcing us in the hospital setting to look at things differently, look at our benefit packages differently and what people truly need and want to stay in the hospital setting,” she said.

Getting nurses to accept help

Burnout in nursing was a problem, and not a small one, before the pandemic.

Good studied burnout before the arrival of the coronavirus.

“We were already headed down a pathway that wasn’t good in nursing. Our burnout rates were in the 30-40% range for severe burnout,” Good said.

The stresses have magnified during the pandemic, due to long hours and the trauma of dealing with patients that are sick or dying due to COVID-19.

Many nurses, even those who say their mental health is suffering, have been reluctant to get help.

“A lot of people think that’s a sign of weakness,” she said.

Good said it’s important to educate health systems and medical boards that getting help is not a sign of weakness.

“There is definitely a false belief out there that if I seek help that there’s potential issues on my licensure,” Good said.

Health leaders need to address the question: “How do we re-educate people that it’s not a sign of weakness, and it’s actually a sign of strength, to reach out and get that assistance?”

A new federal law, the Lorna Breen Act, offers grants to health systems to help support the mental health of healthcare workers.

Mercy Hospital has implemented a peer support group and trained staff to help each other. Good said the peer support program is a way to help staff who are looking for an outlet that is “less intimidating” than calling a counselor.

Hospitals that are focusing on taking care of the mental health of nurses can make a difference, Good suggested.

“Organizations that are putting efforts behind the mental health and the mental toll this has taken, I think the nurses are doing better," Good said. "Unfortunately, not all facilities have that support for their nurses."

Showing up

Even with two years of working in the pandemic, Good said she’s consistently impressed by the tenacity of nurses.

“Every time I think how can you take any more, they seem to step up and take more,” Good said. “They’ve shown up every day. The way they take care of a patient now is no different than how they took care of a patient two years ago. The same amount of compassion, the same amount of respect.”

Good recalled the way nurses at her Missouri hospital rallied to help a patient with COVID-19 who only had days to live. The patient was an avid football fan, so the nurses organized a party so the patient and his family could watch the Kansas City Chiefs.

“Taking the time out to plan something like that in the midst of staffing crisis and the midst of everything else going on was just inspiring to me, that they would look at, ‘How do we take care of the whole patient?” Good said.

“Those are the type of things you can’t put a price tag on, you can’t put a quality metric on, but that is what that family is going to remember.”