Last month, Washington state Senator Maureen Walsh argued
against a legislative action that would provide mandatory, uninterrupted rest
times for nurses. Senator Walsh stated that such a provision could negatively
impact patient outcomes in certain circumstances, and further insisted nurses had ample downtime, and claiming that
they “probably play cards for a considerable amount of the
Her statement did not go over well within the nursing
profession. The sound bite traveled fast and the senator’s office was quickly
inundated with protesting phone calls and decks of playing cards.
Although Sen. Walsh was speaking strictly about specific nurses in specific facilities, one
takeaway from professionals across the country was clear: nurses are
overwhelmed and they need their concerns to be heard instead of dismissed by
However, serving this need is more difficult than may be
evident at first glance. My company recently conducted a nationwide study of
the challenges facing modern nurses, and learned
that nearly half of all respondents (49%) had considered leaving nursing in the
past two years.
This surprising and problematic statistic has many drivers,
but one of the most pressing is a need for better mental health care for
nurses. More than 35% of respondents reported that the state of their mental
health had a negative impact on their work, with an equal percentage (35%)
believing it is taboo to discuss mental health struggles with other nurses.
Far from enjoying idle time playing cards, nurses face heavy workloads and significant stress. Here are three factors that contribute to mental health struggles for nurses, as well as where the industry should focus its efforts to improve mental health care.
Burnout has long been a significant issue in the medical profession, and in our study, 62% of nurses reported feeling regularly burned out. Nurses typically work long hours with heavy responsibilities, a demanding formula that can harm anyone’s mental health. Nearly a quarter of nurses (24%) reported taking medication for job-related anxiety and depression, with three percent of nurses reporting suicidal thoughts.
Burnout also affected work performance for 44% of respondents, which was a contributing factor for the 49% of nurses who contemplated leaving their profession. If even a modest fraction of those nurses had actually abandoned their careers, the impact on the country’s already-understaffed health care system would have been catastrophic.
2. The Nationwide
The problem that compounds all other issues is the
persistent nationwide shortage of registered nurses. The Bureau of Labor
Statistics predicted 1.2 million vacancies would emerge between 2014 and 2022,
and 91% of nurses reported that their hospitals were understaffed.
In 2016 we issued our first study on the welfare of modern
nurses. At that time, 62% reported that the growing shortage had negatively
affected their workloads. In our recent study, the number had skyrocketed to
88% of nurses.
This widening gap continues to progressively harm nurses’ mental health, with more than half (54%) reporting that the increased workload negatively affected their mental health. Patient care is also impacted, with 62% of nurses reporting that the shortage is diminishing the quality of care they could provide.
Administrators and government can do more to help alleviate the shortage, according to nurses. Responding nurses recommended using temporary staffing, offering government subsidies for schooling, and creating new nursing programs. Temporary staffing and travel nursing, in particular, were highlighted as a potential source of immediate relief in areas of greatest need.
3. Harassment and
Workplace harassment and bullying are a significant and widespread problem in nursing, just as they are in many industries across the country. Almost 40% of nurses reported experiencing harassment during the past year, a stunning number that demands a need for immediate attention.
Nurses battle this abuse in all areas of their work. Bullying and harassment come from other nurses (30%), patients (25%), physicians (23%), and administrators (22%). Reports of sexual harassment were less common than other forms of harassment, but 21% of nurses still face it, with the majority of incidents coming from patients.
If there is a silver lining, it is that incidents of
workplace hostility may be decreasing for nurses: In 2016, 45% of nurses reported
bullying and harassment, compared to 40% today. As the medical industry
continues to address and eliminate this damaging behavior, the efforts will pay
off in significant benefits to nurses’ mental health.
Senator Walsh’s comments may have come across as ill-informed, but they did spark a nationwide conversation about the heavy workload nurses carry and the negative impact on their mental health. Even as the senator retracted her comments, there were productive and crucial conversations taking place about improving work conditions and mental health care.
Reducing burnout, addressing the nursing shortage, and stopping harassment and bullying are issues that require attention from individuals and organizations across the entire medical industry. If we all work together to create solutions, we will take much-needed steps toward improving mental health for nurses.
Not since the last time some celebrity or politician said something uneducated about the profession of nursing has there been such a furious backlash. Fellow angry nurses have spent valuable time spewing our collective anger about what Senator Maureen Walsh said, venting about how we feel, creating memes, posting on Facebook, gathering signatures, debating in groups and demanding that action be taken and repercussions suffered. But what exactly was accomplished? Aside from the fact that everyone ran to their neutral corners, patting each other on the back and congratulating ourselves for insulting someone 2,000 miles from our home?
Of the main things I remember being taught during one of my clinical rotations is that when a patient feels a loss of control, they attempt to overcome that loss by controlling their caregivers and their immediate environment. They micromanage their situation, attempting to control their surroundings even while the larger picture of the potential of painful testing, a debilitating illness, or death is being denied and not dealt with.
I think of the patient in this situation as the nurse…we are buffeted by hurtful words and feeling that no one outside of nursing understands our professional lives, we feel as if we have lost control…we HAVE to make the person understand that what they have said is wrong, that what THEY have done is unimaginable. They MUST understand what a nurse goes through, has gone through, and what we are willing to go through in the future for our patients. We become angry and think of how to prove ourselves and explain our position for all to understand. We lash out and why we lash out is because we often times feel powerless to deal with our situation just like our patients. It is easier to scream over Facebook and write emails and letters to a person we will never meet, than to tackle the immediate problem of our own employment circumstances. Half the time we can’t make our immediate supervisors understand what our working conditions are like, so how do we expect to change the mindset of anyone else?
So, by mailing decks of cards did we change anything? With all our emails and letters, did working conditions on our units improve? Did our staffing levels get better? Did our pay increase? Did our benefits change? Did we make anyone finally understand? In a word…nope. What we did do is spend a lot of time, money, energy, and emotion on something we had no control over, much like one of our patients trying to control the uncontrollable.
Imagine what would happen if the time and energy that was expended in writing emails and letters, gathering signatures, and making phone calls to a state senator in a state where we probably don’t live and therefore cannot vote for or against, was spent in improving the working conditions of OUR units, OUR hospitals, OUR health care system?
Imagine if we worked together as professionals with a clear understanding of both sides of a situation, not screaming in reaction to headlines or snippets of information, but the true situation. In this most recent instance, the political person we were attempting to fight against was actually fighting FOR nurses, not against them and said something that while not the most enlightened, was taken out of context. For that, she and her family are receiving death threats…is this really how we want to be perceived—ill-informed and angry? Or as the professionals that we are…in control, educated, and mindful of the big picture?
I put to you that some of what we have done in the past to correct how the public understand nursing is obviously not working if we still have television shows that portray us incorrectly, so-called celebrities that have no idea what we do, and politicians that must constantly be reminded of how valuable we are. So yes, continue to fight the good fight, but be mindful that there will be people that remain ill-informed or say stupid things.
In honor of National Nurses Week, I invite you to take a look at your surroundings and ask yourself “What can be done to change them?” To better the circumstances of the profession as a whole, start with your unit, office or facility because unless that is changed, the rest of the health care system will not be.
Earlier this week, over 1,000 North Carolina nurses and nursing students met with state lawmakers to lobby on behalf of their patients. These discussions were part of the North Carolina Nurses Association’s 2019 Nurses Day at the Legislature. School nurses and the SAVE Act (a bill that would provide advanced practice registered nurses with more practice authority) were among the issues discussed.
Before meeting with legislators, the nurses and students
gathered for an advocacy-themed continuing education program to hear Dr. Ernest
Grant, president of the American Nurses Association, deliver the keynote
address, which included notes about why the SAVE Act is crucial for North
Carolina nurses and patients.
“In some cases, a nurse may have to wait on a physician signature or something like that in order to provide the healthcare for a patient- something they can easily sign for themselves and be on to the next patient, if you will,” Grant shared with the crowd.
As ABC11’s Andrea Blanford reported, North Carolina’s rural areas are currently experiencing a shortage of both nurses and physicians, which is why these issues are particularly crucial right now to all healthcare providers across the state. Luckily, the nurses and students already had the ears of a few legislators, like Rep. Gale Adcock. Rep. Adcock has been a family nurse practitioner for 32 years and is one of three nurses in the General Assembly.
In fact, Adcock
introduced one of the pieces of healthcare legislature that the nurses rallied
for. The bill would ensure every school in North Carolina will have at least
one nurse, as schools currently are experiencing their own nursing shortages.
“There are many districts where nurses have three and four schools they have to cover and that’s untenable,” Adcock said.
Besides advocating for nurses and patients across the state,
the North Carolina Nurses Association (NCNA) provides resources to advance
nursing practice and education. The NCNA hosts the Nurses Day at the Legislature
every other year.
Barbara Stilwell, PhD, RN, FRCN, is on a mission. She wants nurses to be empowered. As the Executive Director of Nursing Now, a three-year global campaign run in collaboration with the International Council of Nurses and the World Health Organization, she and all those involved want nurses’ voices to be heard.
She took time to explain what Nursing Now is and what they hope to accomplish.
What is the Nursing Now campaign? Why did you
start it? Why do you think it’s important?
The purpose of the campaign is as follows: Nursing Now aims to improve health and health care globally by raising the status and profile of nursing, demonstrating what more can be achieved by enabling nurses to maximize their contribution to achieving universal health coverage.
Strengthening nursing will have the additional benefits of promoting gender equity, contributing to economic development, and supporting other Sustainable Development Goals. This “Triple Impact” was identified by a British All Party Parliamentary Group in 2016 which reviewed the contribution of nursing to global health and identified the triple impact—improving health, promoting gender equality, and contributing to economic growth.
specific outcomes of the campaign are:
investment in nursing
in global policy
nurse leadership and influence
evidence of impact
ways of sharing effective practice
The strategy for achieving these outcomes has two interconnected elements—influencing policy globally and supporting action locally. The first involves adopting a high-level influencing approach working with partner organizations and the campaign champions to influence decision makers and organizations at global and regional level to include nurses at every level of decision making.
The second involves providing support to partners
locally, including professional associations and national Nursing Now groups,
to influence policy nationally, and support the development of nursing and
midwifery in their countries. We
want the local groups to create a social movement among nurses and midwives
that will support the aims of Nursing Now and result in changes being locally
The campaign is important because all countries face
enormous challenges in improving health and providing health care due to growth
in non-communicable diseases, changing demography, and the impact of emerging
factors such as climate change and migration, all coupled with rising demand
for health care with its associated costs. Achieving this will require massive
increases in health workers.
Nursing can make an even greater contribution to health
in the future. This is partly because nurses and midwives between them make up
almost half the professional health workforce globally. As importantly,
however, that nurses are particularly well-suited to contribute even more in
the future because of the way in which the whole health environment is
changing. The core arguments are:
- The burden of diseases is changing with increases in long term non-communicable or chronic diseases and—as populations age—more people with multiple morbidities who are living longer (often at home) and dying at home too. There is an increasing concern to care for those with mental health problems too, especially young people. Nurses are already central to much of this home care, and their role will continue to expand.
- These changes require new, more community-based
and holistic models of care as well as greater focus on health promotion and
disease prevention. Implementing new
models of care will require teams that, at times, should most appropriately be
led by nurses because they may be best suited to plan and manage care pathways.
- Nursing philosophy, values, and practice mean
that nurses are particularly well-suited to planning, implementing, and
managing patient centered, community-based care with a view to the full bio-psycho-social-environmental aspects
of health. Moreover,
nurses often work closely with their local
communities and constitute the majority of most health teams; they are ready to step up to the challenge.
To learn more about Dr. Stilwell and the global campaign, visit www.nursingnow.org or check out the radical advocacy special issue of Creative Nursing.
The University of Alabama at Birmingham School of Nursing is making an impact on future nurses outside the United States by partnering with the World Health Organization Collaborating Center at the University of West Indies–Mona Campus in Kingston, Jamaica, to improve how they train future nurses.
UAB instructors traveled to Jamaica to train nursing instructors at the University of West Indies–Mona in 2018 and focused on how to teach with simulations. They also provided training in specialized areas including palliative and end-of-life care.
Traci White, DNP, a UAB School of Nursing assistant professor who traveled to Kingston, tells UAB.edu, “Going to UWI, where there were fresh faces and you could see the changes in their teachings in a matter of days, was invigorating. The faculty were hungry to learn and receptive to what we brought to the table. It excited me to see their enthusiasm for learning.”
UAB Nursing will continue its training in Jamaica through online resources, including UAB’s “Clinical Pearls” professional development videos and virtual debriefings. Distance training will allow UAB to continue to build its support of nurse faculty at the University of West Indies, and help the School of Nursing reach its global health and sustainable development goals.
To learn more about how UAB Nursing is making an impact on future nurses outside the United States by training nurses at Jamaica’s University of West Indies–Mona Campus, visit here.