In addition, nurses need to contend with growing workloads and inadequate staffing, or not having the right number of nurses on the right units to ensure that patients receive safe quality care. Mandatory overtime is another challenge and occurs when nurses must work extra hours beyond their shift because of staffing shortages. All of these issues can lead to low job satisfaction among nurses and are likely to contribute to nurses’ leaving the profession, a trend that began well before the current pandemic struck.
Here’s why the pandemic has made the nursing shortage even worse, and why I think health care leaders need to make bold changes to address the well-being of nurses – for the sake of nurses and patient care in our country.
Disruptions in health care delivery
Nurses, like many health care workers, are physically and emotionally exhausted after working in what has been described as a “war zone” for the better part of the past year and a half. One nurse on the front lines reported irreversible damage from the trauma of caring for extremely sick patients. Others are experiencing shortages of oxygen, equipment and other needed supplies to keep themselves safe and to keep their patients alive.
Hospitals are desperate to fill nursing vacancies. One hospital system in South Dakota is offering incentives as large as US$40,000 sign-on bonuses to recruit nurses to work in the clinical areas that are in most need. This may be a great attempt to draw nurses to an institution, but sign-on bonuses and incentives might not be enough to persuade some nurses to work at the bedside and continue contending with the current workload of the pandemic.
Another strategy to fill vacancies is the use of travel nurses. Travel nurses work for agencies that assign them to hospitals that cannot fill vacancies with their own staff. Although this can be a successful short-term solution, the use of travel nurses is not sustainable over time and it does not help retain experienced staff nurses in an organization. Travel nurses make significantly more money than staff nurses, which may lure nurses away from permanent positions and in turn increase the staffing deficit for hospitals. The average salary for a travel nurse in the U.S. is $2,003 per week, with $13,750 in overtime per year. Some nurses even accept “crisis assignments,” which can pay as much as $10,000 per week. That is significantly higher than the average of $1,450 per week ($36.22 per hour) for a staff nurse.
Focus on nurses’ well-being
For the past 18 years, nursing has been identified as the most trusted profession. Nurses are caregivers, role models, educators, mentors and advocates and have a direct impact on the health and well-being of patients. The health of the nation’s nursing workforce is fundamental to our health care industry. As identified by a 2021 National Academy of Medicine report, nurse well-being and resilience are needed to ensure the delivery of high-quality care and to improve the health of the nation.
Research demonstrates that people with higher levels of well-being have lower levels of burnout and perform better at work. Therefore, some hospitals and unions are offering resources and programs to nurses during the COVID-19 pandemic that seek to reduce stress, promote resiliency and increase well-being. We have yet to see the long-term effectiveness of these programs on the health and wellness of nurses.
The long-term solution to the nursing shortage calls for systematic changes that value nurses and offer them a safe place to work. Examples include implementing appropriate salaries and flexible schedules, ensuring adequate nurse staffing, and creating jobs that allow aging nurses to continue working in direct patient care roles so they can remain in the workforce longer instead of retiring. The pandemic has made more people aware of the distressing conditions many nurses work in. But without systematic changes, the drain of nurses out of the profession – and its negative impact on patient care – will only continue.
If you’re a nurse who loves poring over research, or feels passionate about bringing evidence to the bedside, then doctoral nursing just might be your perfect career path.
Of course, earning a doctorate takes significant time and effort. But because nurses are always engaging in continuing education, “I don’t think the idea of doctoral nursing is so foreign to a nurse,” says Stephen Ferrara, DNP, FNP, interim executive director of Jonas Nursing and Veterans Healthcare, a program that provides scholarship funding for nurses who are attaining a doctoral degree. Earning a doctorate in nursing allows a nurse to engage in such activities as research, apply for grant funding, teach, or enter into clinical leadership in an academic medical center, Ferrera says. It provides “lots of opportunities to take this newfound knowledge and really use it to impact the way that we’re caring for patients and ultimately to improve patient outcomes.”
Two types
As you may know, nurses can earn two types of doctorates. One is the classic doctor of philosophy (PhD) degree, and the other is the doctor of nursing practice (DNP). As of 2019, 37,852 employed nurses had earned a doctoral degree, according to one estimate.
Those who earn a PhD “are generally going to work on generating new knowledge, new research within the field,” Ferrara says. In contrast, the DNP degree “is really translating the knowledge that exists, or the evidence that exists, and applying it to clinical practice. So we think of the PhDs as generating new knowledge, whereas the DNPs are taking that new knowledge and applying it into clinical practice,” Ferrara says. He notes that the DNP has existed for roughly 15 years. (As editor-in-chief of the Journal of Doctoral Nursing Practice, Dr. Ferrara has considerable expertise on the topic of DNPs and their impact. The journal will publish its 15th volume in 2022).
You’ll likely need to invest two to four years to earn a PhD or DNP, depending on the program and whether your program is full or part time, notes Ferrara. PhD programs require a dissertation, while DNP programs require a final or “capstone” project. “The DNPs tend to be a little bit more streamlined in time, whereas the PhD programs are a little bit longer, just due to the nature of generating new research” and the challenges that may come along with that, Ferrara notes.
Systemic solutions
Doctoral nurses, Ferrara notes, can make an impact on systemic issues in healthcare. “We need evidence-based solutions that are easily deployed and constantly reviewed and garnering additional evidence so that we can truly design health systems that are patient-centric, that are not ones where clinical staff are burning out as a result of it. We are largely not present in those boardrooms and making those decisions that truly impact patient care and that’s where the doctoral nurse really can shine and really can escalate the conversation and offer meaningful intervention.”
Four impact areas
For its part, Jonas Nursing and Veterans Healthcare, which is part of Jonas Philanthropies, is designed to assist high-potential doctoral nursing scholars through scholarship funding as well as providing the expertise of subject matter experts. Celebrating its 15th anniversary in 2021, the program has invested more than $27 million in 1,400 nurse scholars in all 50 states, according to a press release.
In August, it announced its 2021-2023 scholar cohort of 76 doctoral nursing scholars in 49 nursing schools. Some 50 of these are PhD candidates and 26 are DNP candidates. Over half of this cohort will be representative of Black, Indigenous and other communities of color.
The program, notes, Ferrara, is founded on four impact areas: environmental health; mental health; veterans health; and vision health. Jonas scholars need to work primarily in one of those areas.
Jonas works closely with specific nursing schools to select the Jonas scholars. “It is actually through the recommendation of the faculty members that the students are encouraged to apply to the program,” says Ferrara. Applicants already have to be enrolled in a doctoral program. A Jonas scholar will be provided a total scholarship of $30,000 over two years.
For the first time, the 2021-2023 cohort will have the support of a group of subject matter experts to guide them in each area of expertise, according to the press release. “These subject matter experts will serve as a mentor, a guide, and a resource for the next generation of nurse scholars who are shaping the future of healthcare in this country,” says Lendri Purcell, vice president of Jonas Philanthropies, in the release.
Family and community
Besides the physical opportunity for doctoral students, the Jonas program brings a “family and community” component as well, says Pamela Wall, PhD, PMHNP, FAANP, who became a Jonas scholar in 2010 as a doctoral student at the University of Pennsylvania. Jonas currently is a clinical associate professor at the University of New Hampshire, teaching as a member of the psychiatric nurse practitioner faculty.
Wall notes that the Jonas scholars represent a diverse group that are “changing our health and leadership outcomes in the United States and globally.” A Jonas scholar directory provides a look at activities of the scholars.
“We are a family community of scholars that starts with your work in your doctoral program, but it extends beyond that. They have been a part of my community and my rhetoric and my family” since 2010, she notes. “It extends well beyond just the monetary component that Jonas brings to the table.”
Working as a long-term care nurse at VA, you’ll help provide a home away from home for Veterans needing around-the-clock skilled nursing care
VA’s community living centers are a home away from home for Veterans in need of around-the-clock skilled nursing and medical care.
At more than 100 centers across the nation, we help Veterans get back on their feet, care for those suffering from dementia and other cognitive issues, and provide palliative and end-of-life care.
Working as a long-term care nurse with this unique patient population is a career that comes with plentiful rewards.
“Long-term care nursing is a specialty. Being in this trusted position as a long-term care health care worker is to be at the forefront of health care delivery,” said Melissa Lasley, RN, nurse recruiter for the VA Maine Healthcare System.
Consider a VA career
Lasley doesn’t just have one reason to consider a career caring for Veterans at one of our community living centers – she has 12 of them.
It’s rewarding. “After finishing a day of work in dementia care, I leave my shift knowing I made a difference in the residents’ quality of life. At times, it feels rewarding in small ways, like de-escalating an anxious resident or engaging them in an intervention. Other times, it’s by being with the resident during their final hours and helping them to connect with family members. In all ways, big and small, we make a difference.”
It’s refreshing. “Residents have often given up caring about what people think and, therefore, say exactly what they mean.”
It’s entertaining. “They have amazing stories. Even Veterans with relatively advanced dementia can recall events from distant past, and it can be good for them to do so, so just ask.”
It’s important work. “As of 2017, the number of Veterans living with dementia was more than 750,000. An estimated 420,000 additional cases were diagnosed between 2010 and 2020. This is a critical mass of heroes, each of whom deserves quality care.”
It’s an honor. “When working with seniors, we often come across those who have lived through loss, immigrations, wars and much more. With all their life history, I always feel thankful and honored that I am entrusted to get to know them and provide the best possible care I can.”
It’s challenging. “Working with clients with dementia is something that not only requires experience and training but continued professional development over time. There is so much to learn about working with this population and room for continued improvement.”
It’s a specialty. “Nurses can develop a sense of pride in becoming an expert in geriatric care, just as they can with any other specialty. When an elderly patient experiences trauma, goes into anaphylactic shock or contracts a urinary tract infection, the clinical picture is far different from that of a 30-year-old. Having the knowledge to quickly assess and treat problems can drastically improve the quality of life for our Veterans.”
It’s a learning opportunity. “Veterans teach us from the moment we first meet. Often, it is just by being witness to their story. Other times, Veterans take on a teacher-like role, which may help them feel empowered, autonomous or a reconnection with their sense of self. From my work in dementia care, I’ve learned that I shouldn’t take life so seriously, laughter and humor are key, courage can always be found, and feeling connected is everything.”
It’s about the moment. “The reality of working with Veterans who have dementia is they may not recall working with you or having met you the week prior. This means our goals and objectives often need to pertain to a resident’s quality of life within the given moment rather than from week to week.”
It’s all about connection. “Building a trusting therapeutic relationship with resident Veterans is of key importance, and building a connection sometimes takes more than verbal interactions. A typical conversation is not always possible. Sometimes, connection is accomplished simply through a calming presence and a gentle approach.”
It’s someone’s parent. “Yes, this is sentimental, but the Veteran geriatric population have some miles on them. They may have fought in wars, raised families and experienced loss. Call it karma or responsibility, but when I care for geriatric Veterans, I hope when my family members grow old and sick, someone takes good care of them too.”
It’s thought-provoking. “Making connections with Veterans who have dementia is about much more than following rules and standards on building rapport; it’s about an intuitive feeling they perceive from your intentions when you approach. After caring for many within the geriatric population and likely attending their deaths, it’s difficult not to be drawn into wondering what amends, regrets and triumphs YOU will have at the end of your life.”
Cutting edge of care
If you need a 13th reason to pursue a career in long-term care nursing at VA, consider this: our community living centers are on the forefront of change.
VA Maine and many other centers are transitioning to a more patient-centered culture based on the needs and preferences of Veterans. At VA Maine, they will be breaking ground soon on a “small house,” similar to the Green House models adopted at some of our other community living centers.
These cozy buildings are designed to house small groups of Veterans and include community kitchens and dining rooms, private rooms and bathrooms, and ample outdoor living space.
“All are an important part of the holistic approach to caring for our Veterans, providing a home setting they are comfortable and proud to live in,” Lasley said.
Work at VA
Give back to a generation of Veterans who has provided so much for their country. Explore a long-term care nursing position with VA.
Helping patients to navigate what comes after a difficult diagnosis is a necessary part of our profession. In my many years working with patients facing progressive diseases, like chronic obstructive pulmonary disease (COPD), I have found that they often have questions, namely:
What
do I do now?
That’s where we, as
nurses and other health care providers, can offer answers. COPD is not
currently curable; however, there is still hope for these patients. Lifestyle
changes and medical advancements make it possible for patients to improve their
ability to breathe and overall quality of life. The objective of treatment is
to slow the progression of the disease and assist with managing its symptoms. As
patients with COPD come to terms with their disease, here’s what I would
recommend to guide them through the next steps of their journey, from diagnosis
to treatment:
Work
With Them to Create a Plan
After giving a
diagnosis of COPD, educating patients on the disease and working with them on a
personalized plan to start addressing their symptoms is an important first
step. In fact, there are many lifestyle changes that patients can make every
day to not only accommodate their new medical needs but also to help improve
lung function. Committing to a diet of anti-inflammatory foods — like fatty
fish or dark leafy greens — participating in regular low-impact physical
activities and other techniques can help to reduce inflammation in the lungs
that can exacerbate symptoms.
Help
Them Take the Steps to Quit Smoking
Smoking can cause
significant damage in the lungs which only increases over time. One of the best
things that patients can do if they’ve been diagnosed with chronic lung disease
is to quit smoking if they currently smoke. It’s important to arm them with information
and tools they need to successfully do so — whether it’s helping them to
identify smoking triggers, create an exercise and diet regimen or connect to
support groups or other resources. For example, at Lung Health Institute, we
offer our patients access to programs like American Lung Association’s Freedom
From Smoking® Plus, a flexible online smoking
cessation program that can be completed in six weeks.
Have an Honest
Conversation About What Treatment Is Right for Them
Every
patient is different, and treatments will vary for each patient with COPD — depending
on the severity of the disease and other factors, including age, fitness level or
medical history. That’s why it’s critical to create an environment where patients
are comfortable being completely honest about how they’re feeling both
physically and mentally. That will ensure that we can provide them with the
best course of action when it comes to their treatment.
Melissa Rubio, Ph.D., APRN, is a nurse practitioner and principal investigator for research at the Lung Health Institute, based at its Dallas clinic. Rubio also currently serves as a visiting professor at DeVry University’s Chamberlain College of Nursing in Downers Grove, Illinois. Prior to joining Lung Health Institute, Rubio worked at Pleasant Ridge Internal Medicine in Arlington, Texas, as a family nurse practitioner. Rubio holds a doctorate in philosophy from the University of Wisconsin-Milwaukee College of Nursing. She also earned a bachelor’s degree in nursing from the same school. She is a board-certified family nurse practitioner and a certified principal investigator. Rubio is also a member of the North Texas Nurse Practitioners and the Southern Nursing Research Society.
Work-life balance is a hot concept in the nursing profession. We hear we need it. We want to achieve it. But does it really exist?
That question has piqued the interest of Adele A. Webb, PhD, RN, FNAP, FAAN, senior academic director of workforce solutions at Capella University in Minneapolis.
Webb plans to study and delve into the concept of work-life balance and nurses. She said recent conversations with nurse executives, including those at HealthLeaders Media 2017 CNO Exchange, left her realizing that the idea needs to be better defined.
For example, if a nurse must take off from work to stay home with a sick child, on that day, family needs more focus than work. And there are times, especially for those who work weekends or holidays, where work will eclipse family.
Still, Webb said she understands the desire behind the idea of work-life balance.
Another question Webb said she is pondering is, “How then do we address or encourage satisfaction and what does that mean?”
She said she has noticed, even among her own family, that different generations of nurses crave different things.
“I have a daughter and a granddaughter who are nurses. My granddaughter is definitely a Millennial. She’s 24, new in her career, and what she wants is opportunity,” Webb said. “She’s always reading, trying to better her skills, and to learn something new.”
This drive to further their skills and their careers is a trait often tied to the Millennial generation. However, it can also be a factor that contributes to their workplace turnover. According to the RN Work Project, almost 18% of newly licensed RNs leave their first employer within the first year.
“How exciting it would be for a young nurse to have the opportunity to be on the quality committee at a hospital. Or to have the opportunity to contribute to care algorithms or standards or care or policies?” she added. “They would learn [so much] from it [and] they could contribute so much.”
While baby boomers are more likely to stay in their positions, they, too, have a need for life satisfaction and often value time and self-fulfillment, said Webb.
For example, offering tuition assistance to pursue a master’s degree may give this generation a sense of satisfaction. Or they may find fulfillment in sharing the knowledge they’ve garnered over their years of experience.
“[Give them] the opportunity to be involved, and be on a budget committee at the hospital and understand the finances and the contributions they make,” Webb suggested. “Train them to be preceptors. Let them share that knowledge with the younger generation.”
What’s Next?
Webb is in the early stages of reviewing published literature for existing information on work-life balance and satisfaction, and plans to interview nurses about their insights. Once she has a working thesis, she plans to connect with nursing professionals through presentations and conferences to see whether her definition and evaluation of work-life balance or work-life satisfaction rings true.
A new report from the Robert Wood Johnson Foundation (RWJF) looks into how nurses in the United States can help boost health and well-being for all Americans, but data shows that those in the field are concerned about being able to do all that they can.
“There are many issues affecting the health of our nation—opioids, measles outbreaks, low literacy rates, untreated mental illness, lack of affordable housing, and many others. Conversations with hundreds of nurses made it clear that they are willing to help people face these challenges, but they can’t do it alone,” said Paul Kuehnert, DNP, RN, FAAN, associate vice president at RWJF. “Nurses need support from their employers, other health care professionals, community organizations, and government entities to better address unmet needs.”
The nurses interviewed shared that nursing as a profession must evolve to meet the ever-growing needs of patients, as well as the shifts within the industry that hinder nurses from learning and helping to the best of their abilities. They also provided their points of view regarding how prepared nurses are after their training and education, and what resources are provided to them by their employers. Interviewees also discussed that while patient needs are expanding, there is not enough focus on them in health care settings.
“Nurses are uniquely qualified to address many of the unmet needs of people and communities, and this research shows they have a strong desire to do that,” Kuehnert shared. “Nursing is consistently ranked among the most trusted professions, and nurses have firsthand knowledge of what patients and communities need to be healthier.”
