Every nurse is familiar with the underlying anxiety of not working a holiday. At the core of that anxiety is a specific fear: the fear of receiving a desperate call from a nurse manager asking them to come into work despite the fact they’re not on holiday rotation. Likewise, every nurse manager maintains a similar level of dread during the holidays and when the summer rolls around. Nobody making or receiving that call wants it to happen, but it does, like clockwork, every year.
Having a fully-staffed nursing unit on days like July 4th, Christmas, or any week during the busy summer travel season tops the wish list of every clinician on staff, for every hospital executive looking to provide the best care possible, and for every family unfortunate enough to have a loved one in the hospital on holidays. But often it doesn’t happen.As the nursing shortage continues – and, in some areas of the country, gets even worse – hospital leaders are struggling to staff their facilities and honor fully paid time off during holidays. Nurses know well ahead of time which holidays they’re working for a given year, but nurses are people, and people lead lives that tend to run afoul of long-term plans. They get sick, change jobs before their rotation begins, and experience urgent personal crises that leave them little choice but to call off. All situations inevitably arise in the short term and create holes in the staffing schedule, forcing nurse managers to dial their way through the phone tree until they find those willing and able to fill them.
But it’s not far-fetched to believe in a future where nurses can choose whether or not they want to work during a holiday. In this future, the underlying anxiety of waiting on a phone call on Christmas or July 4th morning does not exist, where the dread of making that phone call is eliminated, and where hospital executives can rest assured that their facilities are fully staffed every day of the year.
In the future, hospitals have a flexible pool of qualified and eager nursing professionals they can count on to bolster their workforce on holidays and allow their core nursing staff to be with their families and loved ones.
Filling the Gap with a Flexible Nursing Workforce
No matter the holiday, the hospital can be a dreary place when the rest of the world is celebrating, relaxing, and enjoying time off. This is true for most core nursing staff, patients, and families. Yet, a latent pool of flexible nursing talent has demonstrated that nurses are available and eager to pick up holiday shifts and, most importantly, can be relied on to complete them.
CareRev, a technology platform that provides flexible, high-quality healthcare staffing, is one of several digital tools that have emerged in recent years to help healthcare facilities fill shifts throughout the year. According to CareRev data from 2023, hospitals and healthcare facilities have successfully used per diem nursing talent to fill the holiday staffing void.
During Thanksgiving this past year (a notoriously tricky holiday to schedule), CareRev maintained a 95% shift completion rate, meaning per diem nurses not only knowingly picked up shifts on that holiday but completed them. Further, CareRev’s analysis found cancellation rates on holidays to be lower than cancellation rates on non-holidays, an indicator that per diem nurses who intentionally pick up shifts on holidays like Labor Day, Memorial Day, and Christmas Day are explicitly available and open to work these shifts. Additionally, 95% of holiday shifts filled on CareRev’s platform were held by RNs, indicating a lesser need among hospitals for CNAs during holidays.
It is important to note that much of this success is derived from personal relationships and continued partnerships. CareRev’s data shows that 80% of filled assignments on holidays have been sent by a healthcare facility directly to a nursing professional working shifts consistently in their facilities. This demonstrates how facilities can develop positive, trusting relationships with a contingent workforce that can be relied upon to bolster their staff during the most stressful times of the year.
While the scramble to fill shifts during holidays and summer always begins with anxiety and dread, it ordinarily ends with nurse managers offering their core staff some financial incentive. This can be minimized with a flexible workforce. CareRev’s data shows 85% of its filled assignments during holidays in 2023 were filled at a base rate, sans the need for facilities to include a bonus or boosted rate.
Some healthcare facilities have discovered that maintaining a fully functional nursing staff during holidays is possible when nurse managers have access to a flexible pool of high-quality nursing talent. And that might be the most fantastic holiday gift of all.
The nursing profession is a multifaceted group that works in a variety of clinical and non-clinical roles. As the largest segment of the healthcare workforce, the state of the nursing profession has a significant impact on the state of healthcare as a whole. Assessing where nurses find themselves provides insight into what’s going well and what could improve in the world of working health professionals.
In Vivian’s report, healthcare professionals’ attitudes about their careers and well-being is examined in detail based on responses from 863 individuals. With an aging population and the end of the emergent aspects of the pandemic, those who work in healthcare are assessing where they find themselves in this new chapter. The authors of the study introduce it thus:
“Americans’ health depends on the well-being of our healthcare workforce. Our nation’s health workers face a mental health crisis, as spotlighted in a CDC Vital Signs report in October 2023. Mental health and burnout seem to be prevalent among healthcare workers, making it more urgent than ever to have consistent, proactive efforts to bring stress levels down in their workplaces. Healthcare professionals told Vivian Health that means providing more flexibility, work-life balance and lower staffing ratios (i.e., fewer patients per clinician).
“In tandem with all the above challenges, the need for healthcare and healthcare staff continues to rise as more baby boomers reach retirement age. While Gen Z began finding their footing in the workforce in 2023, their attitudes toward work immensely differ from previous generations. Inadequate and outdated nurse retention strategies have added to the shortage of nurses in particular, putting the future of healthcare at a tipping point. The respondents in this report repeatedly identified quality of life — both in and out of the workplace — as their highest priority.”
The Breakdown
The following are noteworthy threads in terms of some of the report’s main findings, and the data show that we’re not doing as well as we could be.
Burnout
26% of respondents indicated that they are high on the burnout scale. 21% are a 4 out of 5, and 25% put themselves at 3. Sadly, 39% said their burnout is worse than this time last year, with 33% saying it was the same.
These numbers indicate pervasive burnout, a condition that can lead to unhappy nurses, suboptimal patient care, and nurse attrition from the workplace or from the workforce entirely.
Many survey participants have taken more time off, moved to less stressful specialties, switched to remote work, returned to school, or changed to part-time.
Regarding employers’ response to staff burnout, 83% said their employer has done nothing to reduce burnout experienced by nurse employees.
The numbers don’t lie — we’re truly facing a mental health crisis among nurses and their multidisciplinary colleagues in these post-pandemic days. The survey found that 46% of nurses had experienced clinical depression in the last 12 months, with only 29% actually booking a visit with a mental health professional.
Workplace Violence
Violence in the workplace is no joke. With 42% of survey participants reporting feeling unsafe at work and 47% actually experiencing workplace violence against themselves or colleagues, the statistics reveal something amiss.
Patients or their families perpetrated the vast majority of reported violence, the very people whom nurses are trying to serve.
Echoing the perception that employers have done little, if anything, to address burnout, 43% stated that the administration had ignored complaints of violence. On the bright side, 42% said they had seen less violence in the last year.
Finances
While many articles about nurse wellness fail to mention finances, financial well-being is worth paying attention to. The study authors wrote: “In the face of growing inflation, ‘side hustles‘ have become common with clinical workers, as 35% of respondents reported having them. Half these side hustles occur within healthcare-related roles, such as per diem work. This presents an opportunity to satisfy this income demand by providing alternative, flexible work options.”
With 60% of nurses surveyed switching to higher-paying roles in 2023, it’s notable that only 30% changed where they live to lower their cost of living. Most participants had side hustles in the healthcare sector, with a smattering pursuing more income through the gig economy (e.g., Uber, Doordash), entrepreneurship, hospitality, the beauty industry, and other pursuits.
Parenthood and Caregiving
51% of those surveyed identified as caregivers or parents, and a quarter stated that their employer was most likely trying to meet their needs as caregivers through flexible hours. The majority didn’t give employers high marks for trying to make it easier for their employees, although most stated that where they choose to work is influenced by their responsibilities as caregivers.
With statistics that likely echo the struggles of workers in other industries, more than half reported not being able to find adequate childcare or caregiving services. Almost half had taken a break from work to care for family members, with most taking a break of less than six months.
Nursing Generations Speak
The Vivian workforce survey found that, of those reporting clinical depression in the last 12 months, the breakdown was as follows:
Gen Z: 56%
Millennials: 59%
Baby Boomers: 36%
In terms of seeking out mental health care:
Gen Z: 28%
Millennials: 40%
Baby Boomers: 21%
In regards to burnout, those who said their level of burnout was better than one year prior:
Gen Z: 44%
Millennials: 33%
Gen X: 28%
Baby Boomers: 22%
With respondents from across the lifespan who were 82% female and 18% male, the population surveyed was not necessarily racially representative:
White: 62%
Black: 19%
Multiple: 8%
Hispanic: 6%
Asian: 3%
American Indian or Alaskan Native: 1%
Native Hawaiian or Pacific Islander: 0.2%
Nursing Has Some Work to Do
As we can see, Vivian Health’s Healthcare Workforce Report for 2024 offers a snapshot of nurses’ well-being on multiple levels. With the “Heroes Work Here” banners and glowing news reports about nurses’ hard work at the height of the pandemic faded into a distant memory, nurses obviously need their employers—and possibly legislators and other leaders—to sit up and take notice.
An ongoing nursing shortage, combined with continued workforce attrition, does the smooth running of the healthcare system no favors, and we risk a great deal by burying our heads in the sand.
Nurse mental health and overall well-being are meaningful measures of the functionality of our healthcare system and the delivery of patient care, and we ignore problems like nurse burnout at our peril.
Is your employer paying attention? Are your needs being met? If not, we have a lot of work to do, and if we can speak up and make our needs known, perhaps someone with the power to effect change will actually listen.
In an evolving healthcare landscape, many hospitals and health systems have a diverse nursing staff of tenured employees, contractors, specialists, and more. While this can be a recipe for a dynamic and collaborative environment, it also has the potential to become precarious without proper management.
Disorganization and lack of communication ultimately trickle down to patients. In fact, a Joint Commission study found that 80% of serious medical errors result from miscommunication during nursing handoff.
With the continued staffing shortages in healthcare, organizational culture is ever more critical for maintaining morale among existing staff.
For one, nursing departments should strive to create balanced schedules and assignments that work for each employee and even out workloads as much as possible. Departmental leaders should be transparent about organizing so there is no perception of inequality. If everyone feels they are pulling the same weight, they will work together better.
However, in departments that rely heavily on contract and travel workers, there can be friction for similar reasons, including doubt about contractors’ workloads, level of commitment, and their skills and qualifications. This is where leaders must emphasize clarifying any misconceptions and the benefits they provide beyond crucial coverage for short staffing, such as adaptability, diverse perspectives, and specialized knowledge.
Shared governance is also becoming a standard practice in many healthcare organizations to empower nurses and foster collaboration. It is a working model where nurses can join councils, allowing them to be involved in decision-making for their departments and patients.
Clear Roles and Responsibilities
There shouldn’t be any ambiguity about assignments and responsibilities among everyone involved in patient care, from RNs to LPNs and UAPs. Along with their daily schedules, consider writing down each employee’s responsibilities in a shared document that everyone can access and reference. This ensures each employee knows exactly what their tasks are and that there is no gap in patient care coverage.
However, it’s also essential to leave room for spontaneous teamwork. For instance, a nurse has a free moment and responds to a patient not in their assigned block to help out another nurse with their hands full. While this isn’t a requirement or expectation, it should not be frowned upon.
Established Onboarding and Training Processes
Onboarding and training can be essential for setting the tone – what the standard operating procedures are, what the day-to-day job will look like, and the organization’s culture. If the goal is to have a cohesive team, these processes should be standardized for all types of staff, whether direct hire or contract worker.
In addition, all staff should have the same continuing education and growth opportunities, promoting a culture of equality and professional development and ensuring that every team member has the resources and support necessary to excel in their roles.
Transparent Communication Among Nursing Staff
In a hospital or clinical environment, losing track of so many moving parts is easy. Nursing teams need multiple modes of communication to ensure they are organized and on the same page.
This includes having proper tools to communicate, especially around patient care. Traditional chart notes and whiteboards in rooms are not going anywhere. Still, many organizations are also integrating newer technologies, such as HIPAA-compliant messaging platforms, for instant communication between staff members. This is especially helpful during emergencies to speed up response time to critical patients.
Good teamwork also means holding one another accountable, creating an environment where employees feel comfortable discussing their challenges and concerns, and collaboratively working to overcome them.
However, there should be an established feedback process for issues that need further addressing. For example, a staff member is consistently underperforming or making mistakes, affecting others – or worse, patients. Staff should know who to escalate these issues to, whether it is department leadership or HR, and how so that they can address and resolve the issue immediately.
Regular Team and Staff Meetings
Teams and departments should be meeting regularly to share important information and updates, as well as coordinate and plan, ensuring alignment of goals and objectives for the team and the organization. Meetings can also provide a forum for problem-solving, decision-making, and feedback, allowing employees to voice their opinions, share ideas, and actively participate in discussions. Additionally, meetings are an opportunity for recognizing and acknowledging individual and team accomplishments.
All these forms of engagement instill a sense of duty and shared ownership, which are fundamental components of a positive workplace culture and effective teamwork. Pair this with solid operational organization and communication to create an unstoppable nursing team that puts patient care at the forefront.
