Stress, burnout and compassion fatigue are conditions now synonymous with nurses on the front lines of the COVID-19 pandemic. Nearly 75% of nurses in Pennsylvania said they feel more exhausted, overwhelmed, and anxious then they did last spring.
But let us be clear. COVID did not create these conditions. Well before the pandemic, many of America’s 4 million nurses had physical and mental health burdens tied to their jobs while the institutions that employ them overlooked or failed to prioritize these problems.
Nurses and their patients have paid a price for that neglect. And it is time for hospital and health system leaders to recommit to making sure they are healthy and whole and can be a bedrock of care in every setting.
In a recent study, nurses who report having poorer physical and mental health were 31% and 62%, respectively, more likely to commit medical errors compared with peers in better health. Two years before COVID, a majority of nurses scored themselves low on physical and mental health.
We sat on a National Academy of Medicine committee that recently released “The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity,” which examined the state of nurse well-being. Here’s what we learned:
There is an “expected culture” within nursing in which young or new nurses routinely encounter bullying, intimidation, hostility and hazing from other staff nurses, supervisors and managers.
About 1 in every 4 nurses experience violence at the hands of patients or their family members. These incidents are often underreported due to lack of workplace reporting policies and fear of retaliation.
Racism, discrimination and dehumanizing attitudes from employers, educators, managers, colleagues and patients are omnipresent. Black nurses have long reported encountering racism at work and in school. But there’s been an uptick in Asian nurses reporting verbal and physical attacks amid COVID-19; and LGBTQ nurses have reported discrimination and harassment.
All of this is contributing to emotional exhaustion and a low sense of personal accomplishment at work leading to poor patient outcomes, higher costs and more nurses leaving the profession.
Hospitals, nursing homes, schools and other organizations that employ nurses have a vital role to play in shaping the conditions that promote well-being. That means prioritizing monitoring and improving nurse well-being, dismantling impediments to health, and being accountable.
It starts with C-suite leaders who must take a deliberate and unwavering zero-tolerance stand. They must develop and implement evidenced-based policies and programs that promote civility and make sure that the hospital governing body is informed and sets a clear direction for implementation, oversight and monitoring for compliance.
As a member of the C-suite team, the chief nurse executive sets the culture and tone for other nurse leaders. The CNE is responsible for informing members of the leadership team about well-being challenges and strongly advocating for adequate pay and benefits, making sure nurses are not overworked, and promoting workplace safety and civility.
C-suite leaders should also make sure nurses are not afraid of being retaliated against when they identify a deficiency in the system. Nurses, for example, should feel free to disclose a disability or mental illness to their employer or request an accommodation to do their job. But many institutions make it hard.
The foundation for nurse well-being starts before they even begin practice. Educators must impart nursing students with the tools and skills necessary to protect their physical and mental health throughout their career. Promoting well-being should be diffused throughout the curriculum in meaningful ways. Some institutions, including, the University of Pennsylvania, have hired a chief wellness officer.
When nurses work for institutions that support their well-being, they are more fully engaged in care, make fewer medical errors, and their patients have better outcomes.
But very little will change until leaders make this a priority. They need to keep their ear to the ground and find a way to stay connected to front-line staff through things like C-suite rounding.
The NAM report envisions nurses more fully actualizing their role in addressing the social, economic and environmental factors that affect health. If we want nurses to succeed in this role, the institutions where they learn and work owe them the support and protection they need to thrive. That support and protection starts with the leadership of those institutions who need to not only listen but hear what their teams are saying.
