Learn what more than 4,000 nurses from across the country are saying about important issues—from bullying to COVID-19 to salary.
The results of American Nurse Journal’s fourth annual Nursing Trends and Salary Survey reveal much about nursing during this tumultuous year. Despite the COVID-19 pandemic and associated challenges, 85% of survey respondents say they would still become a nurse if they had it to do over again. This has not changed significantly in the past 2 years (84% in 2019, 85% in 2018). However, individual responses and comments were likely influenced by the burden of local coronavirus outbreaks on a respondent’s employer and how individual nurses’ and their families’ health have been impacted. Here’s more about what nurses are saying.
COVID-19 and the nursing workforce
Little national data exist that measure how the COVID-19 pandemic may affect the nursing shortage. According to the Nursing Trends and Salary Survey, 85% of respondents say the pandemic hasn’t changed their career plans, 11% plan to change their job or specialty, and 2% plan to leave nursing. In light of COVID-19, this may sound like good news; however, with nearly 3 million employed RNs across the country, even 2% is a big loss. The survey also found that one-third (33%) of those changing jobs or leaving nursing are from the south, including states hardest hit by the pandemic, such as Florida and Texas.
More than two-thirds (69%) of respondents say they’re satisfied with their employer’s response to COVID-19, with 23% being totally satisfied. More than half (58%) say their organization is well prepared or extremely prepared to handle a surge in patients from a pandemic, natural disaster, or other reason for a sudden influx of patients. However, that means over 40% don’t think their organization is prepared.
Pay and perks
Of the respondents, 41% earn $80,000 to $139,999 per year. This includes 37% of clinicians and 57% of managers. More than half (55%) of respondents reported a salary increase in the past 12 months, down from 62% in 2019.
A total of 69% of respondents said they’re satisfied with their salary/compensation, and 75% report satisfaction with benefits provided by their organizations. A full 87% of respondents receive paid time off, including sick time and vacation.
Top benefits include:
- Paid time off 85%
- Health insurance 82%
- Dental insurance 78%
- Retirement contributions 74%
- Vision insurance 68%
- Education funds 49%
Turnover and recruiting
Recruiting RNs has improved slightly. In 2019, 64% of manager respondents said recruitment had become more difficult in the previous 12 months. That number dropped to 59% in this year’s survey. However, 45% of manager respondents report an increase in open positions in the past 12 months, and 50% say RN turnover has increased during that same period. According to manager respondents, the most in-demand specialties are critical care and ED.
Here’s some insight into nurses and length of employment.
- Many respondents (78%) aren’t currently seeking another employer in the next 3 months.
- Less than half (42%) plan to stay with their current employer for 5 years or more.
- More than half (52%) have worked for their current employer for 5 years or less.
What turns a nurse’s head toward another employer?
Most respondents (84%) are satisfied with their current job, but higher pay and an improved setting are the top reasons nurses would accept another position. Survey respondents who aren’t currently looking for another employer were asked to choose up to three options that would make them change jobs. Money was the most common choice (62.5%). Almost one-third (31%) say they would change for a different type of job/more meaningful work, and 30% say they would make a change for a more positive work environment. On a possibly related note, more than half (56%) of respondents report that their workload has increased in the past 12 months.
Satisfaction with current job, salary/compensation, benefits, and amount of authority were fairly comparable between clinicians and managers. Both groups also reported fairly high satisfaction with peer and supervisor relationships.
Insights from nurse managers
The nursing manager population is a mature one. Almost half (46%) of manager respondents are over 55 years old, and 40% are 40 to 54 years old.
One-fifth (20%) of manager respondents work in a community hospital, and 42% serve on a value-based purchasing committee or make purchasing decisions. Only 18% are certified in nursing leadership, which is similar to 2019. Among those certified, the most common certifications are the two available through the American Nurses Credentialing Center (Nurse Executive-Board Certified and Nurse Executive Advanced-Board Certified).
Key manager insights:
- Most report increased workload in the past 12 months (77%).
- Managers are least satisfied with advancement opportunities in the organization (32% rank this
1 or 2 vs. 3 or above, which indicates some level of satisfaction) and amount of time worked (31% rank this as 1 or 2).
- One-third of managers are totally satisfied (5 ranking) with the relationship they have with their immediate supervisor (35%) and support from that supervisor (35%).
Clinical nurse perspectives
More than one-third (35%) of clinical nurses are over age 55, and 34% are between ages 40 and 54. Only 3% of them are less than 25 years old.
Many respondents work in teaching hospitals (27%), followed by community hospitals (23%) and academic medical centers (15%). Certification among clinical nurses is growing, and 42% are certified in their specialty compared to 35% in 2019. Most (83%) have a bachelor’s degree or higher, and 65% aren’t seeking or planning to seek another degree in the next 6 months.
Key clinical nurse insights:
- Half report increased workload in the past 12 months.
- A third (33%) said assignments are not appropriate to meet patient needs at least 80% of the time.
- Nearly half (47%) of organizations don’t have a staffing committee.
- Clinicians are least satisfied with support from management other than immediate supervisor (42%).
- Clinicians were most satisfied with their relationships with coworkers, with 87% ranking this 3 or above.
This year, we asked for more details about workplace violence occurrences in the past 2 years, including why an incident wasn’t reported, the type of report filed, and satisfaction with follow-up.
Bullying and violence among coworkers
Nearly four in ten (39%) of respondents report having been verbally assaulted by another employee or healthcare provider, up slightly from 35% in 2019. In 2020, 42% of managers and 38% of clinical nurses reported they had been verbally assaulted by a healthcare provider.
Almost one-fifth (18%) had been verbally assaulted or bullied by their manager.
About half of respondents (46%) say they intervened when they witnessed workplace bullying. Only 8% didn’t intervene (46% didn’t witness bullying during that time). Many (38%) reported the incident verbally. Of those who reported, only 27% were satisfied with how the situation was handled. One possible explanation for this low number may be that managers aren’t always able to share specific interventions with staff.
Managers were more likely than clinical nurses to complete both verbal and written reports. The most common reasons for not reporting were the belief that nothing would be done about the situation (44%) and fear of reprisal (39%). Managers were more likely to fear reprisal than clinical nurses.
The survey also found that less than 2% of respondents had been physically assaulted by another employee or healthcare provider. Less than one in ten (8%) reported experiencing sexual harassment, and 58% of those didn’t report the incident.
Bullying and violence from patients and their families
Bullying and violence from patients and family members continues to be an issue. In 2019, 59% of respondents reported having been verbally assaulted by a patient. This year, 54% of respondents say they were verbally assaulted or bullied by a patient. Many (40%) reported the incident verbally.
The most common reasons for not reporting the incident were the belief that the incident wasn’t serious enough to report (51%) and that nothing would be done about the situation (40%). Of those who reported, only 56% were satisfied with how the situation was handled.
More than one-third (36%) of respondents say they had been verbally assaulted or bullied by a patient’s family member or visitor. Most (45%) reported the incident verbally.
Almost two in ten respondents (18%) report having been physically assaulted by a patient. Most (47%) made a verbal and written report, with 30% making only a verbal report. The most common reasons for not reporting were the belief that the incident wasn’t serious enough to report (50%) and that nothing would be done about the situation (40%). Of those who reported, only 48% were satisfied with how the situation was handled.
The survey also reveals that organizations are working to address these issues. Most respondents (78%) say their organizations have been supportive in reducing workplace violence. More than three-quarters (77%) have received or arranged for training in how to de-escalate patients, family members, or visitors who become agitated. Of those who have had training, 85% find the training helpful and 71% have applied the training in practice.
Catherine Spader is an author and healthcare writer/editor based in Littleton, Colorado.