It’s clear that the state of the nursing shortage is at a crisis level. As an experienced bedside nurse, a recent nursing psychiatric/mental health graduate student, and a clinical adjunct faculty instructor, I have a strong opinion about what must be done.
In the recent Nurse.org 2023 State of Nursing report, 91% of nurses said they believed the nursing shortage was continuing to worsen, citing burnout, poor working conditions, insufficient pay, and lack of appreciation as the primary reasons. Many actions can be taken to prevent nurse turnover and retain experienced bedside nurses.
First and foremost, nurses require better pay. Hospital administrators can’t forget to value and invest in their core staff. They should consider retention bonuses, incentives for nurses willing to train new nurses or nursing students (paid-time-off, additional pay per hour), all Federal holidays paid, increased night shift differential, and additional weekend differentials.
One of the most important things that can be done to show a nurse they are valued is to listen to them. Staff meetings, which absolutely must accommodate both day and night shifts, shouldn’t focus solely on unit metrics; they also should include discussion of nurse concerns, which then require follow-up. Management should offer periodic individual nurse check-ins, in person or virtually, to allow for discussion of minor issues before major problems arise. Great patient care should be talked about, shared, and rewarded, which may contribute to more great care in the future.
Leadership should remain visible and accessible to both shifts. Intermittent surveys can help assess unit morale. Management also must remember and understand the value of each nurse, their families, their personal and professional goals, and the sacrifices they make, especially in times of national emergency or natural disaster.
Healthcare organizations and nursing leadership should nurture and cultivate work/life balance and prioritize scheduling, allow paid-time-off, limit or eliminate required overtime, offer paid maternity/paternity/parental leave, cap the number of consecutive work days, offer confidential employee assistance programs for mental health purposes, and support home life by offering lactation areas and childcare options.
As for working on the floor, rules must be established for safe patient assignments; floating should include thorough orientation and training, and every code or major incident should require debriefing so that bedside nurses feel adequately trained and prepared and their licenses protected. For the safety and security of all bedside nurses, the following issues and situations must be addressed: violent family members, violent patients of sound mind, a safety plan for handling difficult patients/families (a panic button isn’t a sufficient substitute), nurse-to-nurse bullying and incivility, and physician/provider abuse. In addition, medication errors/mistakes should never be criminalized.
According to the Advisory Board, nurses make up to one-third of staff in most hospitals; however, they’re rarely represented on hospital boards. In a 2022 study, the American Hospital Association determined that nurses represented only 5% of hospital/health organization board members. McKnight and Moore describe nursing shared governance as emphasizing shared decision-making and collaboration among bedside nurses and nurse leaders. With the implementation of unit or hospital councils, staff nurses have can share their opinions, suggest improvements to the patient care that they’re responsible for every day, and assist in making decisions regarding policies, procedures, and process improvements, which ultimately will improve patient outcomes.
Nurses must be invited into any conversation that involves them and their role so they can offer a critical perspective on quality care and the everyday experience of working with patients in their organization and unit. When nurses participate, changes can be made to benefit patients and staff, which can contribute to shorter hospital stays, lower overall costs, and increased family and patient satisfaction. It comes back to being listened to.
Nursing shared governance bolsters professional practice organizations at the same time as it empowers nurses to help make decisions that impact themselves, their colleagues, and their patients. When bedside nurses have an opportunity to participate in decision-making in their workplace, they feel more valued and appreciated, which increases nurse satisfaction, overall morale, and nurse retention rates.
Many nurses experience burnout, but Dean and colleagues point out that the terminology implies that the problem resides within the individual nurse who’s somehow inadequate to tolerate the work environment. The term “moral injury” more accurately illustrates the existence of a broken system rather than a broken person. Addressing system flaws takes the pressure off of nurses feeling that their “burnout” is somehow their fault.
The action taken to mitigate the nursing shortage also must involve new graduate nurses, who will replace bedside nurses leaving to pursue higher education or retire. Formal, contracted nurse residency programs of several weeks to months—which could include one-on-one shifts with a preceptor, lectures by the providers they’ll work alongside, go-to unit mentors, classes, and required certifications in that unit’s area of specialty—would truly bridge the gap between student and professional. These types of residences would prepare new graduate nurses for success by offering them support, guidance, and stability to help ensure they remain in this new role.
Conclusion
Nurses belong at the proverbial table in which they and their role are being discussed so they can provide their unique perspective and expertise. The workforce shortage can be mitigated by attracting and educating future nurses and valuing existing nurses and nurse educators to bolster and restore our country’s bedside defense.
Alyssa King, DNP, APRN, CPNP-PC, PMHNP-BC, CLC, CNE is a Nurse Planner in Lake City, Fla.
References
Advisory Board. What’s missing from hospital boardrooms? Nurses. March 23, 2023. advisory.com/daily-briefing/2023/03/23/nurse-boardrooms
Dean W, Talbot S, Dean A. Reframing clinical distress: Moral injury not burnout. Fed Pract. 2019;36(9):400-2. ncbi.nlm.nih.gov/pmc/articles/PMC6752815
McKnight H, Moore SM. Nursing shared governance. StatPearls. September 19, 2022. ncbi.nlm.nih.gov/books/NBK549862/
Nurse.org. This is the state of nursing. 2023. nurse.org/docs/State+of+Nursing+-+2023.pdf
Wolters Kluwer. How shared governance in nursing works. February 27, 2019. wolterskluwer.com/en/expert-insights/how-shared-governance-in-nursing-works
1 Comment. Leave new
I think that you made so many salient points. This was quite eloquently written and really aimed at many of the fundamental struggles of nursing at the bedside. I think that bedside nurses are expected to be knowledgeable, fierce advocates. However, we are often limited by our resources. As mentioned in the article, we are rarely invited to the table where many decisions are made that effect the daily practice of nursing. We are often left to handle increasing amounts of roles and responsibilities, but we are rarely given the resources to make it humanly possible. Even when nursing is invited to the decision making table it is often difficult to encourage attendance due the exceptional strain that it takes on work-life balance of nurses. We are expected to work Full-time FTE at the bedside, then volunteer (sometimes paid, but often not paid) time to sit at a table where our input is often not observed. This is time away from our family and lives. This is acceptable only in cases of a salaried positions such as leadership, but hourly should never be asked to work unpaid overtime.
I am a very fortunate bedside nurse that works in a unit with an amazingly strong and healthy culture. Our direct leadership excels and makes us feel extraordinarily supported. However, every year we fill out an engagement survey and we rate shockingly lower than the national average support and communication with senior leadership. Our direct leadership is limited in the changes that can be made and most of our concerns get escalated to a board room full of deaf ears.