Here’s What Keeps Nurses Up At Night

The COVID-19 pandemic has officially passed its one-year mark, and everywhere we look, the reflections (from headlines to “Throwback Thursday” timelines) are in full effect. It’s easy enough to pinpoint and reflect upon the moments when Zoomschool appeared to be longer than just a couple of weeks or when paper goods and “hannitizer” flew off the shelves. Getting a grocery delivery window was a beast and a half. Life as we knew it went hiccup. But for those who live and work on the frontlines, the hiccup has been more like a succession of thuds followed by fallout and regrouping. 

In early February, the folks at Nurse Grid, an app that gives staff, departments, and entire organizations better command over schedule distribution and communication, released survey results that show us just how hard the thud has been felt by those who work in the nursing field. However, what is essential to underscore first is that the shortage we often hear about is still in effect. Recent statistics from show there will be over 100,000 registered nurse jobs available per year by 2022. Meanwhile, over 500,000 seasoned RNs expect to retire by 2022, and the Bureau of Labor Statistics “projects the need for 1.1 million new RNs for expansion and replacement of retirees, and to avoid a nursing shortage.” Depending upon the state, nurse salaries vary, but in 2018, average registered nurse salaries were $75,510, according to

Getting back to Nurse Grid, its recent survey provided results that focused solely upon the pandemic’s toll on nurses. Sounding off about their concerns, fears, and plans to leave the field entirely, 9,445 nurses participated in the survey over December 9-18, 2020. Nurses shared their concerns and sentiments about work and life specifically as they related to the pandemic. 

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Concerns That Won’t Quit; PPE Limitations

Despite vaccines becoming more readily available and a possible light at the end of the tunnel, nurses continue to treat patients. The daily potential for exposure to COVID-19 is still hitting nurses hard. When asked for the survey about what they were most concerned about and given the option to choose up to three answers, the number one concern (64%) reported on the survey was possibly infecting family and friends.

One preventative measure, which comes in the form of PPE, remained in flux. Over half of survey respondents (52.6%) said their facility reused PPE and under half (42.7%) reported “adequate” supplies where they worked. Megan Brunson, a night shift supervisor in the cardiovascular ICU at Medical City Dallas Hospital, takes issue with the term “adequate.”

“When asking if we have ‘adequate PPE,’ there is an assumption that this is okay,” she writes in an email. “The better question to ask is if we are at the level recommended by the manufacturer for the PPE per use.”

Citing the example of masks, Brunson adds that an N95 mask should be used for a maximum of eight hours while a surgical mask is recommended for 15 minutes. These materials “are one-time use, not for a full day or to be used in/out of rooms and multiple patients.”

Long Hours And Burnout

It’s known that nurses often clock in and out of shifts that skew widely from traditional hours. For instance, Brunson reported that many in her unit work four to five 12-hour shifts each week. At the same time, Joseph Falise, a Nurse Manager for University of Miami Hospital and Clinics, said that clocking over 60 hours a week is common. 

“This is more than I worked prior to COVID because I was asked to assume oversight of the COVID unit while maintaining my previously assigned areas as well,” he said.

These long shifts coupled with stressors have contributed to a spike in concerns by nurses for their health. In the survey, 61% of respondents reported a fear of burnout, while 40% expressed worry about their mental health.

“The risks of long shifts and many hours for this intense kind of work are well known and could lead to errors, breaches in PPE, practice, and exhaustion. One approach we’ve taken to mitigate this concern is to not allow anyone to work five to six shifts per week and to bring in additional staff as needed,” says Falise. 

When nurses clock out and head home, they face other forms of pressure that impact their overall health and well-being. According to the survey, the average well-being score was 5.87, while career fulfillment scored 5.95 on a scale of 1-10. The survey also found that one in five respondents foresee a new path after 2021, which includes leaving bedside care (18%) or a complete career change (4.1%.)

Well-Being And Beyond

When the first vaccine made headlines for its administration last December, many a pandemic-weary person couldn’t help but cheer. With them becoming more widely available and with eligibility on the rise, many fears have begun to subside, but Brunson and Falise, while hopeful, are mindful of the fact that we aren’t out of the woods yet. 

 “We are still learning about the long-term effects of COVID,” says Brunson. “For example, we’re seeing an increase in post-COVID patients who are severely ill after a stroke or myocardial infarction. They are having a harder time recovering and have much longer hospital stays than patients who have never had COVID.” 

 Falise, who notes that reopening needs to happen at some point, underscores the need to do it safely to avoid massive surges. “I truly believe the answer is vaccinations. This virus is not going to disappear, so we must, at some point, be able to live and work around COVID-19. Vaccines may not be 100% effective, but I think they are our best chance at allowing the world to normalize and protect ourselves from major spikes,” he says.

 Meanwhile, a deeper understanding of what nurses are up against has also changed the conversation at work to workplaces actively seeking ways to ease the burden. To assist the nurses on staff with well-being issues, Brunson says, “[We’ve] become more focused on encouraging wellness and preventing burnout.” Outreach includes providing wellness resources, such as those from the American Association of Critical-Care Nurses, “including blogs, podcasts, peer-to-peer support, and organizational support.”

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