Nursing has always been hard work, but changes in populations, medical technology, electronic documentation, quality measurement, and treatment have made it even more complex, no matter the work setting or role. We've had to become masters of multitasking and "multithinking"-being mindful of and constantly reordering changing priorities as we encounter new patients and families, interact with colleagues, implement treatment protocols, and follow new guidelines and policies. Our day might begin with an orderly to-do list, but by the end of the shift the list has devolved into a crumpled diary of crossed-off and added items, reminding us of all that we couldn't get to. And that was before COVID-19.
As I write this in mid-June, more than a year after the start of the pandemic, much of the population is rejoicing as America opens up for the summer, shedding masks and socializing. But nurses are still dealing with the pandemic-in acute care settings, as they return to the "normal operations" of delayed surgeries and other procedures with exhausted, depleted, and stressed staff; in home health care, supporting the "long haulers" left with post-COVID complications; in schools, developing plans for reopening safely; and in community and public health settings, working to get as many people vaccinated as possible.
In some locales, the numbers of patients hospitalized with severe COVID-19 are still taxing hospitals. According to the Centers for Disease Control and Prevention's COVID Data Tracker website, while the overall number of cases has been decreasing over time, there are still thousands of new cases reported daily. June 17 data showed 12,824 new cases; between June 10 and 16, the seven-day average number of hospitalizations was 13,538.
If there is any group that needs a day at the beach, it's nurses. Many nursing organizations and facilities have developed programs to promote nurses' well-being and self-care practices-everything from apps to video meditation and yoga. These are all well and good to help individuals deal with stress, but what about the factors beyond our control, like conditions in the health care workplace? What do health care workers say are the issues?
In this month's original research article, Munn and colleagues analyzed survey responses from 2,459 health care workers (over half were nurses) in a nine-hospital system to examine workplace factors that affected their well-being and resilience during the pandemic. They found that nearly half of respondents had "at risk" well-being scores, and that "well-being was significantly and adversely affected by lower levels of resilience, use of support resources (such as meditation apps, employee assistance programs, and counseling), feeling the organization didn't understand the emotional support needs of staff during the pandemic, perceiving workload had increased, believing PPE was insufficient, believing staffing was insufficient, and poor psychological safety." The authors caution that these findings may not be widely applicable in that they reflect one health system amid a pandemic.
While these limitations are important to note, much of what the authors found is what I hear from nurses in most acute care settings on an ongoing basis-that organizations don't "get" that workload demands are too much for a lean staff and lead to exhaustion, burnout, and staff departures. This has been a hallmark of nursing for years, so much so that in 1924, a donor provided funds to purchase a beachfront estate-Nurses House-to provide nurses with a place to rest and recuperate (see From the AJN Archives in this issue). The estate was eventually sold and continues today as a foundation to help nurses in financial distress. Last year, Nurses House distributed over $2.7 million to nurses out of work because of COVID-19.
Given the nursing shortage that is already upon us, and will only worsen, acute care systems need to reinvent the work environment and reinvest-financially and emotionally-in its nursing workforce. Workplaces need to demonstrate that they value their staff by addressing concerns and providing meaningful support. Last week, Texas Children's Hospital in Houston announced that 16,000 employees would receive a 2% raise and an extra week of vacation in recognition of their efforts during the pandemic. I hope other systems follow suit. Then, maybe, some nurses will get a day at the beach after all.