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March 17, 2021

The state of America's nurses, in 5 charts

Daily Briefing

    One year out from the start of the pandemic, the American Nurses Foundation, the philanthropic arm of the American Nurses Association, surveyed more than 20,000 nurses to learn how they are faring.

    While some of the findings paint a bleak picture—with more than 50% of respondents saying they feel exhausted, and nearly a quarter saying they are depressed—the survey identified bright spots of resiliency and hope as well.

    Our take: Three strategies to build baseline emotional support


    For the survey, the Foundation polled 22,316 nurses between Jan. 19 and Feb. 16. Of those surveyed, 80% worked full-time and 47% were employed at an acute care hospital with at least 100 beds.

    Of the nurses in the survey, 91% were female, 80% were white, and more than 60% were at least 45 years old. Respondents lived throughout the country, but the largest share of responses were submitted by nurses in California, New York, and Texas.

    According to MedPage Today, the Foundation collected responses using convenience sampling, which means the findings may not be statistically representative of the broader population of nurses.

    Overwhelmed, isolated, and depressed

    Among other questions, the Foundation asked the nurses about the feelings they've experienced over the two weeks prior to their responses. While there were some bright spots—with nearly a third of respondents saying they felt like their work had meaning and 28% saying they felt confident in their ability to handle things—43% said they felt overwhelmed, 28% said they felt a desire to quit, and 22% said they felt isolated and lonely.

    Nurses' reported feelings over the prior 14 days

    Kate Judge, executive director for the Foundation, said while nurses are "still showing up and doing an incredible job," they "have sustained exhaustion and trauma" and witnessed "an unquantifiable amount of suffering and death." She added, "There's no unseeing and unliving what they lived"—and there's no certainty about how those experiences will affect nurses in the long run.

    The Foundation also asked nurses about the mental health resources they had used or considered using since the pandemic hit. Of those surveyed, 24% said they had sought professional mental health support since March 2020. Of the 76% who said they had not sought out mental health support, nearly a third cited a lack of time as their reason.

    Why nurses haven't sought mental health care, among those who haven't done so

    Nurses' thoughts on Covid-19 vaccines

    The Foundation also surveyed respondents about the Covid-19 vaccines. While the majority of nurses had received either one dose (22%) or two doses (48%) of the vaccines available in the United States, 30% said they had not yet received the vaccine.

    Notably, of those who hadn't yet received the vaccine, more than a quarter of nurses said they did not plan to get vaccinated, while a quarter said they were undecided.

    Intentions to seek Covid-19 vaccines, among those not yet vaccinated

    Of those who said they did not intend to get a Covid-19 vaccine, two-thirds cited a fear of short- or long-term side effects of the vaccine, while more than half said vaccine development was occurring too quickly.

    Reasons for not wanting a Covid-19 vaccine, among those who don't intend to receive one

    Of these findings, Judge said nurses' questions around the vaccines must be addressed not only for their own sake, but so that they can accurately and reliably inform the public about the vaccines. Why some nurses want to leave their position When asked about their employment, a substantial share of nurses (18%) said they planned to leave their current position within six months, and another 21% said they were undecided as to whether they would remain with their employer. Of those who said they intended to leave their position in the next six months, nearly half said work is negatively affecting their health or well-being, and a third cited a lack of support from their employer during the coronavirus epidemic.

    Why nurses intend to leave their positions, among those planning to leave within 6 months

    Ultimately, Judge said the survey findings demonstrate that "[w]e still are not providing nurses with all the things that they need. So, vaccinations, [personal protective equipment], mental health, resources, downtime, time to debrief." She added, "And that is something that we, as a country, will pay a price for" (American Nurses Foundation survey, accessed 3/16; Firth, MedPage Today, 3/12).

    Three strategies to build baseline emotional support

    Breaking down health care's "I’m fine" culture

    workforce emotional supportIn the wake of Covid-19, health care organizations must commit to providing targeted baseline emotional support for the three types of emotionally charged scenarios that health care employees are likely to encounter in their careers: trauma and grief, moral distress, and compassion fatigue.

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