Daily Briefing

Nurses are in crisis. Here's how bad it is, in 6 charts.

More than two-thirds of nurses said they've felt exhausted, frustrated, or stressed within the past two weeks—and more than a third of nurses said they don't believe their organization really cares about their wellbeing or responds to their complaints, according to a recent survey by the American Nurses Foundation (ANF).

Resource library: How to provide emotional supports for your workforce

Nurses are stressed, frustrated, and exhausted

For its latest survey, ANF polled 9,572 nurses. Of those, 75% said in the past 14 days they felt stressed while 68% said they felt frustrated, 67% said they felt exhausted, and 62% said they felt overwhelmed. Meanwhile, just 38% said they had felt grateful in the past two weeks, and only 33% said they felt happy.

In addition, in the past 14 days, more than two-thirds of the respondents said they've experienced difficulty sleeping, while 43% said they've experienced an increase in overeating and just over a quarter said they've experienced more difficulty in relationships.

When asked if they had an extremely stressful, disturbing, or traumatic experience because of Covid-19, 42% of nurses said yes, and of those, about a quarter said they've experienced "repeated, disturbing memories, thoughts, or images" related to the incident either "quite a bit" or "extremely" in the past month.

When asked to rate their emotional health, just over a third of nurses said they'd rate it as either "not emotionally healthy" or "not at all emotionally healthy." And when asked if they had sought professional mental health support since March 2020, just 31% said they had while 68% said they hadn't.

Of those who said they had not sought professional mental health support, 45% said they didn't need it, while a fifth said they didn't have time and 16% said they feel they should be able to handle their mental health on their own.

How nurses feel about their organizations

ANF in the survey also asked nurses whether they agreed or disagreed with different statements regarding their organizations.

For instance, when asked if they felt their organization would notice if they did "the best job possible," 41% said they disagreed or strongly disagreed. In addition, when asked if their organization "really cares about [their] wellbeing," 39% said they disagreed or strongly disagreed, and when asked if their organization responds to their complaints, 41% disagreed or strongly disagreed.

(Firth, MedPage Today, 10/15; ANF survey, accessed 10/18)

Advisory Board's take

3 strategies to build emotional support in your organization.

By Katherine Virkstis and Monica Westhead

Mental health struggles in the health care workforce are not new—they were challenges long before the pandemic began. We have discussed why nurses are increasingly burned out and leaving the profession. But these survey findings highlight an unfortunate reality: mental health challenges in the health care workforce are getting worse. The weight of the Covid-19 crisis, along with a poor response from organizations, has exacerbated an already challenging problem. Now, it seems that not only has the tipping point been reached—some people are falling off the edge. How did we reach this point? And more importantly, how can organizations begin to actually support their nurses at such a pivotal time in health care?

How we reached this point and why the conventional approach is not working

Even without the stress of a global pandemic, health care employees face a wide set of emotionally charged situations that can have damaging effects on their well-being. Add a national nursing shortage crisis to the mix, and we end up with a workforce that is exhausted with grief, morally distressed, and emotionally fatigued.

The conventional approach seems to follow a one-size-fits-all approach to emotional support that doesn’t narrow into the unique types of emotional suffering. And while there are existing resources, such as employee assistance programs (EAPs), frontline staff often feel they don’t have time for emotional recovery because they prioritize patient needs over their own well-being. Given how overloaded the health care system is right now, the idea of pausing for peace may seem nearly impossible to a nurse. As a result, many health care workers individually try to cope with emotional challenges in the moment and then move on with their day. This is what we call the "I'm fine" culture. And if the survey highlighted above says anything, it is not working. Organizations need to step up their level of support now.

Three strategies to build baseline emotional support

  1. Extend support across the long-term following traumatic events

    While it is helpful to support to staff immediately following a major event that could cause trauma or grief, most symptoms of PTSD surface within three months of a traumatic event and some may not even reveal themselves until many months or years later. That's why a near-term and long-term approach is critical, offering both immediate support and longer-term resources for staff who are struggling. For more information on how to provide necessary emotional support to staff members, visit our emotional support resource library.

  2. Provide confidential staff forums to discuss moral distress

    What is often referred to as burnout may actually be moral injury resulting from consistent moral distress. While moral distress is a difficult challenge, the solution is relatively straightforward: give staff a safe space to discuss their experiences of moral distress. There are many ways to do this. For examples of effective moral distress forums, see our emotional support resource library.

  3. Embed emotional support into employee workflow by making it “opt-out” only
  4. Staff and leaders know the importance of emotional recovery, yet often put the needs of patients and others in front of their own, especially when they have more to do in less time. When nurses are exposed to traumatic incidents, they often feel too busy with patient care activities to take time to debrief and recover. They may tell themselves, “I’m fine,” and move on to the next high-priority care activity. But this can have a cumulative effect over time. If staff don’t prioritize emotional wellbeing when they already feel stretched thin, it can take a serious toll on their emotional well-being.

    The goal isn’t to prevent trauma in the health care setting—it is part of the job. But leaders should strive to embed tools and processes that make emotional support “opt-out,” rather than “opt-in” following stressful situations. In other words, bring emotional support directly to staff so they don’t have to seek it out. For example, consider embedding a psychological first-aid team—a specially trained team who can provide on-unit, emotional support to frontline staff immediately following a traumatic incident and connect staff with ongoing support when needed. Another option is to create a bundle of emotional support resources, such as bounce-back kits, that managers and frontline staff can easily activate for a team member in need.

    To help eliminate the stigma surrounding mental health, have vulnerable conversations with staff about the power of self-care. You may even consider sharing your own story.

Parting thoughts

When it comes to emotional support, there is always room to improve. Continue to ask your staff what would be meaningful to them—needs are fluid and can change, so it will only help to have consistent staff check-ins. We've developed a conversation guide for how to check in with a staff member about their well-being. Emotional distress is a mountainous challenge, so it is important that the response is just as robust.

For more information on emotional support, consider checking out our emotional support resource library along with our detailed research on psychological safety, psychological first aid and moral distress.

Andrew Mohama contributed to this article

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