According to Medscape's annual "Nurse Career Satisfaction Report 2021," many nurses continue to report experiencing burnout and decreased satisfaction in their jobs—findings that reflect the pandemic's ongoing toll on nurses.
Our take: 3 strategies to build baseline emotional support for your nursing staff
For the report, Medscape surveyed 10,788 U.S. nurses over the summer of 2021. Responses came from a variety of nursing positions, including LPNs, RNs, and advanced practice registered nurses (APRNs), a group that includes NPs, nurse midwives (NMs), clinical nurse specialists (CNSs), and certified registered nurse anesthetists (CRNAs).
Overall, at least 25% of respondents said the pandemic reduced their satisfaction as a nurse. Among the different nursing professions, NMs and RNs were most likely to report decreased satisfaction at 41% and 40%, respectively.
When asked to rate their current level of burnout, at least 20% of nurses reported either being burned out or very burned out. The nursing professions that reported the highest levels of burnout were RNs and LPNs.
Among LPNs and RNs, around a third of respondents said the most rewarding aspect of their job was helping people and/or making a difference in their lives. Overall, LPNs were more likely to cite their relationships with their patients and their pride at being a nurse as rewarding aspects of their job. In comparison, RNs were more likely to cite having a good work-life balance, relationships with coworkers, mentoring/teaching, and the amount of money they make as rewarding job aspects.
However, LPNs and RNs both said administration and workplace politics were the least satisfying aspects of their jobs. In addition, LPNs cited the amount of money they make, patient load, and lack of respect from colleagues as the least satisfying aspects of their job, while RNs were more likely to cite the amount of documentation, emphasis on patient satisfaction, and lack of work-life balance.
Like LPNs and RNs, most APRNs were most likely to cite helping people and making a difference as the most rewarding aspect of their job. The exception was CRNAs, who cited working at a job they like as the most rewarding aspect.
When it came to the least rewarding aspect of their job, CNSs and CRNAs were most likely to cite administration and workplace politics, while NMs cited the pressure to see a certain number of patients each day and NPs cited the amount of documentation required.
In addition, Medscape asked nurses about their experiences with four different types of abuse in the workplace, including:
At least 31% of nurses said they had experienced emotional abuse in the last year. Managers and administrators being the most commonly cited source of such abuse by all nursing professions except for certified registered nurse anesthetists, who cited physicians as the primary source.
When it came to physical abuse, around 20% of RNs and LPNs reported experiencing such abuse in the last year, with patients being the leading perpetrators. Base sizes for CNSs, CRNAs, and NMs who experienced physical abuse were too small to report and were excluded from the data, according to Medscape.
Verbal abuse was the most common type of abuse experienced by nurses, with at least 40% reporting they had experienced such abuse over the last year. RNs in particular reported high rates of verbal abuse at 58%.
Among nurses who experienced verbal abuse, patients were the most cited source for most nursing professions. The exception was among CRNAs, who reported that physicians were slightly more likely to verbally abuse them (61%) than patients (58%).
A majority of nurses across all professions (84%-91%) said they had not personally experienced sexual abuse, harassment, or misconduct in their workplace. However, Medscape noted that past surveys have indicated that nurses are at a heightened risk of sexual harassment, so further research into these numbers may be necessary.
Medscape's findings add to a growing body of evidence highlighting the toll the pandemic has taken on the nursing workforce.
For example, an October 2021 survey from the American Nurses Foundation (ANF) found that 42% of nurses said they had an extremely stressful, disturbing, or traumatic experience because of Covid-19, and of those nurses, around a quarter said they experienced "repeated, disturbing memories, thoughts, or images" related to the incident either "quite a bit" or "extremely" in the past month.
In addition, another survey from ANF in March found that 43% of nurses said they felt overwhelmed, 28% said they felt a desire to quite, and 22% said they felt isolated and lonely.
Kate Judge, ANF's executive director, 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.
Over the course of the pandemic, burnout and other stressors have led many nurses to leave the profession. According to recent analyses by Health Affairs, employment of LPNs and nursing assistants decreased by 20% and 10%, respectively, when comparing the pandemic (April 2020 to June 2021) with the period right before it.
In comparison, RN employment saw just a 1% decrease during the pandemic compared with the period before it. However, this decline was still a significant departure from the steady growth seen between 2011 and 2020. According to Health Affairs, the total supply of RNs decreased by more than 100,000 workers over the course of 2021—the largest decline observed in over four decades.
In March, President Joe Biden signed the Dr. Lorna Breen Health Care Provider Protection Act into law, which will provide new funding and educational programs to support health care workers' wellbeing and mental health.
Industry groups, including the Emergency Nurses Association (ENA) and the American Hospital Association, praised the new law. ENA president Jennifer Schmitz said the law was "a major legislative for ENA and a major milestone for all healthcare workers, particularly emergency nurses who have endured so much over the last two years."
"As importantly, this bill's signing signals to everyone that it is OK to speak up, it is OK to seek help, it is OK to prioritize your self-care instead of suffering in silence," Schmitz added. "Lives will be saved because of the help this new law provides to healthcare workers. (Watson et al., Medscape, 12/29/21)
In 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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