To commemorate the 200th anniversary of the birth of Florence Nightingale, the World Health Organization (WHO) designated 2020 the International Year of the Nurse and the Midwife. The year turned out quite differently than expected, due to the onset of the COVID-19 pandemic.
But in recognition of the contributions made by the healthcare force, the WHO extended the celebratory year by designating 2021 the International Year of Health and Care Workers “in appreciation and gratitude for their unwavering dedication in the fight against the COVID-19 pandemic. “
In a speech in late 2020, the WHO regional director for Europe, Hans Kluge, MD, promised nurses: “We will push back COVID-19 and I promise: we will celebrate you.” Unfortunately, Kluge was unable to keep his promise about pushing back COVID-19, as the pandemic spilled over into 2021 and raged throughout the year, even with the availability of a vaccine. It was not a year of nurses celebrating, but it was a year fraught in turmoil as the pandemic threatened the capacity of hospitals around the world.
The pandemic seemingly far from being over, 2021 is ending with severe staffing shortages and hospitals in many regions — both in the US and abroad — bursting at the seams with COVID-19 patients, to say nothing of those needing care for other conditions.
The sacrifices made by nurses and other healthcare professionals during a pandemic were not overlooked. Many headlines focused on the difficulties workers faced. The pandemic, however, also brought a harsh spotlight to the shortcomings and shortfalls in the healthcare system, both in terms of preparedness and basic support for its nursing staff.
Two main issues for nurses emerged in 2021, according to April N. Kapu, DNP, APRN, president of the American Association of Nurse Practitioners (AANP).
April Kapu, DNP, APRN
” The first is the nursing shortage which was exacerbated due to the pandemic,” she stated. “The pandemic has intensified the problem of burnout, and it has impacted healthcare workers across all levels — doctors, nurses, and advanced-practice nurses. “
The second problem faced by nurses was access to care. She noted. During the pandemic, long-standing inequities in care worsened. Prior to the pandemic there were still gaps in access to affordable and high-quality healthcare, especially for minority communities. It’s all about the patients. We care about patients and want equitable and quality care for all. Kapu stated that this is our main focus.
“There are over 80 million Americans that lack access to primary care. This situation was made worse by the pandemic. “
Workforce issues existed long before the pandemic. Ernest Grant, PhD., RN, is the current president of American Nurses Association. “Insufficient pay, burnout, and opportunities have been problems for a while. But now it’s gotten worse. Overworked and underpaid nurses are a major problem. “
Dr Ernest Grant
A poll conducted among 1000 US healthcare workers in September found that 18% of respondents quit their jobs during the pandemic, while another 12% have been laid off. Among those who stayed on the job, nearly a third (31%) have considered leaving. And overall, 79% of healthcare professionals reported that the current worker shortage has affected them and their place of work.
Another survey, from NSI Nursing Solutions, found that as a result of the pandemic, many nurses are quitting their jobs in substantial numbers across the country; 62% of hospitals reported a nurse vacancy rate higher than 7.5%.
” We are working to exhaustion due to the lack of nurses and we are being asked to come in every day without a break,” stated Kapu. “Nurses are dealing in physical and emotional exhaustion. They are witnessing colleagues and patients die. This is causing burnout to worsen, and more nurses are leaving the profession, saying they can’t handle it anymore. “
Grant also pointed out that travel nurses, who have been in high demand since the start of the pandemic, can earn anywhere from five times to 15 times the average nursing pay. He said that it is frustrating to work side-by-side with someone who is earning more. “
The global nursing shortage was well-known before the pandemic. It is now worsening. In late 2020, the global nursing workforce was estimated at 27.9 million but with an estimated global shortfall of 5.9 million nurses, according to the International Council of Nurses brief on the global nursing shortage and nurse retention. About 89% of these nurse shortages were concentrated in low- and lower-middle countries, with huge gaps in countries, the brief stated. Of the national nursing associations surveyed, 20% reported an increase in the number of nurses leaving the profession as a result of the pandemic.
But, the US is not the only country suffering from shortages. Before the pandemic, many European countries reported a shortage of healthcare workers. The European Commission published an annual report on skill shortages and surpluses in Europe for the period of 2019-2020, and it found that nearly all 22 EU nations reported a shortage of healthcare professionals, such as doctors, nurses, and healthcare assistants. For example, Germany has reported that all 16 of their federal states experienced a decline in their care workforce.
“Bedside nursing staff have less than three years of experience on average,” stated Phyllis Whitehead PhD/CNS, president-elect of National Association of Clinical Nurse Specialists. “During the pandemic many experienced nurses chose to retire or travel. What I see across the nation is that the nursing workforce is shifting to traveling to make more. This leaves less experienced nurses at the hospital. “
But 2021 had some silver linings for nursing, and in some ways has stimulated positive changes that will impact the profession going forward.
Jan Powers (RN, PhD), president of the National Association of Clinical Nurse Specialists noted that “one of its nice things, if there is anything to be said about it, was the expansion of scope of practice by all advanced practice nurses.” “
The scope of practice for APRNs varies according to state law, with 24 allowing full practice authority, according to AANP. During the pandemic, 21 other states temporarily suspended or waived all practice agreement requirements.
Another positive effect of COVID could be that staff shortages and pandemics have prompted nurses to demand better work conditions. Kaiser Permanente, the California-based health system giant, tried to force a two-tier pay schedule that would have cut wages for new nurses by 26%. Kaiser Permanente tried to force a two-tier pay schedule that would have reduced wages for new nurses by %. However, Kaiser was met with strong opposition from its unionized workforce. To ease safety concerns, staffing ratios were also adjusted.
Nurses from Massachusetts, Pennsylvania, North Carolina, North Carolina and Colorado have been involved in union struggles over staffing and working conditions. In Pittsburgh, for example, RNs at West Penn Hospital voted to authorize a strike this year, less than a full year after they joined SEIU Healthcare Pennsylvania. Chief among their complaints: The hospital system had balked at improving staff ratios even as it offered bonuses, up to $15,000 for some, to hire registered nurses to fill vacancies. They were able settle without having to walk out.
The pandemic continues to be a problem, with different predictions about what nurses can expect. Grant says that the nursing workforce issues are not going away anytime soon.
“The three most pressing issues right now are the mental health and well-being of nurses, workforce issues, and social justice issues, and these will be carried over into 2022 and beyond,” said Grant.
He said that many nurses won’t get the right care due to the stigma attached in seeking care for mental illness. He said, “It could reflect on their license that the they sought mental health care. This could be an issue when it is comes to being employed.”
“Nurses reported that their mental health was being affected in surveys. However, we are not seeing any improvement in working conditions right now and hospitals are still crowded with COVID patients. “
Unless this stigma is removed and nurses are able to take care of their mental health needs properly, there will be more burnout and more nurses quitting their jobs. He said, “We see it over and over.” “Nothing is being done in order to make the workplace less stressful. Nurses are being made to work overtime. It’s a vicious circle that never ends and it’s hard to see a way out. “
Mental issues can also contribute to workforce concerns, Grant stated. Grant said that nurses who are exhausted and require time off because of burnout are among the most common causes of stress in the workplace. He said that although burnout has been a problem for healthcare professionals for a long time, it has reached unprecedented proportions.
” There is growing frustration and violence at work — nurses are being attacked both by their patients and their families, as well as by their colleagues — and this isn’t being addressed. It all comes back to better staffing, greater time off, higher wages, and better treatment. “
The bottom line is that many of the problems nurses are currently facing are due to dysfunction within the US health system, Grant stated. In September, he wrote to Xavier Becerra, secretary of the US Department of Health & Human Services, asking him to convene healthcare personnel, government officials, and key stakeholders to address workplace issues.
“I’ve been a nurse for over 40 years, and there’s always been a nursing shortage or a workforce issue, but nothing to the extent we are seeing now,” said Grant. “I have not heard from Secretary Becerra. However, I have heard from his staff who claimed they were doing background research and checking my statistics. “
Both short-term and longer-term solutions are required right now to stop the growing nursing shortage, he said. “We cannot allow this to continue because in the end healthcare will implode itself …..” This is why we must address the issue and provide the resources necessary to solve it. “
Social Justice is another area that needs to be addressed. The pandemic has put a spotlight on inequities within healthcare. In January 2021, the ANA, in collaboration with several other nursing groups, formed a commission to examine the issue of racism within nursing nationwide and describe the impact on nurses, patients, communities, and healthcare systems. Grant stated, “We need diversity in nursing. One of my goals is for the workforce to reflect the population.”
The pandemic could continue to offer unique opportunities for nurses, particularly advanced practice nurses. Whitehead explained that the policy and emergency regulatory changes that allowed them to practice in more states may be a pathway to full practice authority. She said that APRNs will be able to fill in the gaps in primary care if they are allowed to practice more independently.
“CMS increased the CNS [certified nurse specialist]’s ability to order home healthcare and durable medical equipment. This may be permanent,” Whitehead said. “While the situation is dire, there may be a bright spot. “
But it is not all roses and Whitehead stressed that nurses need to be at the bedside. She said that it is important to increase nursing participation, especially by bringing more men into this profession. “In medicine, once a man’s profession, it’s now 50-50,” she said. Nursing is a different story. We are missing half of the population right now. “
She pointed out that there is a need to develop new and more creative models of care. Whitehead stated, “We can’t continue looking at things in the same way.” Whitehead said that some are considering establishing hospitals at home and moving acute care to the home. We need more nurses. All nurses must be allowed to practice at the full extent of their licenses, no matter what we do. “