Introduction
Nurse burnout is a significant issue that can have a negative impact on the quality of patient care and outcomes, and add to a high rate of turnover and a nursing shortage in the medical workforce. According to a policy brief from The Ohio State University College of Nursing (2020), nurse burnout is a grave issue that affects the quality of care, patient care, and the healthcare workforce. As a result, effective policies and suggestions to address the shortage of nurses due to burnout are critical. This paper aims to investigate policy alternatives and make suggestions for tackling nursing shortages in the United States.
Policy Alternatives to Decrease Nurse Shortages in the United States
Increase Staffing
Nursing shortages are a persistent problem in the United States. A study by the American Association of Colleges of Nursing (AACN) predicted that by 2022, there will be a scarcity of over one million registered nurses in the US (Daniel & Smith, 2018. The workload increased and nurse burnout increased as staffing shortages were exacerbated by the COVID-19 pandemic (Schlack et al., 2022). This exacerbated the shortage while increasing the burden and strain on nurses, resulting in high rates of exhaustion and resignation.
Elevated nurse staffing levels have been linked to better patient outcomes, lower nurse burnout, and low job satisfaction.
According to a study by the University of Virginia, growing nurse staffing levels can save hospitals by lowering nurse turnover and enhancing patient outcomes, saving $1.6 million per year (Fricklas, 2019). The researchers looked at data from 166 health facilities in Virginia and Washington, D.C. Nurse-to-patient proportions of 1:4 for surgical wards, 1:2 for intensive care facilities, and 1:1 for critical-care settings are recommended by the American Nurses Association (ANA, 2018). However, according to a study published in the Journal of the American Medical Association, only a few hospitals met the suggested nurse-to-patient ratios.
To address the shortage of nurses and improve nursing staffing levels, healthcare providers must prioritize employing additional nurses. As the Bureau of Labor Statistics (2022) noted, registered nurse employment is expected to grow 9% between 2020 and 2030, with approximately 175,900 job openings each year. According to a study by the National Institute of Nursing Research, higher nurse staffing levels are linked to lower mortality rates, fewer hospitalizations, and reduced rates of healthcare infections (Lasater et al., 2021). The study investigated information from 168 hospitals and more than 1.3 million patients.
Research by the Journal of Nursing Administration discovered that greater nurse staffing levels are related to a lower incidence of nurse fatigue and dissatisfaction with work (Lin et al., 2019). (Lin et al., 2019). The research reviewed information from 524 nurses who worked in acute care hospitals across the US.
Address Nurse Burnout
According to a JAMA study, a high proportion of nurses who left their jobs due to burnout reported a difficult working atmosphere. Among nursing staff who had considered quitting their position (n = 676 122), 43.4% cited burnout as a factor in their choice to leave their current position (Shah et al., 2021). Resolving nurse burnout is critical to ensuring nurses’ well-being and the service of high-quality care. The policy alternatives listed below can be used to tackle nurse burnout.
Employers in the healthcare industry can promote a positive work atmosphere by providing sufficient tools to assist nurses in their duties and encouraging healthy interrelationships among colleagues. According to a study conducted by the Nurses on Boards Coalition, 60% of nurses polled said their management did not provide adequate tools to promote their well-being, which can influence job dissatisfaction and burnout (Nurses on Boards Coalition, 2019).
According to a survey of 659 nurses, 553 (85%) asserted workplace incivility, and 239 (37%) noted that they had incited workplace incivility to other coworkers (Wei et al., 2018). Therefore, workplace relationships are critical in creating and sustaining a positive workplace atmosphere. Patients treated in hospitals with poor working conditions had a 16% lower probability of surviving in-hospital cardiac arrests than those treated in hospitals with respectable working conditions (We et al., 2018). Patients’ dangers of death and inability to be rescued were significantly lower in healthier workplaces where nursing staff were more pleased with their work and had a higher intent to stay.
Healthcare employers can support nurses’ mental health and wellness through assistance for staff members, counseling, and peer support programs. According to a Biomedical Central study, 87% of 812 nurses polled reported physical or mental stress symptoms, which can influence burnout (Dyrbye et al., 2019). The Lorna Breen Health Care Provider Protection Act was reported and signed into law in January 2021. (Columbia University, 2021). It aims to provide mental wellness and support for healthcare providers, such as nurses.
Several studies have investigated the effect of a flexible schedule on nurse burnout. One such study, released by the Journal of Nursing Management in 2018, examined the impact of schedule flexibility on nurse burnout and intention to leave. The study surveyed 384 nurses and discovered that those with flexible schedules experienced significantly less turnover, emotional exhaustion, and depersonalization compared to those with rigid schedules (Cicolini et al., 2018).
Another study of 87 cross-sectional research indicated that working more hours per week was related to depersonalization and emotional exhaustion (Dall’Ora et al., 2020). Emotional exhaustion was linked to 12-hour or longer shifts. The study also found that operating on permanent shift patterns rather than rotating shift patterns had no effect on burnout, but operating irregular shifts did have an effect on a composite burnout rating. Implementing policies to tackle nurse burnout can enhance both care quality and patient outcomes, in addition to nurses’ health and well-being.
Increase Nurse Wages
Data from Nurse.com’s 2022 Nurse Salary Research Study show that 29% of 2516 nurses across all permit types thought about leaving in 2021, up from 11% in 2020. Higher pay proved to be the most influential motivator to stay among nurses considering leaving the profession, followed by stronger support for work-life balance and a more sensible workload (AACN, 2021). Raising nurse salaries is a policy option to improve nurse retention while decreasing burnout.
A 2019 research article in the Journal of Nursing Administration states that higher nurse wages are associated with lower turnover rates. The study examined data from 1,902 care facilities and discovered that a 10% rise in nurse salaries was affiliated with a 1.5% decline in licensed practical nurses (LPNs) and registered nurses (RNs) turnover rates (Huang & Peng, 2019). The study also discovered that wages had a greater impact on turnover for RNs than LPNs.
According to a BLS report from 2021, the average yearly salary for registered nurses in the US is $75,330. The report also predicted that RN employment would grow by 7% between 2020 and 2030, which is more than the mean for all occupations (AACN, 2021). According to an ANA survey conducted in 2021, 79% of nurses affirmed that pay and benefits are significant considerations in work satisfaction, and 63% of nurses agreed they could consider quitting their present job for better pay and benefits. A total of 5,191 nurses from all 50 states participated in the survey. These studies indicate that raising nurse salaries could be a viable policy to mitigate nurse turnover and exhaustion.
Do Nothing
“Doing nothing” is not a suitable policy option for addressing nurse shortage and retention. Failure to tackle these problems can have serious ramifications, such as a shortage of competent nurses, declined patient satisfaction, and reduced quality of care. Lee and Ayers (2021) reviewed 24 studies and discovered consistent proof that greater levels of job burnout due to nurse shortage were linked to a lower level of healthcare quality.
Furthermore, according to the American Nurses Association (2021), the COVID-19 pandemic has raised the priority of addressing nurse burnout and retention, with many nursing staff quitting their jobs due to stress and burnout. In short, “doing nothing” is not a feasible policy for addressing nurse shortage and retention, as it can have serious negative consequences for patient outcomes and aggravate the nursing shortage.
Recommendations to Solve Policy Problems in Handling Nurse Shortages
The first suggestion is for healthcare providers to increase resources and support to address nurse burnout. Some resources include mental health and wellness initiatives that provide stress reduction, resilience coaching, mindfulness, and other stress-reduction strategies. The National Academy of Medicine (2019) states that healthcare organizations must create positive work settings to encourage clinician well-being. Furthermore, healthcare providers can provide sufficient staffing and workload management techniques to assist nurses in reducing stress and workload. Furthermore, nurses can benefit from ongoing professional growth and education opportunities by acquiring new skills and being updated with the best nurse practices.
Secondly, increasing funding for courses in nursing can help address nurse scarcity by increasing the number of skilled nurses in the workplace. For example, the University of Minnesota and Minnesota State University will form the Coalition for Nursing Equity and Excellence in October 2022. (AACN, 2021). They will collaborate with every nursing school in the state, healthcare providers, and other stakeholders to increase registration in nurse educational programs, increase fairness in the nursing field, and improve student success.
Thirdly, supportive leadership should be provided, emphasizing clear dialogue, collective decision-making, and an environment of appreciation and cooperation. Nurses should have opportunities to develop leadership qualities and mentorship relationships in healthcare settings (Nurses on Boards Coalition, 2019). Listening to nurses’ perspectives can assist in developing a favorable work atmosphere that enhances nurse job satisfaction and performance.
Conclusion
Nurse shortage necessitates effective policies and suggestions that boost nurse well-being, promote a productive workplace, and enhance the quality of patient care. Policies include increasing staffing, addressing burnout through programs for mental wellness, and encouraging a healthy work environment. Additionally, as noted, increased salaries could enhance job fulfillment and encourage nurses to remain employed, significantly reducing staff turnover and enhancing patient care.
Recommendations include increasing resources and support, funding nursing education programs, and providing supportive leadership. To guarantee nurses’ well-being and promote quality healthcare delivery, healthcare providers and policymakers must collaborate to implement such policies and suggestions.
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