Since the start of the Covid-19 pandemic, the dire state of nursing has been grist for endless headlines, studies, and think pieces, as has the epidemic of clinician mental health problems.
People like me who are concerned about nursing have been hoping that this moment might actually be a catalyst for progress and a step toward enacting some of the reforms the profession needed well before SARS-CoV-2 changed lives around the world. The pandemic exposed — and exacerbated — the cracks that already existed, from understaffing to unsustainable patient loads to workplace cultures that often minimize mental health.
My colleagues and I at Trusted Health were interested to see if the widespread conversations around mental health were being translated into programs, benefits, and institutional and cultural change for nurses on the frontlines. We dug into this via the company’s annual survey conducted in May of this year, which more than 2,500 nurses answered via an online questionnaire.
The results don’t paint a pretty picture. Nurses’ mental health has not rebounded to anywhere near its pre-Covid levels, even as the most acute phase of the pandemic appears to be subsiding. On a scale of 1 (poor) to 10 (excellent), nurses rated their current mental health and well-being at an average of 5.8, compared to an average of 7.8 before Covid-19, representing a decline of 26%. They also reported a range of physical and mental health issues as a result of the pandemic, including burnout, compassion fatigue, and depression.
The majority of nurses said they were not satisfied with workplace support for their mental health. And perhaps most disturbing, 1 in 10 nurses reported they had had suicidal thoughts since the start of the pandemic, more than twice the incidence of such thoughts among U.S. adults.
Despite seemingly endless conversations in the public sphere about this issue, two-thirds of nurses said that the stance of the health care industry on nurse mental health had not changed since the start of the pandemic. Even worse, 95% said that their mental health was either not a priority for the health care industry or that it was a priority but there were inadequate measures in place to support it.
My interpretation of these findings is that the majority of nurses see the conversations and campaigns about mental health as mere lip service, and believe that the health care industry has made little in the way of substantive changes to make nursing a more sustainable career path.
When viewed through this lens, it's little wonder that nurses are unlikely to seek support at work for mental health issues that could harm their ability to do their jobs. Nearly 60% of survey respondents said they were either "somewhat unlikely" or "very unlikely" to share feelings of acute depression, suicidal thoughts, or mental health issues with their manager or another individual at their facility, citing concerns about confidentiality (72%), job security (69%), and minimal or no effort to address the issue they are experiencing (64%).
And — no surprise here — 64% of nurses said they were less committed to the profession than they were before the pandemic, a 39% increase from the 2021 survey. This figure is particularly worrisome when these responses come from nurses who are still in the profession. Even those who have stayed the course through more than two years of the horrors of caring for patients during a once-in-a-generation pandemic now have one foot out the door.
My biggest takeaway from the results is that nurses don't feel supported or cared for by their facilities and leaders. They don't feel that the sacrifices they have made over the last few years have been honored through the kind of cultural changes that would make nursing more compatible with their mental health and well-being. And yet I feel heartened knowing that many of the near-term solutions are straightforward.
For nurses experiencing acute distress, crisis hotlines, one-to-one counseling, and therapy are still essential, but the respondents in this year's survey made it clear that benefits that support their well-being over the long term are top of mind. Flexible scheduling, wellness stipends, and access to fitness facilities and/or classes topped the list of offerings the respondents ranked.
The desire for new and innovative scheduling options aligns with previous research from Trusted Health, which found that nearly three-quarters of nurses (71%) said their experiences as nurses would improve if they had more control over their schedules, and more than half (52%) said the way that nurses' schedules are traditionally set — three 12-hour shifts per week, with schedules built four to six weeks in advance — lowers their job satisfaction. Nurses are watching workers in other highly skilled industries gain access to things like flexible hours and remote work and some nurses are being lured away by opportunities in other industries that recognize their value. To keep nurses at the bedside, hospitals and health systems need to find ways to offer them the same opportunities.
They also need to take decisive steps toward addressing the long and well-documented history of stigmatizing clinician mental health. The fact that nurses are experiencing extremely high levels of depression, trauma, stress, and suicidal thoughts, and yet don't feel comfortable disclosing potentially these issues to their employers, is alarming, particularly when those struggles directly result from the demands of the job.
More needs to be done to create a culture in which nurses feel safe talking about their mental health, and know that doing so won't have negative consequences for their employment. When mental health programs are launched and promoted to nurses, they should be packaged with strong messaging around confidentiality and job and license security.
Improving the relationship between nurses and their managers is another important step toward creating the kind of psychological safety net that's necessary for nurses to come forward. The average nurse manager has between 85 and 90 direct reports, leaving little time for mentorship or building rapport. The impact of this is evident not only from nurses' reticence to talk about their mental health, but also in the fact that just 3% of nurses reported in the Trusted 2022 survey that their relationship with their manager was keeping them committed to nursing.
Given the outsized importance that this relationship plays in nurse satisfaction and retention, it is in need of a massive overhaul. Hospitals and health systems need to better train their nurse managers, find ways to free them from the tedium of tasks like staffing and scheduling, and help equip them to lead from a place of transformation rather than transaction. This includes encouraging and facilitating substantive discussions about nurses' career aspirations, well-being, and contribution to the larger profession, rather than simply about compensation, scheduling, and day-to-day tasks.
The pandemic has ushered in a profound shift in conversations about mental health and the workplace. More and more Americans are realizing not only that they are unwilling to sacrifice their mental health for the sake of their jobs, but that their employers should play more active roles in helping support it.
Based on the sacrifices nurses have made over the last two-and-a-half years, they deserve this kind of support. And the stakes couldn't be higher for them to get it.
Danielle Bowie is a registered nurse, an expert on the nursing workforce, and vice president for clinical strategy and transformation at Trusted Health, a career marketplace for health care professionals.
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