It was a Friday night, and Jennifer Gingrich was in tears as she walked the halls of the hospital. “This isn’t sustainable,” she whispered to herself multiple times.
It was the height of the COVID-19 pandemic, and as a nursing supervisor, Jennifer was on the edge of burnout from trying to manage through a staffing shortage. The emotions she was feeling that night are far too common, and too consistent, among those who have chosen nursing as a profession.
Nursing is incredibly rewarding, but also very demanding. After years of a worsening talent shortage combined with increasing patient care demands, nurses are experiencing burnout at an alarming rate. Nurses will tell you they love what they do, and in the same breath say they don’t currently have the ability to do it well.
Obviously, more pay and reduced workloads would greatly benefit the state of nursing. But, what do we do in the short term to make things better.
To answer that question, we interviewed several nurses from the Emcara Heath team. We wanted the voice of the nurse to take center stage. We brought together professionals who had experiences across a wide variety of patient settings, including acute care, ICU, neonatal, ED, complex care management and pediatrics. They have served an average of 20 plus years in the profession.
Here’s what they had to say.
For Gingrich, it’s not just about recruiting more people to be nurses. She thinks to effectively address the nursing shortage and reduce burnout, we need to evaluate how we deliver healthcare in the first place.
“The model where all patients just head to the hospital when they are sick so they can get better shouldn’t be the model moving forward,” she said. “We need to turn healthcare on its head and properly educate individuals, be proactive and bring care to them in the community, to their home environment.”
Also on Gingrich’s wish list is a uniform approach to patient care ratios across the country.
“It doesn’t fix everything, but it would fix some things,” she said, pointing to the fact that currently patient ratios can be arbitrary and very inconsistent from one region to the next. What the proper ratios are, and how to apply them, might be up for debate. What’s been proven by research is that when a nurse has fewer patients, outcomes improve.
Stacey Moyer has worked the hospital floor and spent time in pediatrics and neonatal intensive care units. She sees a few additional ways to change the dynamics of healthcare to benefit nurses and patients.
“I would love to see more education on diet and exercise and chronic diseases happening with our kids in our schools,” she said. “Educate early. This is how you ultimately fix healthcare.”
She also pointed to the mental health crisis as a priority for healthcare.
“We’re in this huge battle, and we’re losing,” she said. “We need more funding for mental health, more people to help in this area. We need more therapists, more programs, more clinics, just more. It’s really hard to deal with mental health concerns without proper support. And without addressing mental health issues, patients can’t do what they need to do for their physical health.”
Another obstacle identified by Moyer is the speed of care. She believes healthcare interactions are too rushed and are moving way too fast for patients and care teams, both in the hospital as well as the doctor’s office.
“Nurses don’t have time to provide proper education to patients,” Moyer said. “Our patients are vulnerable. They don’t understand everything about the diagnosis they received, the medications they are supposed to take, the care plan they are supposed to follow. It just creates a revolving door at the hospital.”
Despite a big push to recruit more nursing students in recent years, the number of individuals retiring, or transitioning to a new career, is outpacing the production of new nurses. A case of too little, too late.
“We knew for 20 years a nursing shortage was coming,” Gingrich said. “There’s a cycle to this. We have been here before.”
Shana Smith, who has spent most of her career in critical care and complex case management, thinks the nursing profession should get back to its roots of in-person recruitment events. She suggests nursing is a profession where in-person engagement is most effective to make the case for pursuing a career. In the meantime, she’s doing her part by making nursing a family affair.
“If people in our family aren’t sure what they want to do with their lives, we push them into nursing,” she said with a chuckle. “I have a niece, a daughter and two sisters who are nurses, and I’ve even convinced some of my daughter’s friends to go to nursing school.”
In addition to examining ways to improve recruiting, Gingrich suggests a stronger focus on retention efforts, saying that if an organization is not doing everything it can to retain talent, it is being shortsighted. It costs more to train someone new, or to pay a travel nurse, than it does to take good care of existing staff members.
One way hospitals in particular can address retention is by investing in training.
“In the hospital setting, you could help retention efforts by continuing to train staff and make sure they are growing and expanding their capabilities,” Smith said. “By offering continuing education and cross-training your staff, the nurses you have will be better in their roles, and more fulfilled.”
Gingrich, Smith and Moyer all made the transition to home-based primary care when they accepted positions with Emcara Health. Each of them believes there is tremendous merit in the concept of home-based care, particularly when it comes to nurses doing what they do best.
“In just the first few days of working with patients in their homes, I felt more effective as a nurse than I had in a long time,” Gingrich said. “By bringing care to the home, we can treat issues earlier and keep people out of trouble.”
For Smith, the deployment of a multidisciplinary team in support of patients is the magic formula for home-based care.
“The team-based approach really works.,” she said. “Having the ability as a nurse to pull in a physician, a behavioral health specialist, a pharmacist or even a community health worker who can assist with SDoH needs, it’s just such a unique opportunity to drive better health. We are able to personalize care, and make sure every patient is really seen. No one falls through the cracks.”
Moyer points to the additional time that home-based teams can spend with patients as a critical part of the value proposition.
“It can take a while to gain trust with patients,” Moyer said. “I remember a patient visit I made with a physician in upstate New York. When we first arrived, she barely let us in the front door. By the end of the visit, I was getting the grand tour of her home, every nook and cranny. We took extra time with her that day, and it made all the difference. That’s the power of what we are doing with the home-based model.”
Travel nursing as a way of addressing staffing challenges has been around for a long time and is here to stay. While leveraging traveling resources might be necessary for many organizations, Gingrich feels it is important to consider the ramifications of this practice on organizational culture.
“I think in some cases, providers might rely too heavily on travel nurses,” she said. “They have less training on a specific hospital’s policies and procedures, and they are by definition less invested and loyal to the facility. Plus, they are being paid three times or four times more than full time staff, and that can create tension.”
“What I hear most from my friends and former colleagues is that inconsistency with staffing is the biggest struggle for them,” she said. “With so many travel nurses, and so much turnover, you just have everyone coming in and out and there is no opportunity for consistency, for culture or for everyone to get comfortable with each other’s work styles.”
Gingrich recalls earlier in her career when the nursing staff was told to deliver patient medications via tongue depressors because there were no more spoons, and no budget to order more.
“We shouldn’t be worried about things like that,” she said. “Not when we are already overburdened and doing our best to deliver care to patients. But somehow, that’s where the line was drawn. Spoons.”
Her advice to provider organizations is to better manage allocations of resources and to understand that some cost cutting efforts are much more costly to morale and the quality of care being provided than the amount of money they save.
Another way to enhance support for nurses while positively impacting morale, culture, productivity and retention is to be flexible and understanding.
“I remember one night there was a huge snowstorm, and several of us were asked to stay overnight,” Moyer said. “I had small children at home, so I couldn’t stay. The next day, I tried to drive back to work and had to turn around because the roads were just too dangerous. My manager was livid with me. I offered to work a double shift the following day, but that wasn’t enough to make amends for wanting to stay safe for my children.”
While Moyer fully appreciates that management was under a lot of pressure and dealing with several staffing issues, she thinks they lost sight of the bigger picture in the process. Creating a culture where it was taboo to be sick, late or otherwise not fully available for a shift made the working environment more stressful and eroded the staff’s morale.
For Smith, one of the most powerful things you can do to support nurses is to listen to them.
“It’s not like you always can meet all the needs that are present,” she said. “But if you just have a conversation with nurses and make sure they are heard, it really goes a long way. In the process, you can help nurses understand more of the context of what’s happening, and you might discover there are some meaningful things you can do to positively impact their jobs.”
This goes both ways. Moyer says nurses need to hear you as well.
“Acknowledge what’s happening, both the good and the bad,” she said. “Be candid with the staff, be transparent about issues and why things are the way they are.”
One of the most powerful ways to better support nurses seems to also be the most simple and straightforward. Recognize them. Nurses will sacrifice themselves for their patients. That’s how they are wired. They are empathetic, and they are fueled by caring for others. As a result, their love languages include recognition and appreciation. If those languages aren’t being spoken, there will be issues.
“When a provider tells me a joke and makes me laugh, or asks a thoughtful question, it matters,” Smith said. “When your supervisor or a provider recognizes good work, treats you like a person and invests in you as a relationship and not just a transaction, it makes an incredible impact.”
“I love nursing, but I’m a wife, mom, daughter and sister too,” she said. “I really want balance between work and life and to be seen and treated like a whole human being.”
In terms of recognition, even the small things make a big difference.
“Burnout is a real thing,” Moyer said. “Twelve hour shifts. Nights. Weekends. Holidays. It’s really tiring, and it is physically demanding. Being short staffed only adds to this pressure.
So, say thank you. Give nurses a high five. Just show appreciation. You can offer a gift card or a free lunch to a nurse who had to stay after a shift because of a code. The little things count. Simply being appreciated and acknowledged for the job you’re doing can go a long way.”
This is particularly important when considering that nurses are on the front lines with patients, which means they are also often the target of complaints and dissatisfaction from patients when something goes wrong.
“Earlier in my career, when my job was to care for premature babies, the families were always so appreciative and let you know how grateful they were,” Moyer said. “Not every nurse has that type of patient panel and won’t get consistent affirmation. So that is a hole leadership needs to fill.”
Gingrich added that healthcare organizations should advocate for nurses by having behavioral standards in place and clearly communicated to patients.
“We are often seen as the complaint center,” she said. “In situations where a patient is unhappy with the experience, it can get brutal for the nurse. We are busting our butts out there. We don’t need to be attacked while doing our job.”
Experienced nurses have seen, and been through, a lot in their careers. At the end of the day, they truly love what they do. They are warriors, who fight for their patients every, single day. In case you are reading this and pondering a career in nursing, we wanted to end on a positive note. One quote from each of our nurses on the benefits of nursing, and why they love the profession.
“Nursing is an incredibly diverse field,” Smith said. “There are so many opportunities and so much mobility. You can work in a hospital. You can travel and see the world. You can start your own business. You can advance your education and training to become a nurse practitioner. You can focus on a specialty. It’s almost endless.”
“There is always a new challenge waiting, and that has always motivated me,” Moyer said. “I love caring for people. I have a gift for listening and advocating. That’s what nursing is all about. It is extremely satisfying.”
“My mom was a nurse, and so was my grandmother,” Gingrich said. “I do this work because I care. I don’t think most people realize just how much nurses are advocating for them. We do this because we genuinely love helping others heal. And that’s been true for nurses since the very beginning.”