Nursing Burnout, the Great Resignation, and the Future of Nursing

• A 2021 survey by Hospital IQ found that 90% of the nurse respondents are considering leaving the profession.
• Nurses cite a lack of support, higher patient-to-nurse ratios, and burnout as the reasons.
• Nursing administrators have the capability to improve nursing satisfaction and retention.

Registered nurse Sarah Warren knows all too well about burnout.

After only two years as a nurse, she experienced emotional and physical exhaustion.

"I worked on an unsafely staffed unit that first year and became more and more exhausted by my work by the day," Warren said.

Then the COVID-19 pandemic hit. Warren recalled experiencing "a period of adrenaline" in March 2020 knowing her role was crucial for her community.

But it quickly faded.

As the pandemic went on, nurses and healthcare workers were left scrambling for personal protective equipment. They also were responsible for even more patients — adding to their already full assignments. As a result, many suffered and continue to suffer from burnout.

"I experienced PTSD after that first year [of the pandemic] and again in 2021 due to the impacts of the delta variant on my community," Warren said.

Both experiences led her to seek help through therapy, and she was eventually placed on antidepressants.

Unfortunately, Warren's experience — before and during the pandemic — is all too common.

The burnout and mental health impacts she and thousands of nurses experienced are reverberating through the healthcare industry. Nurses are leaving their current institutions for other hospitals, switching roles in the healthcare field, or leaving the nursing profession altogether.

Reducing that burnout will require stakeholders to address myriad factors that cause it. Those factors include a lack of support and untenable patient-to-nurse ratios. Solutions start in higher education and extend to hospital administrators.

The Effects of Burnout on Nurses

Workers in many fields experience job burnout. But even prior to the pandemic, studies showed that one-third of nurses experienced symptoms of burnout. These symptoms include:

• Depression
• Lack of concentration
• Anxiety
• Post-traumatic stress disorder (PTSD)
• Fatigue
• Detachment
• Headaches
• Muscle pain
• Insomnia
• Stomach pain

Burnout also has a negative effect on work productivity, which decreases the quality of care provided to patients. Nurses can begin to experience:

• A lack of personal achievement
• A lower sense of job satisfaction
• An increased feeling of incompetence in their job role

"Sadly, the majority of experienced nurses are unhappy in their roles or have been for quite some time," Warren said.

New nurses are also being thrust into chaotic and toxic environments. Warren said this doesn't give them enough time to experience "the honeymoon period" — a period of time when new nurses solidify why they went into nursing in the first place.

Nursing on the Verge of 'Great Resignation'

A survey conducted by Hospital IQ in November 2021 found that 90% of nurse respondents are thinking about leaving the profession in the next year.

The data confirms what Warren experienced firsthand: "Nursing has been hanging on by a thread for a very long time," she said.

According to the Hospital IQ survey, nurses are thinking about leaving the profession due to:

• A shortage of nurses and technicians
• High patient-to-nurse ratios
• Impacts on patient care
• An increase in manual tasks
• Poor processes and inefficient workflow
• A lack of technology solutions

Warren said she stays in nursing because she has a deep passion for nursing and helping her community. Nurses serve as liaisons between the healthcare system and patients by providing care — even in undersupported conditions.

"I need to be the change I wish to see. And staying in the profession, for me, means fighting for nurses and patients alike," Warren said.

Nurse Education Can Help Stem Burnout

Even as the nursing profession faces the threat of a great resignation, the Bureau of Labor Statistics projects about 194,500 nursing positions will need to be filled each year, on average, from 2020-2030.

That means the healthcare industry won't just have to deal with the current burnout crisis. It will also have to educate thousands more nurses every year. Fortunately, educating more nurses may also help alleviate a nursing shortage that helps accelerate nurse burnout.

A 2019 survey by the American Association of Colleges of Nursing (AACN) found that U.S. nursing schools turned away more than 80,000 qualified applicants from baccalaureate and graduate nursing programs that year. This was due to:

• Lack of clinical sites
• Lack of classroom space
• Lack of clinical preceptors
• Budget constraints
• Lack of nurse educator faculty members

The lack of nurse educators is a critical reason for the nursing shortage. There simply aren't enough nurse faculty members to teach nursing students.

Nursing schools cite low salaries and retirement as reasons for the insufficient number of faculty members. A September 2021 report by the AACN shows the vacancy rate nationwide for faculty positions increased from 6.5% in 2020 to 8% in 2021.

In order to attract more nurses to nursing education, stakeholders need to start thinking outside the box. They need to strategize on:

• Increasing their budget
• Reviewing bottleneck budget constraints and creating lasting solutions
• Creating bridge programs for retired nurses to work and/or volunteer as nurse educators
• Working with policymakers to bring attention to the nursing shortage crisis
• Creating strategic partnerships to help increase student capacity and expand student enrollment in nursing programs

Prior to the pandemic, there weren't enough nursing students to begin with — and nurses like Warren paid the price starting in March 2020. If stakeholders don't want burnout to continue, they need well-educated nurses to step in, and they need to encourage them to pursue higher education.

What Nursing Administrations Can Do to Improve Nursing Satisfaction

With access to resources like capital, big data, and technology, nursing administrators have the capability to improve nursing satisfaction and retention.

"In order to retain nurses, you must reverse the clock on past decision-making that has led to the current state of nursing," Warren said.

Nurses' dissatisfaction with the profession can be traced back decades — and it only seems to be getting worse.

To address the concerns of understaffing, nursing organizations like the AACN have taken initiatives to improve the nursing shortage. One way is by creating a centralized application program called NursingCAS for registered nurses and graduate nursing programs.

Another way nursing administrators can improve nursing satisfaction is by simply acknowledging that nurses are burned out. They need to create a measurable outlet for nurses to voice their frustrations.

"We need our systems to acknowledge the mental health impacts of our work and provide us with real-time support," Warren points out.

Other strategies to improve nursing satisfaction include:

• Salary increases
• Improved communication
• Clear avenues for professional advancement
• Educational sessions on burnout and improving awareness
• Creation of avenues for feedback and quality improvement
• Empathy
• Commitment to improving workplace conditions

The Future of Nursing

The future of nursing rests in the hands of stakeholders like chief nursing officers, nurses executives, and hospital administrators. But it also rests in the hands of nurses.

"I believe nurses who advocate for the profession will encourage the change needed," Warren said.

As the saying goes, decisions will be made for you if you're not in the room. So nurses need to pull up a chair.

Becoming a nurse advocate is a great way to improve current nursing conditions. Nurses must realize hospitals cannot run without them, nor can patients be cared for without a nurse present. When united together, nurses have the power to create impactful changes in healthcare.

For example, during the pandemic, New York-based nurses took to social media to show the injustices and lack of personal protective equipment they were given to protect themselves and their patients.

As a result, Andrew Cuomo, then the governor of New York, signed into law the safe staffing bill, which appoints a clinical staffing committee to design a safer staffing plan. Each year, a staffing plan will be submitted to the state Department of Health by July 1.

The impact of nurses leaving the profession is creating a huge dent in the nursing profession. Stakeholders need to act now to improve nursing satisfaction and prevent rapid turnover in order to preserve the future of nursing.