Future of Nursing in MI - August 2022

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Page 8 The Future of Nursing in Michigan August, September, October 2022 Nursing Crisis Fatigue and the Hope for Change By Beth Ammerman, the ANA-MI Nursing & Health Policy Committee Chair, and committee members: Alexa Andersen, Marina Andriyakhova, Debbie Bach-Stante, Ramona Berry, Wanda Chukwu, Sarah Jennings, Holly Thalman, and Nadine Wodwaski Nurses are in crisis! As the rest of the world is bouncing back from the COVID-19 pandemic and returning to normalcy with relaxed workplace rules including no longer masking, no pre-entry questioning, and a general feeling that the pandemic is nearing the end, for nurses and other healthcare workers, COVID-19 is still very real. We are still wearing masks and personal protective equipment at work, which is most of our waking hours, and we are still caring for very ill patients. We are still living in the COVID-19 pandemic, and it lingers on… and on… and is taking a toll on us. A study by Sriharan, West, Almost & Hamza (2021) reported evidence from both the COVID-19 pandemic and previous pandemics and shows that “nurses experience the highest levels of psychological distress compared with other health professionals.” Crisis fatigue is a very real concept that “people often experience when faced with a chronic stressor that creates continuous challenges in their life.” (Caldwell-Harvey & Coelho, 2020). Crisis fatigue is a feeling experienced by many nurses in healthcare systems today resulting in low morale, feelings of inadequacy, frustration, and despair. Many nurses are leaving their jobs in hospitals and healthcare systems due to crisis fatigue. For some, it results in more than changing jobs as nurses are dealing with crisis fatigue in various ways. While some nurses are fleeing organized healthcare to pursue other careers, others are turning to travel nursing for better pay. Those left behind are struggling with the idea that they are working alongside travel nurses and doing the same job for less pay. The morale they gained from having a cohesive team of supportive coworkers in the past is now disrupted due to increased work demands, transient coworkers, and staff vacancies. So, what lies ahead for nursing? In a time when nurses are desperately needed in acute care (hospital) settings, they are being drawn away from different nursing opportunities in search of a better work/life balance. The appeal for employment that better matches nurses’ expectations have furthered the challenge to find nurses willing to care for the most acutely ill patients. Five main factors shift nurses away from acute care nursing: workplace environment and demands, overutilization of staff, the appeal of non-acute care options, imposter syndrome, and the intent of many nurses to further their degrees often leading them to administrative or other nonacute care work. This has led to changes in how nurses interact in the workplace and the need to place additional demands on the nurses. Workplace Environment and Demands The COVID-19 pandemic brought changes in the schedule, culture, and comfort of the acute care nursing workplace. The schedule of a nurse working three 12-hour shifts per week used to be the envy of many other professionals; get the work done, and still have four days to spend with family and personal life. During the pandemic, many professionals in other careers shifted from working five 8–10-hour days per week in an office to the flexibility of working from home, and they have never returned to the brick-and-mortar workplace. During the pandemic, nurses were not only required to leave their homes, but to enter settings with a new deadly virus and work longer hours, with mandated overtime, to compensate for the lack of human resources (nurses and other hospital employees). Additionally, nurses were gowned, gloved, and masked for long shifts, becoming physically and emotionally drained while caring for consistently overflowing patient counts. The rationing of personal protective equipment, combined with staffing shortages and other inpatient staff fearful to enter rooms, led to non-nursing tasks becoming the responsibility of direct care nurses. Since nurses were masked and gowned and in the patients’ rooms already, they were now also emptying trash cans, delivering food trays, and holding tablets so the patients could communicate electronically with family and physicians. Ongoing staffing shortages among all levels of inpatient staff have led to the continuation of these work conditions. Nurses are weary and crisis fatigue has set in. One solution is to have transformational nurse leaders which can have a positive influence on managing these challenges. Today’s nurse leader will have to understand the impact of nursing on a global level. The current pandemic has caused a financial strain on America’s health care system. Stamps et al. (2021) noted that nurses reported feeling unsupported by uninformed or misinformed peers and family, as well as lonely when caring for a client diagnosed with COVID-19. Many nurses during COVID-19 have taken early retirement packages or decided to work as travel nurses because of the increased payments received from the agencies hiring. The current nursing shortage, workload imbalances, and nurses’ burnout during the pandemic have also contributed to many nurses facing emotional and physical strain while working. The added layer of stress while working during a pandemic has led nurses to be in crisis mode. To help address the issue concerning nurses’ fatigue, retention, onboarding training, and training new graduates, many healthcare facilities are reaching out to foreign nurses to help fill in the gaps due to challenges with staffing. According to the American Nurses Association (2020), there is a national nursing shortage. With rising openings and employment, the U.S. Bureau of Labor Statistics projects 194,500 average annual openings for registered nurses between 2020 and 2030, with employment projected to grow by 9%. This shortage has led to many healthcare facilities returning to utilizing nursing agencies and nurses from different countries to fill the gaps. There is a need for all nurses - including those with titles such as chief nursing officer, nurse manager, and charge nurse, as well as frontline nurses, to act as transformational leaders. According to Boamah (2022), nurse leaders practicing transformational leadership can be an effective way to improve workplace culture and improve retention. According to Stamps et al. (2021), “nurse leaders” support is essential to creating a safe workplace in which nursing staff are protected, supported, educated, and empowered. Nurse leaders can first ensure that they are advocating for nursing staff members by involving nurses in the decisions that impact their practice environment. This collaborative approach would create a communicative plan that includes everyone involved in providing patient-centered care. Nurse leaders and all staff members can promote advocacy by agreeing to treat support staff, new graduates, and visiting nurses as professionals and equals. The commitment to open communication and collaboration will lead to nurses developing additional conflict resolution skills while working under duress. Nurse leaders and staff members feeling empowered to act as leaders will assist in the commitment to providing quality service and care to our patients during these times of transition. There is a need to create a workplace culture where staff members feel supported and empowered, as well as knowing how to care for themselves. Overutilization of Staff Exhaustion and illness have led to a human resources crisis in nursing. Furthermore, 21% percent of nurses polled in a national survey reported the intention to leave their job within a year (Koehler & Olds, 2022). Other studies have shown even higher rates of intent to leave. Those who were willing and able have persevered, but the seemingly few that covered for the many have reached their breaking point. The overutilization of acute care staff through mandated overtime and refusal of requests for leave is a complex issue and clearly, the demand for the scarce resource of nurses is driving complicated decision-making. However, refusing nurses breaks that are essential to their health and wellbeing is accelerating their rapid exits. A research study found two common interests for bedside nurses across generations: reasonable workload and manageable staffing (Koehler & Olds, 2022). Focusing on these areas is imperative to improving retention. Appeal of Non-Acute Care Options When nurses leave the bedside, where do they go? Many nurses are seeking employment in non-acute care (non-hospital) settings. In addition to the drive to leave bedside nursing for the reasons already listed, the decrease in pay to step away from the hospital is no longer a barrier. Traditionally, pay for working in a hospital was better than working in an office. However, nurses are in demand, which has increased compensation. Registered nursing jobs administering aesthetic injection treatments such as Botox Cosmetic (onabotulinumtoxinA) provides nurses with compensation just as well, if not better, along with the added bonus of “normal business hours” and often less stress and physical demand. Nurses have recognized that they can make the same amount of money in a less stressful, healthier environment, working a regular schedule. Imposter Syndrome In every new role, there is an adjustment period where professional standards, responsibilities, and expectations are identified. Unfortunately, when high achievers fail to fully internalize their accomplishments despite their obvious successes, it leaves them with a sense of self-doubt and fear of exposure as a fraud leading them to believe they are fooling others into thinking they are more capable than they are (Clance and Imes, 1978). This is called Imposter Syndrome. Imposter Syndrome in nursing is common and can occur in up to 82% of individuals (Bravata et al., 2020). It can be very distressing and have consequential effects on job satisfaction and personal performance. In nursing, the novice nurse is vulnerable to feelings of doubt when it comes to feeling ready to meet the expectations of their patients, colleagues, and themselves. This often destroys self-confidence and a sense of belonging, and can lead to burnout and decreased job satisfaction. This cascade then leads them to work outside their comfort level, ultimately feeling the need to leave the nursing profession. This also leads to crisis fatigue in many new nurses.
August, September, October 2022 The Future of Nursing in Michigan Page 9 The COVID-19 pandemic left many organizations adapting to a reduced workforce while many were forced into a work-from-home life instead of the office. Everything from higher education, appointments, and meetings became remote with the use of platforms such as Zoom and Microsoft Teams. The pressures to meet performance expectations left a toxic taste with many (Plotnikof & Utof, 2021). Additionally, being isolated led to more social media scrolling and comparing filtered lives of others, seemingly full of accomplishments, with their own. This led to those who reported working with more responsibilities and less supervision, ultimately increasing thoughts of self-doubt and fear of exposure as a fraud. There is not a lot of consensuses around evidence-based treatments for Imposter Syndrome; however, it is suggested that raising awareness helps to manage Imposter Syndrome both personally and within an organizational setting. Imposter Syndrome can be difficult to identify, as many conceal their perceived inadequacies. Having open communication and discussions of performance between managers, preceptors, and new nurses helps to highlight the differences of feeling incompetent and being incompetent, as they are two very different things. Whether employees are working on-site or working from a home office, offering career development activities and having access to resources such as resilience training helps to reduce symptoms of Imposter Syndrome (Bravata et al., 2020). Effects can also be mitigated by setting healthy expectations and creating cultures where employees’ accomplishments are acknowledged and celebrated. As we know nurses are leaving for a variety of reasons, and those who are left behind are often stressed, overworked, underappreciated, and understaffed; where do we turn to get more help? There is a need to revisit the way nurses deliver care in the acute care setting. Role of LPNs in Acute Care In light of the recent decrease in the registered nurse (RN) workforce in acute care, licensed practical nurses (LPN) are being brought back to the field. Several hospital systems across the country are expanding new graduate RN programs and bringing back the RN-LPN team nursing. Over the last two decades, Magnet status has been a goal for the standard of practice for healthcare systems. Magnet status is an award for the highest ranking of nursing whereby education and development of nurses is stressed: “throughout every career stage, leading to greater autonomy at the bedside” (ANCC, 2022). Evidencebased sources steered Magnet designations toward creating and maintaining a nursing workforce that is Bachelor of Science (BSN)- prepared. This trend has nearly eliminated LPNs from the in-patient departments, but with the shortage of RNs, is now the time to bring these nursing professionals back on board? Currently, 584 out of 6,093 hospitals in the United States have designated Magnet status, or 9.3% (ANCC, 2022). The Bureau of Labor Statistics projects the need for both RN and LPN jobs to increase by 9% from 2020 to 2030 (Bureau of Labor Statistics, U.S. Department of Labor, 2022). What does it mean for LPNs? What would it mean for hospital systems that “phased out” non-BSNprepared nurses? The answers are not the same for everyone, but there are options. Incorporating LPNs into the acute care setting decreases the staffing shortage; however, clear policies on the role, duties, and responsibilities consistent with the scope of practice in a specific state are necessary. While LPNs were once actively working in hospital settings, the push for an all-RN workforce left many LPNs working in alternative settings like outpatient clinics and long-term care facilities. With the severe RN shortage that we as a country are now experiencing, is this the time to bring the LPN back into the acute care setting to help alleviate this shortage? What would the care model look like? Would this be temporary with the LPNs present only for the crisis, only to be sent back out of the hospitals again in a few years? LPN to RN transition programs and incentives should be clearly defined to provide opportunities for professional growth and longterm employment should the hospital consider applying for Magnet status. The time when LPNs were “phased out” of the acute care is fresh in our memory; therefore, it is imperative to be straightforward in describing the setting in which the role might only be temporary. One way is a short-term contract for LPNs not pursuing the RN-BSN path, and another is monetary incentives for “seasoned” LPNs that previously worked in comparable settings. In addition, it is fair to expect that each hospital considers ways to offer LPNs to practice within their scope of practice in acute care. This will allow more skilled nursing professionals to assist in the current staffing shortage crisis. Nursing Crisis Fatigue and the..continued on page 10
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