Where have all the nurses gone?

Healthcare workers have had enough.

After enduring years of stressful and heartbreaking work through the Covid-19 pandemic, healthcare workers had hoped that this crisis would motivate the changes we desperately need to fix our health system, only to find out that nothing meaningful has changed.

Now, they’re quitting in droves. In 2021, healthcare and social services workers quit at a the highest rate in twenty years, according to data from the Bureau of Labor Statistics. At the peak in November 2021, 3% of these workers quit their jobs. While the quit rate has slowed somewhat, in October 2022 the quit rate was 2.5%, still higher than any month before 2021.

What’s driving this trend?

It’s not a secret what factors are behind this healthcare worker exodus. In surveys of nurses and reports from healthcare worker unions, many of the similar problems come up.

Staffing shortages are a huge concern. When nurses are short-staffed, the number of patients they are caring for at a time grows, which makes it increasingly harder for workers to give patients the care they need. In a 2022 survey of nurses in Massachusetts commissioned by the Massachusetts Nurses Association, more than half said that understaffing was their biggest obstacle to delivering quality care. Staffing problems create more burden for remaining nurses, leading to more of them quitting, which exacerbates the problem. It quickly becomes a downward spiral.

Workplace violence is also a key issue. High tensions and reduced staffing during the pandemic were conducive to unchecked violence against healthcare workers. In an online survey of 373 nurses working in hospitals, 44% reported experiencing physical violence and 68% experienced verbal abuse from patients in the first few months of Covid-19. From 2019 to 2020, the rate of violence in hospitals increased by 25 percent in one year alone, according to data from the Bureau of Labor Statistics, as reported by the AFT Nurses and Health Professionals union.

“There’s no point in staying in nursing if we’re expendable.”

Reese Brown, former travel nurse, NBC

The issues caused by understaffing and workplace violence are exacerbated by a widespread feeling from healthcare workers that they aren’t being heard or appreciated. In many cases, the experience of working through the pandemic and watching patients and coworkers die has left nurses traumatized, but hospitals have not done enough to address this moral injury. Hospitals’ efforts to make healthcare workers feel appreciated, like pizza parties or rock-painting activities, can feel tone-deaf when not accompanied by real policy changes that improve their work situation.

Proposed reforms

To address these issues, healthcare workers and unions have proposed a variety of solutions including:

• Support legislation to protect healthcare workers from violence, such as the “Safety From Violence for Healthcare Employees Act“;
• Ensure that healthcare workers are protected from infectious disease and given the PPE they need to do their job safely;
• Create safe staffing requirements to ensure appropriate patient limits for nurses and protect patient safety;
• Conduct targeted outreach and coordinate educational efforts nationwide to fill shortages in the regions most in need;
• Provide affordable access to training and expand student loan forgiveness programs to remove barriers to training, and;
• Create apprenticeships, bridge programs, and training programs within hospitals to fill shortages quickly, where possible.

Fulfilling our promise to healthcare workers

If nothing is done, the shortage of healthcare professionals in the U.S. will only get worse. A recent report from McKinsey estimates that by 2025 we could have a shortage of between 200,000 and 450,000 nurses nationwide.

In 2020, we anticipated the widespread loss of healthcare workers and recommended that we offer a “GI Bill” of sorts for health professionals, to address their long-held concerns about mental health, safety, and administrative burden.

“In order to retain health professionals after this epidemic, we must do more than recognize their sacrifices, or address their current anger. We must answer their long-held concerns—and involve them in charting new policies and ways of keeping them healthy enough to tend the sick.”

Judith Garber, Shannon Brownlee, & Vikas Saini, Zocalo Public Square

Such a “GI Bill” is needed now more than ever. If we want to have a working healthcare system three years from now, we have to listen to what healthcare workers want and give them a voice in creating the policies that shape their work.