These days when a nurse sneezes, the surgeon, hospital, and patient, catch a cold.
Recent data indicate that from 2020-2021, the number of registered nurses decreased by more than 100,000—the biggest drop in over four decades.1
With nurses representing nearly 50% of the health workforce2, this has a cascading effect in the form of stress on the remaining staff, canceled or postponed surgeries, and hospital revenue.
“It’s pretty unsettling when surgeons are being told, ‘You can’t operate on your normal schedule next week because we don’t have enough nurses available,’ says Alexander Vaccaro, M.D., Ph.D., M.B.A, president of Rothman Orthopaedics Institute in Philadelphia. “When this happened to me last week, the hospital was eventually able to incentivize several nurses to come in early and participate in the procedures. In addition—and this is a big part of it—our workplace tends to be an unintimidating environment where everyone feels part of the team.”
But clearly, says Dr. Vaccaro, scrambling for nurses is not a long-term solution.
Look Back to Go Forward
“As a first step, we have to assess and streamline the nursing pipeline. Are we truly doing things that get people interested in nursing? Are we establishing programs in high schools indicating that nursing is a valued profession that deserves support?”
“Secondly, we have to address any issues getting in the way of nursing education. What can be done about the lack of nursing educators? Is there sufficient funding to support students? Then we have to ensure that the pay is competitive for a given geographic area. It is disheartening for a nurse to find out that visiting nurses two miles away are being paid more than they are.”
Until we make a substantial dent in this problem, states Dr. Vaccaro, patients are waiting and suffering.
On the other side of the country, things aren’t much better, says Jeffrey Wang, M.D., chief of the Orthopaedic Spine Service and co-director of the University of Southern California Spine Center.
“Our facility has lost roughly 30% of its nurses since the start of the pandemic. The traveling nurse situation has exacerbated the issue as our existing nurses routinely get offers to become traveling nurses—and on some occasions they go right down the street!”
Consistency of Care
“There are a lot of new faces in the OR these days and you don’t know what they know. Because these new nurses come in at different levels of experience, it can be a bit of a hindrance to care. And even if they have spine experience, for example, they still have to learn our facility’s way of doing things. As a result, we have had to shift a lot of time toward getting people fully trained.”
Ortho Pods = Teamwork
Dr. Wang: “We have now increased pay and improved working conditions, so things are easing up a bit at our institution. I would say that what has really made a difference is that we have established ‘pods,’ or teams so that when new faces arrive, they are assigned a pod and go through orientation with their group. The administration got on board with this because it was evident that morale was low because of the constant barrage of new faces. Everyone could see the difference between working with your ‘regular’ nurse and a new face, i.e., the former person could just about read our minds!”
“If there is any benefit to this shortage,” adds Dr. Wang, “it is that all the non-nursing staff is realizing the critical work that nurses do…we truly have a new appreciation for what they bring to the table. I think our workplace is now a more collegial environment. On a personal note, I have just tried to be more patient and appreciative of the nurses, as I am dealing with new faces and am constantly in a training mode with new personnel.”
Word must have gotten around about the nicer, more supportive atmosphere, says Dr. Wang. “We were thrilled to just rehire a former nurse to head up our spine nursing pod.”
Nicholas Piuzzi, M.D., director of the Cleveland Clinic Adult Reconstruction Research (CCARR) and Musculoskeletal Research Center (MSRC) at Cleveland Clinic in Ohio, says that what we are seeing is a perfect storm of an aging population, the pandemic, and retiring nurses.
“It’s vital that we work with nursing schools to open training slots and increase the base. In addition, we need to determine what can be done more efficiently, when we can use telemedicine, and what tools might give nurses the ability to work at the top of their licenses. Regarding telemedicine, for example, we have to examine how we get reimbursed—sometimes it’s hard to get reimbursed for a phone call. As a healthcare system we can do better.”
Physicians Alone Won’t Cut It
“As a society we need to recognize the tremendous value in nurses—retaining them in a supportive workplace should be a top of priority for the healthcare system. Physicians alone can’t do anything. It’s like flying a plane—you need the whole team—engineers, maintenance workers, people who clean plane, those who sell the tickets, etc.”
We should widen the lens, says Dr. Piuzzi, concerned about other shortages in the healthcare system. “We have a stagnant number of orthopedic surgeons. The training takes so long that in the meantime, we have to make our services more efficient to be able to better execute our daily tasks. We need a dedicated and creative task force working on this because better benefits and/or higher wages only go so far.”
“We need to come together and recognize that times are changing, and we must evolve along with them.”
Dr. Piuzzi is onto something. While for years there was a budding recognition of the importance of mental health, the pandemic has brought that lesson home in virtually all professions.
A May 2022 survey of 2,500 nurses found that on a scale of 1 (poor) to 10 (excellent), nurses rated their mental health and well-being at an average of 5.8, compared to an average of 7.8 before COVID-19. An alarming 1 in 10 nurses reported they had had suicidal thoughts since the beginning of the pandemic, more than twice the incidence of such thoughts in the general U.S. adult population.3
Research has found that nurses are less likely to reach out for assistance for issues such as depression and anxiety.4 Fortunately, the National Institute for Occupational Safety and Health is reaching out to them, with a new Health Worker Mental Health Initiative. In part, their program aims to:
- Raise awareness of mental health issues, including the risk of suicide and substance use disorders
- Eliminate barriers to accessing care
- Identify workplace and community supports for health workers
- Reduce stigma related to seeking and receiving care for mental health
- Identify and improve data, screening tools, trainings, resources, and policies to address health worker mental health5
Given the scope of the problem, real change will take time. In the meantime, say Drs. Piuzzi, Wang, and Vaccaro, kindness and genuine staff appreciation can go a long way.
References:
- https://www.healthaffairs.org/do/10.1377/forefront.20220412.311784/
- https://nightingale.edu/blog/nursing-shortage-by-state/
- https://www.statnews.com/2022/07/21/health-care-industry-lax-approach-nurses-mental-health/
- https://www.wolterskluwer.com/en/expert-insights/supporting-nurses-with-substance-use-and-mental-health-issues
- https://www.cdc.gov/niosh/newsroom/feature/health-worker-mental-health.html
