Survey shows newer nurses are especially impacted by COVID-19, inadequate staffing, and dangerous conditions, and are fleeing the profession
CANTON, Mass. – More than 8 in 10 registered nurses in Massachusetts say in a newly published survey that the quality of patient care in hospitals has gotten significantly worse over the last two years as the COVID-19 pandemic careened into a fragile healthcare system already burdened by profit-driven staffing shortages and high-risk conditions for patients and nurses.
Nurses said they must be compensated better for the stress and pressure they endure, while newer nurses especially decried the lack of staffing and support in “The State of Nursing in Massachusetts,” a randomized survey of Massachusetts RNs conducted March 30 to April 7 by Boston-based Beacon Research. Note that in key places throughout the survey results, newer nurses express how they are especially impacted by poor conditions and plan to leave nursing at high rates.
The survey, released to coincide with National Nurses Week, May 6 to May 12, shows that nurses across Massachusetts are dedicated to their patients and believe in the importance of their practice, but are emotionally exhausted, feel increasingly disengaged and are more likely because of the pandemic to leave the profession or reduce their hours. Email firstname.lastname@example.org for a copy of the survey results and charts.
The percentage of nurses who said this year that the overall quality of care in Massachusetts hospitals has gotten worse (83%) is higher by nearly 30 points than any other year. Additionally, 49% of nurses said the quality of care has gotten “much worse,” with only 3% saying it has gotten better over the past two years.
“I have never seen nurses so demoralized by conditions at the bedside and how difficult it is to provide the kind of care our patients deserve,” said Katie Murphy, a practicing ICU nurse and president of the Massachusetts Nurses Association, which commissioned the survey. “The coronavirus has made it even harder to be a healthcare professional dedicated to safe patient care, but the pandemic alone did not create these problems.
“For many years, our healthcare system has focused relentlessly on profits, executive pay and expansion at the expense of maintaining local services and making sustainable investments in frontline staff and patient care quality,” Murphy said. “Nurses across Massachusetts are calling on hospital executives to improve staffing, pay and benefits to address the nursing profession’s intense stress and help recruit and retain the nurses necessary to provide safe patient care. For National Nurses Week, what nurses really want are healthcare executives to listen to them, invest in them and support them so they can do the work they love.”
Major Challenges Facing Nurses
While the COVID-19 pandemic has exacerbated staffing problems, the issue of understaffing of hospitals is a long-standing crisis created and sustained by the hospital industry’s multi-year effort to increase profit margins at the expense of safe staffing levels and ensuring quality patient care.
Massachusetts has among the highest population of nurses per capita in the nation, yet many nurses refuse to put their license or their patients’ lives on the line under longstanding staffing practices. WBUR reported in February that the state Board of Registration in Nursing showed a 24% increase in licensed registered nurses compared to June 2019 (see graph below). And that was in addition to nearly 12,000 temporary — or travel — nurses licensed during the pandemic.
As Katie Murphy told WBUR and “The State of Nursing in Massachusetts” demonstrates, it’s not a shortage of nurses that the state is facing but rather “a shortage of nurses willing to work under these conditions.”
Survey results related to nurse staffing and time with patients:
- 55% of nurses said understaffing is the biggest obstacle to providing quality care. Lack of appropriate staffing levels is a particular concern of newer nurses, with 68% of nurses with 0 to 5 years of experience saying understaffing is the biggest obstacle they face to delivering quality care.
- The number of RNs who said they do not feel that they have enough time to provide patients with the care and attention each one needs jumped to a record high of 71%, up from 60% last year.
- Among direct care nurses, 71% said their employer did a fair or poor job providing the staffing levels needed to properly care for COVID patients, a 12-point jump in negative ratings from last year.
- 71% report having inadequate time with patients, an 11-point jump from last year.
- Among bedside nurses, two-thirds (67%) reported not enough time with patients. For nurses with 0 to 5 years’ experience this jumps to 92%.
Survey results related to inadequate pay and benefits, other serious problems:
- Almost two-thirds (64%) of nurses said inadequate pay or benefits is a major challenge. This response is up from 48% reporting lack of pay or benefits in 2021 and 27% in 2019 – a 37-point increase in nurses having a concern about pay and benefits over just three years.
- Over the last two-years, most nurses have seen RN positions being left vacant (84%). In 2019, just 50% of RNs saw positions left vacant.
- Nurses report an increase in the use of travel nurses (76%), and an increase in non-permanent nursing staff (68%).
- Nurses have also seen increased use of mandatory overtime (+10 from 2021) and use of on call (+6 from 2021).
“Nurses’ concerns about inadequate pay and benefits represents the high cost of burnout, moral injury and the increase in workplace violence nurses face every day, all exacerbated by the pandemic,” Murphy said. “The recruitment and retention of nurses needed to address these problems and enable nurses to provide quality care hinges on hospital executives investing in their permanent workforce.”
Nurses Assess COVID-19 Employer Response
Massachusetts nurses generally gave employers poor grades when it came to their handling of the pandemic. Except for ensuring the COVID vaccine was easily accessible to staff and providing adequate testing for staff to track infections, RNs rated their employers’ COVID response in the negative.
- Four-in-ten (43%) gave their employer an A or B grade, while a three-in-ten (30%) gave their employer a C.
- More than 8 in 10 direct care nurses rated their employer either fair or poor for the job they did:
- Compensating nurses for their efforts during the COVID crisis.
- Providing adequate time off to deal with the impact of working during COVID.
- Providing the emotional and psychological support nurses need to deal with the aftermath of the pandemic.
- Providing emotional support services.
- 44% of nurses report having been infected by COVID-19.
- 56% of those infected said it was “definitely” or “probably” from their workplace.
The Impact on Nurses and Retention
The pandemic, combined with pre-existing understaffing and workforce problems such as healthcare violence, has harmed nurses and created serious repercussions for industry retention. Despite nurses’ dedication to patient care, they feel exhausted and morally injured.
- Although 95% of nurses surveyed said they always or sometimes look forward to being able to help their patients and 89% always or sometimes feel that the work they do is significant and worthwhile, a similar number (94%) also always or sometimes feel emotionally drained from work, and two-thirds (65%) feel disengaged from work.
- 33% of RNs reported planning to leave nursing sooner than originally planned. Among newer nurses with 0 to 5 years of experience, 37% are planning to leave sooner – the highest percentage of any experience group.
- 25% of nurses said they plan to reduce their hours because of their experience with the COVID pandemic.
- 25% of nurses think they will leave the field of nursing in two years or less.
- Newer nurses, with five years or less of experience, are more likely to leave the profession now, with 25% this year saying they plan to leave nursing within two years, up from 18% in that experience range last year and 10% in 2019.
- Among nurses who said they will leave nursing sooner because of COVID, 99% said that they always or sometimes feel emotionally drained from work and 83% feel disengaged.
The experiences shared by newer nurses in “The State of Nursing in Massachusetts” coincides with recent studies examining the impact of COVID-19 on nurses and especially nurses with fewer years of experience.
- Data analyzed and published last year by Press Ganey. Ganey showed that nearly 30% of registered nurses are at risk of leaving their organization and nurses younger than 35 who have been at their current employer for less than a year are most likely to leave voluntarily.
- A survey released last month by the American Nurses Foundation found that 69% of nurses under age 25 said they have suffered from burnout—more than double of those older than 25 (30%). Additionally, 60% of nurses under age 25 and 57% of nurses 25-34 said they generally felt unsupported by their organization.
What Nurses Say Would Help
Here are some of the many ineffective and often demoralizing ways hospital executives have “thanked” nurses and other healthcare workers during the pandemic: Breakfast sandwiches, pizza, buttons, journals, billboards heralding “healthcare heroes,” granola bars, Hershey kisses and glossy magazine advertisements. In “The State of Nursing in Massachusetts,” nurses were honest about what they want.
- 80% said time off to recuperate
- 74% said financial support
- 41% said counseling services and 39% said support groups
Among those nurses who said they plan to leave the profession within two years, these are the main persuasion strategies that could keep them working as nurses:
- 69% said salary increases
- 53% said enough support staff
- 49% said limits on the number of patients to care for at one time
- 44% said favorable time off benefits
- 41% said pension benefits
“The nursing profession has suffered for many years from a top-down, corporate approach to healthcare that emphasizes financial gain over patient safety and sustainable working environments,” Murphy said. “It is no surprise that nurses feel not merely burnt out but morally injured and exploited by the healthcare industry and are fleeing in large numbers.
“One of the most concerning set of findings from this survey is the devastating impact current working conditions are having on our newly graduated and novice nurses, as these are the nurses who constitute the hope for the future of our profession,” Murphy said. “These results make clear that any efforts and funding expended to increase the pipeline of nurses are doomed to fail unless and until hospital executives ensure the working conditions these nurses need to make them want to stay.”
Additional Survey Details
A majority (62%) of RNs interviewed were not MNA members. Respondents were randomly selected from a complete file of the 150,000 nurses registered with the Massachusetts Board of Registration in Nursing, and geographic quotas were used to ensure accurate representation across all regions of the state. Nurses were contacted through text and the survey was completed online on their phone or computer.
Screening questions were used to verify that respondents were registered nurses working in Massachusetts. Slight age and care setting (teaching hospital, community hospital, non-hospital care) weights were applied to ensure the data accurately matched demographic information available on the statewide list of nurses and the actual breakdown of healthcare facilities across the state.
A total of 462 interviews with Massachusetts nurses were completed as part of this survey. Questions have a margin of error of ±4 (at the 95% confidence level).
Founded in 1903, the Massachusetts Nurses Association is the largest union of registered nurses in the Commonwealth of Massachusetts. Its 23,000 members advance the nursing profession by fostering high standards of nursing practice, promoting the economic and general welfare of nurses in the workplace, projecting a positive and realistic view of nursing, and by lobbying the Legislature and regulatory agencies on health care issues affecting nurses and the public.