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Nurses love their work, but not their workplace

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Hospitals have been struggling to retain nurses. Vicki Good, chief clinical officer of the American Association of Critical-Care Nurses, talks about improving the environment for nurses.

With hospitals struggling to recruit and retain nurses, it’s clear that many nurses are seeking a better work environment.

Nurses haven’t lost their passion for taking care of patients, says Vicki Good, the chief clinical officer of the American Association of Critical-Care Nurses. Good, who took the post last fall, is focused on improving the workplace for nurses.

“What nurses are telling us right now is they love their work, but they don't like the environment, and what's going on in the hospital environment right now,” Good says.

Hospitals have made some strides in filling nursing jobs, but there is much work to do, Good and other healthcare leaders say.

In an interview with Chief Healthcare Executive®, Good discusses the ongoing frustration of nurses, their difficulties with burnout and dealing with violence in hospitals, and steps health systems can take to help their nurses.

“People just don't feel like there's teamwork,” Good says. “They don't feel like there's collaboration. They feel like the communication has gone down. And all of those things have to come together to produce that environment where people want to be there.”

(See part of our conversation with Vicki Good in this video. The story continues below.)

‘Negative scope creep’

Hospitals continue to battle with financial challenges, and healthcare leaders said they’ve had a difficult time hiring and keeping nurses, along with other healthcare workers.

As hospitals have been understaffed in other areas, nurses have picked up extra duties beyond their nursing responsibilities, and that reduces their time with patients, Good says.

While saying hospitals face real challenges, she explains, “What seems to happen is, if a different discipline can't get it done, the nurse is the last one sitting there before that patient, so they are the ones that have to get it done.”

“And so a lot of what I would call negative scope creep has happened, where a lot of things have gotten placed on the nurse's plate to get done,” Good says. “And that's decreasing their ability to do actual nursing care. So, you know, nurses are just crying for the fact that they just want to do what they were trained to do, and they want to be a nurse. They want to be able to spend time with their patients.”

Nurses will help with housekeeping and emptying trash because “the room still has to be clean,” Good says. Nurses may also help deliver medication if the hospital is short on pharmacy technicians, or assist with breathing treatments if there’s a shortage of respiratory therapists. They’ll answer the phone calls coming to their units because “most hospitals have eliminated secretaries,” Good says.

“It’s all those little things that you don't think about that start to add up to a lot,” Good says.

Nurses, especially those in critical care, want more time to focus on patients, and more time to help the families of patients.

“Those families are suffering,” Good says. “They're going through the worst day of their lives, oftentimes, especially if it's an unplanned critical illness, which most are. You're all of a sudden finding yourself in a very difficult position as a family having to make tough decisions.”

Nurses are willing to pitch in and help, but they don’t want to do it at the expense of their patients.

“It’s not that we're not team players, and we don't want to do whatever it takes to take care of the patient,” Good says. “But we want to make sure we've got the right people to do the right job at the right time.”

Some leave quickly

With experienced nurses leaving the bedside, newer nurses have fewer role models to help guide them. ECRI, the patient safety organization, cited the challenges in bringing in new clinicians as the leading threat to patient safety in a recent report.

Some younger nurses are leaving their jobs after a relatively short time. While some are moving on to advance their career, some can’t handle the work environment, Good says.

“The scary part is, what we're seeing is we have plenty of nurses coming in. But they're working for a year or two years,” Good says.

Some experienced nurses who are overwhelmed often feel too drained to add the responsibility of training newer nurses on the job. Some of those veteran nurses are choosing not to stick around.

“You’ve got all these new people coming in,” Good says. “The people with five to 10 years of experience are tired, and they're just exhausted from having to reorient so many people, because we have so many new grads that aren't sticking with it. So it does become this conundrum because they're tired. They don't want to precept but we've got new talent that we need to have strong mentors for.”

Burnout and violence

Particularly since the emergence of the COVID-19 pandemic, nurses have said their work has taken a toll on their mental health, including stress and burnout. Good says that it remains a significant problem.

Some nurses are reluctant to get help for mental health struggles, and Good says too many see seeking assistance as a sign of weakness.

“They don't feel like they should have to ask for help,” Good says. She adds that she’s encouraged that nurses are forming peer support groups, which can help nurses who need to talk with someone who understands their difficulties.

Good says she’s encouraged that more nurses are pushing health systems to develop solutions for burnout and staffing shortages.

“I think that is huge, because when nurses are saying, let's talk solutions, instead of all the problems,” Good says.

Many nurses also routinely encounter violence and aggressive behavior, which has become common in hospitals.

Much of the violence is in emergency department behavioral health units, she says. But Good also worries about those in medical-surgical units, which often don’t have the same security and resources. Even in intensive care units, nurses encounter difficult situations with the family members of patients.

“This is still a very serious issue,” Good says.

How hospitals can do better

Some hospitals are taking useful steps to help nurses, Good says.

More hospitals are moving to flexible scheduling, giving nurses options other than 12-hour shifts. More flexible schedules can help hospitals retain younger nurses with smaller children, and some longtime nurses who would like to stay on the job but may be weary of working 12 hours a day.

“Healthcare has always been very rigid,” Good says. “You either work 12 hours, or you don't work at all. And we've got to learn how to be more flexible to meet those demands of the younger generation. So there's lots of health systems that are starting to play with scheduling.”

“It's starting to spread. But I wouldn't say it's widespread yet. You know, old habits die hard,” Good says.

But she adds, as more health systems find success with flexible scheduling, “I think it's getting the attention of others. And I think we're going to see a lot more joining that practice.”

Hospitals and health systems are going to have more success even if they simply have more meaningful conversations with nurses about improving the work environment. Good suggests that such discussions should be occurring throughout hospitals. Many doctors are also thinking about a career change due to stress, according to a recent athenahealth survey.

“The issues that physicians are facing with the work environment are the same issues that nursing is facing with the work environment,” Good says. “And so we've got to come together as a team to address that.”

The American Association of Critical-Care Nurses is also aiming to play an important role. The association is launching the Healthy Work Environments National Collaborative, an initiative with teams at more than three dozen hospitals to create better workplaces and improve the retention of nurses. The program is slated to run into 2026.

“It's really going to be something … we're hoping to change a lot,” Good says.

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