Shortages, stress, and violence: Nurses aren’t seeing progress in the workplace

Many nurses face a vicious cycle.

Because of shortages of nurses at many hospitals, nurses are battling stress and burnout, says Jennifer Mensik Kennedy, president of the American Nurses Association. And those difficult working conditions are driving more nurses to consider career changes.

With staffing shortages, nurses have more demanding workloads, and it’s wearing on them, Mensik Kennedy tells Chief Healthcare Executive®.

“If you're in urban settings, you're feeling the shortage, but not as much as you are in those rural settings,” she says. “And so we’re still hearing from a lot of nurses in rural areas that the shortage, of course, feels like it's getting worse. The stress of everything that's going on, well-being, workplace violence makes the feeling of turnover even greater.”

“So it feels like nurses are having issues continuously, and we're not really making a lot of headway on that,” she says.

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

• Read more: Nurses are making a ‘desperate cry’ to fix their work environment

Violence across the board

The Health Resources & Services Administration has projected a 10% shortage of registered nurses by 2027. More than 138,000 nurses have left the workforce since 2022, and 40% of nurses surveyed said that they are thinking of leaving by 2029, according to a report released last month by the National Council of State Boards of Nursing.

Many nurses are frustrated with facing threats, abuse and physical assaults on a regular basis. Emergency nurses say violence has risen in recent years, with more than half saying they’ve been assaulted or threatened in the past 30 days.

The spate of violence isn’t improving, and it’s playing a big role in the stress on nurses, and why some are leaving, Mensik Kennedy says.

“Nurses are more likely to be abused or have an incident than police officers or correctional officers, and 75% of workplace violence is happening in healthcare settings,” she says. “And I wish I had an understanding of what's going on in the public.”

“People are coming in angry, frustrated with the system, and nurses are getting the brunt end of that stick, of that frustration with our overall healthcare system. So, you know, we really do need to focus in and hone in on solutions, because that just further impacts turnover and the stress that nurses are feeling in the work environment,” she says.

While emergency nurses are most likely to be attacked given the volume of patients they face, nurses in all areas of the healthcare system are being assaulted.

“Whether it's in maternity wards, it’s in outpatient clinics, home care agencies, it's just across the board. So there's really not one area that's exempt from it,” she says.

The American Nurses Association continues to back federal legislation to give nurses and other healthcare workers more protections, similar to those working in the airline industry. Nurses have supported bills that would call for greater penalties for those assaulting healthcare workers. They’ve also pushed for the Occupational Safety and Health Administration to require hospitals and health systems to develop strong violence prevention plans.

While the House of Representatives has passed legislation to offer more protection for healthcare workers in the past two congressional sessions, those measures have stalled in the Senate despite considerable bipartisan support.

Some hospitals have developed stronger measures to protect nurses and other healthcare workers. While the American Nurses Association continues to make their case for more federal protections, Mensik Kennedy says hospitals and health systems must do their part to curb violence and reduce burnout.

“I think it's important, outside of federal and state legislation, for organizations to bring in services as well, to help have those conversations, to be able to help inform their managers, so the managers have the tools they need to work with their staff as well, to help do what they can,” she says. “And so this isn't just a one-prong approach. It really is going to take legislation, regulation and evidence-based practice to decrease this workplace violence and the issues and the well being stress that we have.”

Staffing matters

Hospitals and health systems that are looking to improve their work environment for nurses, and bolster their chances of retaining good nurses, need to look at their staffing levels, Mensik Kennedy says.

She acknowledges that it’s not easy with potential reductions in federal aid for hospitals and uncertainty in the economy.

But she said better staffing provides a better work experience for nurses and better patient care. Nurses will be able to talk more with patients and can help provide a better patient experience, and could reduce tension that leads to patients getting frustrated and hostile toward nurses..

“Giving nurses the time that they need to spend with patients, I think that will drastically also reduce those incidents because patients feel heard,” Mensik Kennedy says. “Patients will feel taken care of. And nurses will know that they're providing better care, because it's not just about passing medications or fixing a bandage, right? It's about listening and sitting there and being there for people.”

“I think that return on investment is priceless, because then you have reduced turnover, you have happier nurses, better patient satisfaction. So it really is a really holistic approach,” she says.

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Medicaid concerns

Nurses are worried about the prospect of reduced funding for Medicaid. House Republicans have introduced a plan that analysts say would likely result in states offering coverage to fewer people.

With fewer people getting covered, Mensik Kennedy says she’s worried that more people will arrive in hospital emergency departments for treatment. She’s also worried that more people will arrive with more serious problems due to delaying care.

“We're going to see people go back to getting treated way too late,” she says. “And it's a much more costly system when we have people show up to the emergency room with advanced stages of cancer, or advanced stages of diabetes, because they couldn't get taken care of because they didn't have the resources that they need.”

Some hospital groups said the changes in Medicaid funding could add to the cost pressures on rural hospitals and safety net hospitals, and could cause some to close. Hospitals will be providing more care to those with no ability to pay, and that could push some past the brink.

Mensik Kennedy worries about hospitals being pushed to the brink with reduced Medicaid coverage. And she worries about the impact on nurses.

“There'll be nurses who will lose their jobs if we cut Medicaid,” she says.