As Staffing Problems Increase, RN Job Satisfaction PlummetsAugust 4, 2022
A majority of registered nurses (RNs) surveyed said they had appropriate staffing levels on their unit less than half the time, according to a new study.
“That should be scary to a lot of people,” Beth Ulrich, EdD, RN, of Cizik School of Nursing of the University of Texas Health Science Center at Houston, told MedPage Today.
Additionally, the survey of more than 9,000 nurses, which was published in Critical Care Nurse, found that just 24% of respondents said their units had the right number of nurses with the right skills and knowledge more than 75% of the time, compared with 39% in a 2018 version of the study.
The 2021 survey from Ulrich and colleagues is the fifth in a series focused on healthy work environments produced by the American Association of Critical-Care Nurses (AACN), beginning in 2006.
Perhaps one silver lining is that of the nurses who said their units were appropriately staffed more than 75% of the time, 49% reported that they did not intend to leave their current position in the next 3 years.
However, “[a]cross the board, all the things we measure about the health of work environment declined,” Ulrich said, referencing AACN’s six standards of a healthy work environment — appropriate staffing, skilled communication, true collaboration, effective decision-making, meaningful recognition, and authentic leadership.
A 2019 meta-analysis found that healthier work environments are associated with decreased odds of patient mortality, adverse hospital-related events, and poor safety outcomes. And a 2018 study found that nurses with healthier work environments had less burnout, job dissatisfaction, and “intent to leave.”
There are good data suggesting “if you bring new nurses into an unhealthy work environment, they will go right out the back door,” Ulrich said.
So hospitals can spend a lot of money recruiting new nurses, but unless they pay attention to the work environments, those nurses are not going to stay, she added.
“Nurses don’t like to work short-staffed,” Ulrich said. “That’s one of the things that just breaks a nurse’s heart.”
“They leave work, and they’re mentally calculating … ‘Here’s all the things I wasn’t able to do today,'” she said.
Other worrisome findings from the new study:
- Only 40% of nurses reported being “very satisfied” with being an RN, compared with 62% in 2018
- Two-thirds of nurses said they intend to leave their current position in the next 3 years (compared with 54% in 2018), and 36% of those plan to leave in the next year
- Fewer than half of participants in 2021 agreed with the statement, “My organization values my health and safety,” compared with 68% in 2018
Of 7,399 RNs who reported at least one incident of abuse in the prior year, 65% reported verbal abuse, 28% reported physical abuse, 23% reported discrimination, and 13% reported sexual harassment
Among AACN’s healthy work environment standards assessed in the survey, the “most concerning” was appropriate staffing, Ulrich and co-authors noted.
There was a decline from 2018 to 2021 in the ratings of all items in the Critical Elements of a Healthy Work Environment 4-point scale (higher scores signify greater agreement), but scores related to the statement that “RN staffing ensures the effective match between patient needs and nurse competencies” fell from 2.66 in 2018 to 2.33 in 2021 — the lowest rating in all of the four previous AACN surveys.
Scores for another statement focused on nurses’ decision-making power — “RNs have opportunities to influence decisions that affect the quality of patient care” — also fell from 2.91 in 2018 to 2.56 in 2021, erasing gains made in this areas between the 2013 and 2018 surveys, the authors noted.
And scores related to an item measuring nurse leaders’ commitment to the concept of a healthy work environment fell from 2.79 in 2018 to 2.50 in 2021.
The highest rates of communication and collaboration were seen between RNs and other RNs, then RNs and physicians, then RNs and frontline administration, and the lowest rates were seen between RNs and administration.
As for “meaningful recognition,” nurses continued to report that recognition is most meaningful when it comes from patients and their families, as prior AACN surveys found.
While the negative results can be “overwhelming,” Ulrich said, the survey also provides direction for improving work environments.
Among those who intend to leave nursing, for example, the top factors that nurses said could cause them to reconsider were a higher salary and benefits (63%), better staffing (57%), and more respect from administration (50%). In 2018, these were cited by 46%, 50%, and 42% or respondents, respectively.
Also, when asked whether their units had begun to implement AACN’s six standards of a healthy work environment, 29% of survey participants said units were “well on their way” or “fully implemented,” and 71% said that implementation was “not at all” happening or “just beginning.”
And survey participants in units that had implemented the standards were half as likely, at 26%, to report an intention to leave their position in the next 12 months, compared with nurses working in units that had not implemented such standards, at 52%.
“Without improvements in the work environment, the results of this study indicate that nurses will continue to exit the workforce in search of more meaningful, rewarding, and sustainable work,” Ulrich and co-authors wrote. “It is time for bold action, and this study shows the way.”
In all, 9,862 nurses responded to the survey, and 9,335 met the study criteria of being currently practicing RNs. Participants hailed from all 50 states and the District of Columbia, and 112 lived outside the U.S.
The mean age of participants was 46.5 years and the mean experience level was 17.8 years. A total of 91.6% reported working in acute care hospitals, 78.3% in direct care, and 19.4% in a Beacon unit (i.e., recognized with an AACN Beacon Award for Excellence for employing evidence-based practices).
Half of survey participants said they cared for patients who had or were suspected of having COVID 50% or less of the time, and the other half reported caring for those patients more than 50% of the time.
For the 2021 survey, the researchers expanded the survey to include RN members and “constituents” from AACN’s database — a “convenience sample.” The authors used a shorter version of the original survey tool, with 12 items as opposed to 32, and used emails, website promotions, and publications to invite participation.
Study limitations, the authors noted, included that because respondents were not randomly selected, participants may not reflect the RN population and the results may therefore not be generalizable.
Funding for the study was provided by the American Association of Critical-Care Nurses.
Ulrich and co-authors reported no conflicts of interest.