Nursing is a profession chosen by exceptional individuals who adapt to any challenge. Yet, over the last four years, this well-earned skill has progressed into complex hospital system demands to over-perform their role – AND the roles of the entire interdisciplinary team. The COVID-19 pandemic forced several healthcare professionals into retirement, virtual positions, or other careers entirely – leaving a gap in available staff for nearly all hospital positions. The nurse is the one person responsible for each patient’s care coordination. Why not have them perform the tasks that other departments are too short-staffed to complete? Why not praise the nurse with heroism to convince them to work in high-stakes departments while removing the lifeline of assistance and injecting impossible expectations? What could go wrong?
- Why are nurses leaving the bedside?
- What Is Hospital System Failure?
- What Can Hospital Systems Do to Improve Nurse Satisfaction in the Workplace?
Why are nurses leaving the bedside?
There are several contributing factors as to why nurses are leaving the bedside. Moral distress is the leading cause of nurses ending a career they have worked immensely hard to reach. The choice is obvious when faced with the decision to provide poor quality healthcare that puts them and their patients at risk or leave the bedside. It comes down to hospital system failure. Nurses enter their profession with the idea that they will help others, relieve pain, and better lives. However, once they enter the workforce, they are drowning in the reality that this dream is witnessed few and far between. Workforce obstacles create walls they cannot move, while hospitals choose profits and CEO pay raises over quality patient care, safe working conditions, and fair employee pay. If healthcare organizations’ priorities do not shift toward empowering their staff and patients, nurses will continue to leave, and the staffing crisis will become a true nationwide emergency. Nurses want to work in a facility that takes care of their well-being so they can focus on providing the best possible care for their patients. Everyone has a right to a safe, fair, and positive work environment. Nurses are leaving the bedside because the system is treating them as disposable machines instead of the compassionate human beings they are. The system is failing us – and we know it.
What Is Hospital System Failure?
Hospital system failure, in nursing terms, represents the failure of a hospital to implement and enforce employee rights, provide workplace safety or maintain quality patient care with safe nurse-to-patient-ratios within departments. Hospital system failure includes those who deny improved working conditions for their staff, enforce disciplinary policies over a culture of safety, and silence those who express concerns. System failures are the root cause of nurse burnout, dissatisfaction, and hopelessness. Nurses take pride in providing outstanding patient care. Yet, subsequently, the need for more support from their organization makes it impossible to reach the patient care goals they strive for. Healthcare workers feel replaceable, undervalued, and abused by the system.
What can we do to create real change against a system that thrives on indifference? Implement hospital policies that prioritize breaks, improve employee morale, enforce safety, and establish trustworthy teams within departments.
What Can Hospital Systems Do to Improve Nurse Satisfaction in the Workplace?
Hospital Systems can significantly improve their organization’s work environment if they focus on trust, prioritize the team’s needs, support workplace safety protocols, ensure employee rights, and actively listen to feedback from staff while maintaining open communication and honesty in decision-making. Employees who feel heard, valued, and cared for will become committed to their profession and empowered to live up to their organization’s values and standards. An employee who feels unsupported and voiceless will reach burnout at an astronomical rate, exhaust all compassion toward patients and team members alike, and become consumed with moral distress until the day they quit. What can improve work conditions and save the healthcare workforce from moral distress and immanent burnout?
1. Be a Trustworthy Leader
Trust is the foundation of a comprehensive team. Strengthening the trust and cohesion of coworkers, management, and upper leadership greatly influences nurse satisfaction, creates belonging, and builds fulfilling relationships. Unreliable leadership creates a disaffiliation between employee and employer. These feelings of division lead to hostile work environments, resentment, anger, and disloyalty to a department, organization, or career. To gain trust within a team, you must first listen to their concerns and then take productive action toward improvements. A leader focusing on empowerment over punishment will embody the necessary characteristics to organize resolution and optimize change. Nursing is a career filled with anxiety, stress, overwhelming workloads, traumatic events, and mental fatigue. Without trust in their leadership, staff will consider the ease of leaving before the struggle to be heard.
The best leaders are willing to voice the need for change regardless of the anticipated reaction from those above. CEOs praise quiet leaders for their lack of disruption, but staff resent them for their lack of a spine. If you fear for your job because you spoke up against a system flaw, what does that tell you about the organization itself? Developing supportive efforts for healthcare workers starts with voicing the needs of frontline workers and fighting for those needs to be met with compassionate change.
2. Prioritize Lunch Breaks
Studies conducted on the advantages of regularly enforced breaks and the prevention of acute fatigue among nursing staff on 12-hour shifts showed a benefit in quality performance and a decrease in stress among staff. Acute fatigue in the workplace can quickly turn into chronic fatigue outside of work, therefore eliminating recuperative measures by the individual staff member and continuing low mental functioning during the following shifts. We cannot simply pretend that work stress does not carry over into our everyday lives. We cannot sit back and say breaks are for weak nurses who can’t handle the demands of the job they signed up for. It is inhumane to continuously expect nurses to skip lunch or “eat at the desk” because the “floor is too busy.” This is an unrealistic standard to hold any human to and highlights the need for a break nurse in every department. Nursing is a job that demands high mental functioning to keep people safe and alive. Even if individuals are not physically exhausting themselves, they are mentally exhausted by constant prioritization, critical thinking, and evaluative decision-making. If you want to keep your staff healthy, happy, and working as a team – create a team that cares about one another enough to work together toward regular uninterrupted breaks – or face the consequences of low morale, irritability, and indifference of your staff members. One cannot care for others before first caring for themselves – but there needs to be trust that those in positions to help will provide enough support to do so. A nurse running on fumes cannot maintain the energy to function as the machines they are too often treated like.
Providing a relaxing environment to take these breaks is just as crucial as getting the break in the first place. An employee break room should not be a closet or hallway space. It must be a room with closed doors, adjustable lights, a fridge, a sink, a microwave, a table, and an area to rest comfortably. Creating an area your employees will enjoy is easy.
Five recommendations managers can do to improve break-room experiences:
- Match the number of available tables and chairs to the number of employees taking breaks simultaneously – ensure employees have space to sit comfortably.
- Install lockers, hooks, and tables for employee coats, work bags, and other belongings.
- Provide comfortable chairs or couches – a massage chair is a great option, too.
- Provide low-light options for overstimulated employees who need a more calming environment to recuperate.
- Place the positive feedback and employee events board in plain view for frequent reminders of outstanding accomplishments and what events they can look forward to outside of work. Avoid discouraging department data boards in rest areas – these are better utilized in huddle areas, department binders, or emails – Places the employee can review during work time, not break time.
3. Promote Co-worker Morale Outside of Work and Approve PTO
In high-stress professions like nursing, reenergizing outside of work is essential to employees’ well-being and mental health. Healthcare workers perform crucial patient care, work extended shifts, and run the risk of mentally and emotionally draining themselves from traumatic experiences during work time. On top of the demands of their profession, nurses must maintain a work-life balance, relationships, families, friendships, and hobbies. When an individual feels unsupported in one area of their life, the motivation to enhance other areas dwindles. Team-centered environments need to embody a connection of trust, camaraderie, and understanding of one another to maintain cohesive collaboration. Employers should organize an event committee within their departments, and as an organization, to encourage employee bonding outside of the work environment. Building a strong team starts with human connection.
Inclusive team-building event suggestions:
These suggestions are dependent on the areas in which you live and what is readily available to most hospital staff. We are not suggesting that the hospital pay for each or any of the coworker events, but it is strongly encouraged to have a committee, events information board, or group social media page available for staff to use to communicate inclusive events. It’s imperative that coworkers take the time to learn about each other’s personalities outside of work, as doing so significantly impacts their understanding of each other’s workplace characteristics. Identifying the strengths of co-workers brings loyalty and security in an unpredictable environment. The better you know someone, the more you can trust and rely on them. Coworker group events are not just about having fun (although that is important). They are about building deeper connections, relieving stress, and bonding with people who face the same professional struggles. Belonging supports healing and allows others to freely express the mental health challenges brought about by the job – team-building events can save lives and prevent isolation, loneliness, and suicidal ideation in healthcare workers. We are one team; be present for one another.
Another necessity to improve the mental well-being of nurses involves the regular approval of PTO requests. Nurses drain themselves in stressful environments. Many of them feel shame for requesting off or calling in sick because they know it means the team will be short-staffed again. Management that continuously guilts nurses for requesting time off creates resentment and disloyalty to the organization. People earn their PTO hours, and they have a right to use them. The hospital will be short-staffed with or without them there, but they deserve to utilize their hard-earned time off as they so choose – without the guilt and shame from management or other staff members. To keep your staff alive – approve their PTO.
4. Fully Staff Departments and Support Safe Nurse-to-Patient Ratios
Appropriate nurse staffing improves patient outcomes, limits medical errors, and creates a safe work environment. Comparatively, nurses who continuously work short-staffed are exposed to chronic fatigue, adverse patient care events, and burnout. These consequences are preventable.
The states that have successfully passed nurse-to-patient ratio laws have developed staffing committees composed of a minimum of 50% clinical employees who monitor staffing needs and implement adjustments promptly. These committees assist in developing a plan that works with the frontline staff, supervisors, and patients. They work directly with their state’s board of nursing and are required to produce staffing data upon request or annually, depending on the state’s law. This is meant to hold hospitals accountable and eliminate unsafe patient assignments while supporting departments in greater need. The lack of appropriate nurse-to-patient ratios is a critical component of the nurse shortage crisis as a system failure that resulted in over 10% of RNs with active licenses leaving nursing between 2020 and 2022. Nursing organizations are now fighting to implement safe nurse-to-patient ratios on the federal level to prevent hospital industries from overloading nurses with horrific patient care loads nationwide.
5. Follow a Full-Capacity Action Plan
Another effective tool to suppress staff overloading is establishing a full-capacity action plan. These plans begin with overcrowding in the emergency department and follow the chain of admission into the inpatient setting. The plan must include criteria for emergency department diversion protocols in which ambulances must bring their patients to an alternative nearest hospital unless the patient is appropriate to wait in their waiting room and follow triage standards of care. Diversion is used in emergency departments when hospital resources to effectively care for patients are completely exhausted. In this instance, no beds (including hallway beds and chairs) are available to intake new EMS patients, and on-call or overtime staff are unavailable to assist with the high acuity overload. Diversion creates the opportunity for ED staff to maintain quality patient care and reduces the chances of medical error in resource-lacking situations.
The full-capacity action plan includes the necessity to move emergency department boarded (ED inpatient hold) patients into inpatient hallway beds to free up ED resources and space. Data shows that patients who are admitted without available inpatient rooms prefer to be held on the inpatient floor overflow and hallway beds over the emergency department. The ER remains chaotic and loud 24/7. The lights must remain on regardless if patients are trying to sleep in hallway beds. Ambulances are in and out frequently, alarms are heard constantly, and people are moving about the hallways endlessly. Inpatient floors have a less chaotic, more peaceful, and more private hallway experience comparatively.
6. Implement Zero-Tolerance Policies Against Workplace Violence
Acts of violence are the third-leading cause of occupational injuries in the United States, according to the Bureau of Labor Statistics Census of Fatal Occupational Injuries (CFOI). Healthcare Professionals are among the top 10 highest-risk occupations for experiencing verbal and physical violence, assault, threats, harassment, and intimidation. The Occupational Safety and Health Administration (OSHA) recommends the best way to limit workplace violence is for employers to implement and enforce policies toward safety. OSHA suggests, “One of the best protections employers can offer their workers is to establish a zero-tolerance policy toward workplace violence. This policy should cover all workers, patients, clients, visitors, contractors, and anyone else who may come in contact with company personnel.” These zero-tolerance policies are important for establishing which behaviors are never acceptable in the workplace and to send a message to those who break the policy that there will undoubtedly be consequences for their poor behavior. Outlining what behaviors are considered misconduct and the consequences of those violations is necessary for liability purposes and setting clear expectations for staff.
Employers can keep their staff safe through the development of multidisciplinary committees that focus on reducing violence in specific workplace scenarios. These committees must include direct patient care staff who participate in the organization’s safety policies and are aware of adjustments that need to be made. They can be used as part of the investigative team when misconduct allegations are initiated. The investigating team members should exclude those who have intimate friendships with those involved in the misconduct report. Management and supervisors must remain neutral and look at all information given from both sides of the report.
Healthcare systems must establish a baseline of safety procedures nationwide to include:
AVADE self-defense training and CPI de-escalation trainings are additional safety measures to protect the wellbeing of your staff, prevent workplace violence, and maintain an organizational standard for self-defense that will assist in backing your staff members if ever brought to court.
Improving a toxic work environment is accomplishable by taking the steps toward employing trustworthy management, prioritizing staff breaks, increasing co-worker morale, maintaining fully staffed departments, conducting full-capacity action plans, and keeping employees safe with a strict and enforced zero-tolerance policy. The lives of patients and healthcare workers depend on these strategies. Nurse satisfaction is contingent on hospital system overhauls prioritizing employee wellness, safety, and humanization. Nurses are not machines, and patients are not profits; They are people who deserve to be treated with respect. Let’s create an environment where that is a realistic possibility.
