New survey results from the North Carolina Nurses Association (NCNA) show the North Carolina nurse population is increasingly facing severe challenges on multiple fronts, with little reason for optimism in the short term. The pre-pandemic shortage of nurses willing to work at the bedside is worsening, workplace violence incidents continue to rise at an alarming rate, and various factors are feeding into unsustainable levels of burnout.
“We cannot ignore this or continue to operate like nothing is wrong,” says NCNA President Meka Douthit Ingram. “These problems, unfortunately, feed into each other and exacerbate the situation. Warning signs have been flashing for a while, and the longer it takes to address these systemic issues, the harder it will be to pull the profession out of this nosedive.”
While not a scientific survey, the results from NCNA members corroborate previous surveys’ assessment of the dire state of nursing burnout and mirror national trends. The survey was conducted from October 27-November 8 and garnered 315 respondents.
Nursing Shortage
Quantifying the nursing shortage from day to day can be challenging since facilities are not required to report their hiring data to any clearinghouse agency. However, nearly 80 percent of the NCNA members responding to this survey reported a current shortage at their facility, with 37.5% indicating that the shortage was “severe.”
- Yes – We have a severe shortage: 118 (37.5%)
- Yes – We have a moderate shortage: 131 (41.6%)
- Not sure: 7 (2.2%)
- Not Applicable: 30 (9.5%)
- No – But we have a shortage pending: 6 (1.9%)
- No: 23 (7.3%)
On a scale of 1 to 10 (with 1 being no impact and 10 being high impact), respondents said the staffing shortage averaged 5.9, with some 69 respondents (22 percent) logging a 10. In addition, almost 58 percent of the NCNA members said staffing shortages had forced them to work longer hours or take different assignments.
Workplace Violence
A plurality of respondents (48.6 percent) said they have personally witnessed violence in the last two years, with more than 27 percent reporting that they were victims of workplace violence. This issue is one of the greatest threats to the physical and mental well-being of nurses, and the recurring message from NCNA members is that the problem is getting worse:
- “I have been cussed out, blessed out, and threatened behind my back by parents on my unit (NICU) for things I did not do.”
- “Physically combative patients, not enough hospital security to have an officer on the unit if we have an aggressive patient.”
- “Families think they can say and do whatever they want. They scream and cuss while administrators allow it. Patients have always been violent, but at least they are sick.”
- “I work in the emergency dept. Every single shift I work I am verbally assaulted by patients or their families due to wait times. I have been physically assaulted by patients at least once a week.”
- “Family being violent towards me because doctors do not call them back. Patients have physically assaulted me, kicking, punching, and twisting my arms. Recently I had a patient hyperextend my finger, causing limited mobility and pain.”
In the wake of NCNA member June Onkundi’s murder in November, allegedly at the hands of a patient, workplace violence is understandably top of mind for many nurses.
“Verbal and physical abuse of nurses is reaching epidemic levels, and it is going to expedite all of our worst-case scenarios for the nursing shortage,” said NCNA CEO Tina Gordon. “Nobody should be expected to cope with this kind of violence. I expect an exodus from the profession if patients, families, employers, facilities, and law enforcement cannot come up with some real solutions to dial it down significantly and quickly.”
COVID
If there is one area with a hint of optimism, the survey results show that COVID is no longer overwhelming hospitals and other facilities the way it had been for the previous two years. That does not, however, mean the pandemic is over. For example, NCNA has asked its members the same question about COVID’s recent impact on a scale of 1-10 since the summer of 2020; in four previous surveys, the answer had never averaged below 7.4. This time, however, it came in at just 4.2. While that is a significant and welcome improvement, it still indicates a significant impact, with 7.6 percent of respondents logging a 10.
Burnout
The ongoing challenges to the nursing profession are fueling a burnout crisis that shows no signs of letting up. NCNA asked its members, “On a scale of 1 to 10 (with 1 being no impact and 10 being ready to leave the nursing profession due to burnout), how is your mental and emotional well-being?”
The average answer was 5.2, down only slightly from the 5.6 reported from the same question in February. Notably, 11.7 percent of respondents answered a 10, with nearly one-third of respondents giving an 8, 9, or 10.
Some of the NCNA’s members’ comments summarize the plight of the profession better than any statistical analysis could do:
- “Due to staffing shortages, resource shortages, and verbal assaults by patients and their families, I dread going to work. I have come to hate working at the bedside.”
- “My mental and emotional well-being was already taxed and burnt out before COVID-19. With the added pandemic, it’s been one of the biggest challenges to deal with and keep present without becoming numb or entirely bitter to see how leadership has handled the situation.”
- “I’m ready to find a new career.”
- “Further downtrodden about the future of healthcare. The system runs on people’s power, and those people are being squeezed to the max. I feel routinely abused by families and neglected by my employer.”
- “I have anxiety and panic attacks and have started therapy. I don’t want to do this anymore.”
- “I am burned out. I don’t feel appreciated, and the quality of care we are providing is not fair to
the patients.”
Survey Results Mirror National Level
NCNA says the results from this survey line up with findings from others at the national level and highlight the need for drastic steps.
Many nurses working now may only be willing to do so for a little while longer. Neither the healthcare infrastructure nor the pipeline of new nurses are prepared to handle the worsening shortage. NCNA and other organizations have spent the last few years calling for systemic changes to alleviate some pressure on the nursing profession and renew those calls now, with even more desperation.
- Survey Finds Nurses Burning Out at Unsustainable Rate - December 6, 2022