The Complex Reasons Behind the Ongoing Nursing Shortage in the US

According to recent reports, the US is facing a significant nursing shortage. Many assert that nurses left the profession due to their refusal to get vaccinated during the pandemic. However, the truth is far more nuanced, as this article will explore.

PTSD and Trauma Among Staff

As shared by a Registered Nurse (RN), the pandemic has been a period of immense stress and trauma for healthcare workers. Patients became verbally and physically abusive towards nurses, often driven by misunderstandings about their condition. One RN described being spit on, yelled at, and even physically assaulted. The emotional and psychological impact was so severe that she developed Post-Traumatic Stress Disorder (PTSD).

Speaking about these experiences helped her process her feelings, but it was a distressing process. Her story, although distressing, highlights the immense pressure and emotional toll faced by nurses, which can often lead to job dissatisfaction and the decision to leave the profession permanently.

High Attrition Rates Among New Graduates

Another key factor in the nursing shortage is the high attrition rate among new graduates. According to experiences shared by nurses who have worked in ORs, up to 25% of graduates leave the profession within their first year. Here are some of the reasons behind this:

Lack of Retention Pay: While starting salaries can be competitive, there is rarely additional pay given for retention beyond the initial period. Difficult Work/Life Balance: Long working hours and irregular schedules make it challenging for nurses to maintain a healthy work-life balance. High-profile events during cases can result in extended shifts, often without additional pay. Continued Education and Advanced Degrees: Many nurses move on to pursue advanced degrees, which take them away from direct patient care. This shift can lead to the loss of experienced nurses. Adverse Work Conditions: The OR is often a high-stress environment. Issues like understaffing, unprepared equipment, and lack of breaks can contribute to burnout.

Challenges in the Operating Room (OR)

Based on personal experiences and observations, the OR can be a particularly challenging environment. The following is a detailed account of common issues faced by OR nurses:

Starting Time Adjustments: Nurses often have to adjust their start times, sometimes clocking in as early as 6:30 or 7 AM, leading to a busy day without breaks. Equipment Issues: Scissors may be dull, instruments may be missing, and staff may not be prepared for procedures, all of which contribute to stress and longer working hours. Post-Operative Duties: Nurses are often left to clean up the OR after a case, even when cleaning staff is absent. Extended Shifts: It is common for cases to run over, leading to mandatory overtime without additional compensation. Following these late shifts, nurses still have call duty, adding to the already heavy workload. Irregular Schedules: Call is typically scheduled weekly, and weekend calls can extend from Friday to Monday. These irregular schedules make it difficult for nurses to plan their lives outside of work.

While some health systems may offer a certain level of support, the hospital culture in many cases does not include breaks or relaxation periods for staff. This contributes to a high level of stress and burnout.

A Personal Journey

As someone who has worked in the OR for 28 years, the evolving challenges are clear. Despite a love for the job, the decision to go back to school for an MSN (Master of Science in Nursing) was driven by the desire to move into a different role. The focus on advancing knowledge and skills can provide liberation and new opportunities, but it also means a departure from the hands-on, patient-facing aspect of nursing that many find rewarding.

While the nursing shortage is complex and multifaceted, it is crucial to address the underlying issues—such as trauma, high attrition rates, and challenging work conditions—that are driving nurses away from the profession.