In September, the American Nurses Association asked the Department of Health and Human Services to declare the national nursing shortage as a national crisis. At the same time, the American Association of Critical Care Nurses found 66 percent of ICU nurses were considering leaving the profession. Talk to any hospital, and you’ll hear of high turnover and struggles to fill shifts. So far, the solution has been to throw ever-increasing pay rates at nurses – yet somehow, they’re still walking away from hospitals and sometimes the entire profession. It’s time to ask the obvious question: are we going about this the wrong way?

To know why nurses are walking away, we need to know what is driving them away and what would entice them to stay.

Looking beyond the burnout answer

It’s a well-worn cliché at this point that the COVID-19 pandemic has accelerated burnout. Nurses have dealt with PPE and equipment shortages; many were redeployed to new areas; time and again, they cared for dying patients whose families couldn’t visit to say goodbye. Today, in addition to the continuing COVID admissions, nurses must treat high volumes of patients who delayed care for the last year.

But it’s a mistake to think this is the only factor driving staff away. Nurse burnout was a problem long before anyone heard of the Sars-coV-2 virus. Many feel lean staffing models are inadequate to handle patient volumes and acuity. Some experienced nurses say they feel disrespected in the healthcare workplace, sidelined from front-line decisions, and silenced when it comes to process improvements. Seventy-two percent of nurses reported unprofessional behavior from a provider in the last year – and many report physical and verbal assaults from patients and their families.

The repercussions extend beyond low team morale and feelings of professional disengagement. Both new and experienced nurses are asking themselves if they need a change of workplace or a change of career. Some are exploring new pathways like research and teaching – choices that take them off the unit floor. It’s a dangerous exodus that needs practical solutions.

How can healthcare systems retain their nurses? And how can nurses rejuvenate while staying in the medical field?

A new approach to solving nurse shortages

Current challenges won’t vanish overnight, but several solutions are successfully keeping nurses connected and committed to their original mission.

Safer and supportive workplace cultures

Nurse bullying and poor staffing ratios are so common that they’ve become a cliche. For decades now, nurses have complained about being expected to do the worst grunt work in the worst facility conditions of all healthcare workers. Just like any other workplace, a toxic culture will drive off employees. Hospitals serious about retention need to address bullying, listen to staff feedback, and consider augmented staffing models to lighten the load.

“Nurse burnout is a cop-out term to take accountability off the company to provide a safe environment with appropriate staffing/ratios, adequate resources, and up to date, functioning equipment,” said Helen Ianiello, an RN who works in underserved Indigenous communities. “Safe means a non-toxic atmosphere where physicians, nurses, and ancillary staff treat each other with respect and look out for each other, especially when staff are in harm’s way – not one where all the physicians watch from the nurse’s station as the only three nurses in the unit are trying to hold down a combative patient.”

Embracing travel or locum tenens

The healthcare industry tends to present locum tenens benefits from the facility side. Locums staff can relieve overworked, stressed-out, and burned-out providers, it’s true. But this kind of work also offers significant benefits for the nurses doing the relieving. They can take breaks between assignments to replenish their energies; they can take advantage of flexible scheduling to spend more time with their families or pursue side interests.

Travel nursing can also offer a refreshing change of pace that breaks through their jadedness. Visiting different parts of the country and working hands-on with diverse patient populations exposes them to new perspectives and helps them expand their clinical skillsets. For some, working locums becomes a long-term career choice; others return to full-time work after a few years.

Treating underserved communities

It might sound counterintuitive that many nurses find resource-poor environments enrich their sense of purpose. But nurses passionate about solving healthcare disparities often say it’s the best way to fulfill the altruism that drove them into nursing.

“We get to know the people within the community on a first-name basis. We put so much effort into educating them so they don’t return feeling worse,” says Helen Ianiello. “Through all the emotions – the fear, the frustration, the sadness, the anger – we build connections and hope. They are my purpose for doing what I do, for being who I am.”

Sarah Swenson, a critical care nurse who’s served as a U.S. Peace Corps nurse in Malawi and more recently in resource-challenged Tribal nations, noted the gratification of making a direct impact on severe disparities. “The teamwork and ingenuity during this last year and a half has been so exciting to experience,” she says of the pandemic. “Working on the critical care response team has been so rewarding as I feel like I’m really making a difference in areas where help is needed and appreciated.”

Changing career abandonment into professional rejuvenation

It’s time to move beyond mere hand wringing when it comes to the nurse shortage. The profession is at a make-or-break point. Hospitals must implement supportive workplace changes now and take steps to keep staff satisfied and morale positive. At the same time, disillusioned nurses can look beyond traditional job parameters to find new sources of inspiration and fulfillment. Only then will the most important player in this triangle benefit: the patients.

Morgan Haynes is a health care executive.

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