Nurse Burnout and the Great COVID Hangover

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By Jeff Richards, partner and COO at SnapNurse

COVID-related disruptions have disrupted supply chains and labor forces around the world, but none more severely than the healthcare system. The crisis started with a lack of PPE and patient care supplies and escalated from there with patient overcrowding and elevated staff-to-patient ratios that went on for many months.  

As a result, most hospitals, health systems and long-term care facilities have experienced significant turnover during the last year and a half as full-time staffers reached a point of burnout in the middle and later stages of the fight against COVID-19. 

If you stop to consider everything healthcare workers have endured during the pandemic: from the enormous early surge of patients to the high level of acuity, the crushing patient-to-staff ratios, death after death, tragedy after tragedy, day after day, it is heartbreaking but understandable.

All told, the weight of COVID-19 has placed an enormous burden on doctors and nurses. Today as the dust starts to settle on the spread of the Delta variant (the third or fourth wave to sweep the nation), we’ve entered a phase that could be considered “the crisis after the crisis;” a burgeoning and exponential staffing shortage caused by what is effectively a COVID hangover in healthcare. 

The causes for that hangover are complex and include burnout, retirement, career change due to health risks, fatigue from longer and more demanding work shifts, challenging working conditions, frustration at low wages, strike-related staffing shortages, travel nurse fatigue, and friction between full-time and temporary support staff.

Add it all up, and hospitals around the country find themselves significantly understaffed heading in 2022. What’s more, that understaffing is causing even more friction as those full-timers who remain are suddenly working with far more temporary staffing agency nurses who command higher pay and more overtime for doing the same job. This, in turn, causes more nurses to leave in frustration and more staffing nurses to fill the gaps. 

At my company, SnapNurse, we’ve seen an increase greater than tenfold in demand for supplemental staffing. We have multiple hospital clients who were using 70-100 agency staff pre-pandemic and today are using 10 times that amount with more with 700-1000 of their staff coming from agencies today.

In addition to this exponential leap in demand during the last two years, it is about to be compounded by the anticipated departure of 20% of healthcare workers quitting over a multitude of reasons (burnout, anti-vaccination mandate, early retirement).

As of mid-August 2021, a staggering 27% of healthcare workers were still not fully vaccinated, according to The Covid States Project, a collaborative effort by researchers from Northeastern, Harvard, Northwestern, and Rutgers.

Those numbers have surely decreased somewhat since August, particularly in places where vaccine mandates create an actionable threat of job loss. More than 150 employees quit or were fired for failing to get the vaccine in one Houston hospital alone. In New York, where vaccine mandates for healthcare workers are now in place, 90 percent of all healthcare workers and 95 percent of unionized nurses in the state have received the vaccine. 

So, mandates work in terms of driving staff to get vaccinated, but mandates also accelerate resignations and terminations of staff who are all desperately needed.  However, the number of hospitals with a mandate has still not reached critical mass. Less than half of all hospitals nationwide – only 41%, or roughly 2,570 facilities in total – have a vaccine mandate in place, according to data collected by the American Hospital Association and reported by The Washington Post.

We expected that number to rise dramatically in the wake of President Biden’s announcement that most healthcare facilities accepting Medicaid or Medicare funding would be required to vaccinate their employees. For now, however, the mandate itself is tied up in court and not fully enforceable.

Public support for mandatory vaccinations is also increasing, with 52% of adults supporting vaccine requirements, according to a September 2021 study from The Economist.  

For hospitals with a vaccine mandate, many have not experienced the expected massive resignations and terminations, which should lead to an increasing number of healthcare institutions following this path. With fewer options to practice medicine without a vaccination and a steady decrease in vaccine hesitancy, there will be even fewer staff exiting their facilities to avoid it.

The real heavy lifting to recover from the pandemic will be a multi-pronged approach that will come down to enhancing working conditions through sustaining optimal staffing levels.

As hospitals replace the gaps in coverage caused by burnout, resignations, and vaccine mandates, they should do so with an eye to right-size staff-to-patient ratios. With enough short-term or temporary nurses in place, hospitals can eliminate mandatory overtime and ensure that their workers get the breaks and lunch hours they need.

Hospitals should also take the step to ensure that mental health counseling is easily accessible for everyone on staff. Battling COVID-19 is a taxing job, to say the least; the sustained losses from the pandemic are grueling, and the work has taken its toll on mental wellbeing nationwide.

If caring for full-time and part-time nurses is the first and most urgent priority, the second and equally critical priority is to minimize any operational disruptions that create poor working conditions.  This means partnering with agencies who are nimble enough to respond rapidly to provide much-needed staff, preventing the unnecessary overtime that increases burnout of the core staff.  Something as simple as having standard breaks and lunches and much-needed vacation time can prevent the vicious cycle of overwork and burnout.  

For all the reasons outlined, 18% of nurses quit nationwide last year. The reality is, we don’t know if they’re gone forever. The vast majority left because their work had taken a toll, and they needed to recover. We may well be able to bring them back into the workforce with flexible schedules, shorter workweeks and benefits that allow them to manage the stress of the workload. We cannot wait for the labor market to produce enough new nurses to replace them all. The risk of losing more nurses is too significant if that happens.  Hospitals and health systems need to do everything in their power to retain the nurses they still have while building new flexible partnerships with staffing agencies to supplement the core staff. Hospitals can leverage the strengths of agency partners to manage the gaps in the core workforce until they recover from the severe staffing shortages produced from the COVID hangover.