Addressing Workplace Challenges for Nurses

Although the COVID-19 Public Health Emergency officially ends in May 2023, nurses are still facing workplace challenges during this year’s National Nurses Month, themed “You Make a Difference.”

“The world has witnessed the valued contributions of nurses and how vital they are to our health care system,” said American Nurses Association President Jennifer Mensik Kennedy, PhD, MBA, RN, NEA-BC, FAAN. “It’s up to us to ensure they feel that value and receive the respect and support that they deserve.”

At the start of her term in January, Mensik Kennedy had pledged to address the most pressing challenges facing nurses, including nurses’ health, nurse staffing, workplace violence and racism in nursing.

How nurses are affected by challenges on the job

The American Nurses Foundation (ANF) 2023 Pulse on the Nation’s Nurses Survey Series, the Three-Year Annual Assessment Survey, found nurses feel stressed and unsupported by their employers.

“The emotional impact really has been detrimental to the overall health of our nurses,” Mensik Kennedy said. “The nurses we have surveyed have been very open with us, sharing some of their raw experiences.”

The latest ANF survey “revealed that nurses are continually stressed, frustrated, angry and feel a lack of respect from patients and employers,” Mensik Kennedy added. “Most nurses have explained in detail the level of violence they face on the job, and the increased workload, all of which are deeply discouraging and lower morale while creating a negative, unsatisfactory work environment.”

Greg Hammer, MD, a professor at Stanford University School of Medicine in Palo Alto, California, author of GAIN without Pain: The Happiness Handbook for Health Care Professionals, calls the current situation a self-propagating loop. He explained that everyone feels stressed these days, and when that happens, people don’t behave well. Additionally, places are having a lot of turnover, with not enough nurses available.

“People get extra stressed when they are stretched thin,” said Hammer. He added that our brains are wired to have a negativity bias, and people tend to overthink the past and future. This can lead to low self-esteem, regret and depression about the past, and fear and anxiety about the future.

“Happiness occurs in the present moment,” Hammer said. “We can rewire the way we think, due to neuroplasticity.”

Hammer suggests nurses rewire those negative tendencies using his four-step process known as GAIN: Gratitude, Acceptance, Intention and Nonjudgment. It begins with a daily three-minute meditation, breathing in deeply through the nose and out through the mouth. When completed, nurses can expect lowered blood pressure, being more present, and feeling happier and more resilient.

The top workplace challenges for nurses

In addition to feeling stressed, overworked and discouraged, the ANF survey found that nurses are reporting an increase in workplace violence and verbal abuse.

Terry M. Foster, MSN, RN, CEN, CPEN, CCRN, TCRN, FAEN, the 2023 president of the Emergency Nurses Association, reported observing increased incivility and hostility from patients and their family members in the emergency department.

“It’s puzzling as to why people feel they can act that way,” Foster adds. “They are angry and want to hit somebody.”

To stay safe, Foster recommended nurses take physical protection classes, always stay between the patient and the door, recognize when a situation is escalating, and learn to foster calmness. Nurses also need to feel comfortable calling security staff.

Staffing shortages are another workplace challenge that nurses face almost daily, Foster said. At the same time, patient acuity is at an all-time high.

“Patients are so sick, with multiple disease processes and medications,” Foster said. “When it’s out of control, it eats at your heart and soul.”

Racism also remains detrimental to nurses, Mensik Kennedy reported. Several health systems have committed to improve diversity and inclusion, and ANA has developed a Journey of Racial Reconciliation to acknowledge past harms to nurses of color, and help to mitigate, manage and offer solutions for today’s challenges.

7 ways nurses can overcome workplace challenges

1. Start with self-care.To effectively navigate workplace challenges, nurses need to start by caring for themselves and saying “no” to extra shifts, Foster said. Nurses know their limits and should embrace downtime.

“I have to take care of myself before I can help others,” said Foster.

Sleep, exercise and nutrition are essential for taking care of nurses’ physical health, Hammer said, adding that personal resilience is the only thing in an individual nurse’s control. Other changes to improve the workplace are the responsibility of leadership.

2. Use available resources. The ANF, ENA, American Association of Critical-Care Nurse and the American Psychiatric Nurses Association developed the Well-Being Initiative in 2020. The program helps nurses through a number of free resources and tools for improving mental health, connecting for peer support, practicing gratitude, recognizing and mitigating post-traumatic stress disorder, and dealing with grief.

Several hospitals, including Memorial Hermann in Houston and St. Elizabeth Healthcare in Edgewood, Kentucky, have established quiet rooms for nurses to step away from the stress, meditate, listen to music and unwind before going back out on the floor with patients.  

3. Share with others. Talking with colleagues or others who understand can produce tremendous benefits.

“It always helps to talk with a colleague or someone else about the stresses and difficult challenges you are facing – whether it’s with a family member, mental health professional, friend or colleague,” Mensik Kennedy said. “Talking with your colleagues...also helps validate shared experiences while enlightening both parties on how you can find ways to support, encourage and motivate each other.”

4. Work together. Nurses can make a difference when they band together. Mensik Kennedy suggested that nurses need to support each other, be each other’s allies and work together to end bullying and other conflicts in the workplace.

5. Maintain a sense of humor. Foster recommended maintaining a healthy sense of humor and laughing with your colleagues.

“I have gotten through many a rough shift by having a sense of humor,” Foster said.

6. Get help when needed. When nurses need more assistance to deal with workplace challenges, they should understand that it’s alright and important to seek professional help. Yet stigma still exists as a barrier to obtaining mental health care, according to a 2023 article in AACN Advanced Critical Care.

AMN Healthcare serves as a StigmaFree Company in partnership with the National Alliance on Mental Illness. Onward Healthcare and AMN Healthcare’s Employee Assistance Program and clinical management teams are available to travel nurses to talk through workplace issues.

7. Advocate for change. Mensik Kennedy encourages nurses to continually engage in advocacy efforts, and to speak up and voice their concerns to leadership.

“Nurses must lead and engage in institutional policy changes for a healthy work environment and actively support investments and policies that support their efforts and overall well-being,” Mensik Kennedy said. “Through advocacy, nurses must engage at the state and federal levels to support bills that will strengthen the nursing workforce.”

Until the nursing profession can successfully address the key issues facing the workforce, nurses will continue to struggle, and some will opt for less stressful work that will worsen the already significant nursing shortage. It’s time to practice self-care and build resilience, and for employers to step up and eliminate some of the workplace angst.

Despite the challenges that nurses face, “It’s still a rewarding profession,” Foster said. “I still love being a nurse and taking care of someone who is really sick.”

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