A critical shortage: Amid burnout, fatigue, exhaustion, nurses leave their jobs

In 2021, at the height of the pandemic, Denelle Korin was assigned to the covid wing in an acute care hospital in central Pennsylvania where she worked as a nurse.

For months, Korin saw patients die. Like thousands of nurses across the country, she herself put her health and safety in danger, working for months behind cumbersome protective gear.

It was one of the most traumatic experiences of her life, said Korin, who now suffers from PTSD and takes medication to sleep.

“I was having terrible nightmares,” said Korin, a nurse coordinator with SEUIC Healthcare Pa. “Nightmares of me being stuck in a covid wing and not being able to get out. I have flashbacks. I revisit those times like a movie in my head. Things patients said to me. Things that happened. It’s truly crippling.”

After 20 years on the job, Korin has given thought to leaving nursing.

Liz Engle has been a nurse for only six years but already understands why nurses contemplate quitting the profession.

A registered nurse in the pediatric intermediate care unit at Penn State Health Children’s Hospital, Engle was spared much of the difficulties of caring for covid-19 patients, but the current outbreak of respiratory illnesses that has led hospitals to max out on capacity has been a source of emotional and physical toll on her and other nurses.

“You see these things people aren’t supposed to see every time you go to work,” Engle said. “You see a family’s worst nightmare and you are expected to go home and disconnect and not think about it. That’s just not the case. If you are invested in the situation, in the care of that patient, you are not able to just turn that off.”

Korin’s and Engle’s experiences underlie a current national crisis in nursing: more and more nurses are leaving their jobs, many reporting the compounding duress of burn-out, exhaustion, and an overwhelming sense of not being valued by patients or hospital administrators.

“You have this shortage of staff all over, not just in nursing,” said Maureen Casey, a nurse at Penn State Hershey Medical Center and president of the SEIU’s chapter at the center.

“Nurses have to spend more time drawing blood or cleaning rooms before the next patient can come in. You have this snowball effect. Not enough people are working jobs and the entitlement of people coming in,” she said. “Nurses are not putting up with this. They say I can go elsewhere. I can do nurse consulting from home. Or work for an insurance company by answering the phone at home.”

Two years ago, as the pandemic upended every aspect of daily work and life, nurses were elevated to heroic status.

As the pandemic ravaged communities, they were honored with nightly standing ovations and hailed on social media. Streets were lined with homemade posters praising the work of so-called angels.

That landscape has changed dramatically.

In the past two years, nurses have increasingly reported being exhausted and burned-out by their jobs. Many, like Korin, bear the scars of working through a pandemic.

“There’s a lot of physical aspects to the job,” Engle said “There are long shifts, days without breaks. Essentially you are running around the unit for 12 or 13 hours doing physical, heavy labor sometimes for multiple days in a row. Sometimes you barely have time to drink water or time to use the bathroom.”

At the same time, nurses have become targets of an increasingly angry public. They report a rise in verbal and physical aggressions against them by patients and their families.

“It feels more now than ever that people are coming in with really heightened emotions,” Engle said. “We are seeing higher levels of verbal aggression and physical aggression toward healthcare workers. It seems it did a complete 180 degree turn from when people were coming in so grateful and appreciated that we were there when they needed us.”

Studies have shown the pandemic’s effects on nursing and the healthcare sector.

According to Health Affairs Forefront, a recent Medscape survey found that 40 percent of nurses said covid-19 reduced their level of career satisfaction; 25 percent said they would not choose to be an RN if they could do it over again, and 15 percent of those said they would leave the profession in three years.

“It feels like healthcare workers went through something hugely monumental though covid, but then never got a break.” said Megan Waite, a registered nurse in the pediatric intermediate care unit at Penn State Health Children’s Hospital. “I feel people really don’t understand what we are expected to do in these unprecedented times. We pull together. We help each other and have the understanding that everybody is struggling. We are all going through the same issues as nurses. Ultimately it’s about patients and helping each other and keeping each other well.”

Waite, who has been a nurse for less than five years, is studying to become a nurse practitioner.

The alarming shortage of nurses nationwide has created a crisis poised to worsen.

“Hospitals did the best they could under the circumstances but it was like you went to war,” said Mary Ellen Smith Glasgow, dean and professor at Duquesne University School of Nursing. “It was like nothing we had ever seen before. No one thought about the mental health of nurses. Everyone was trying to survive. It has taken a great toll. Many nurses have left. Many nurse leaders have left.”

According to a recent report by the McKinsey & Company, the U.S. will see a shortfall of half a million nurses by 2025. The nursing sector is expected to lose 30% of its workforce by 2025, fueled by the retirement of an older demographic and a dearth of new nurses entering the field.

Health experts say the supply of registered nurses is under threat. A 2022 study by Health Affairs Forefront shows the total number of RNs decreased by more than 100,000 in 2021 alone — a far greater drop than observed over the past four decades.

An estimated 660,000 baby-boomer RNs who worked during the pandemic are expected to retire by 2030, the study shows. If a substantial number of these older RNs exit the workforce earlier, the nurse workforce reduction could disrupt nurse labor markets throughout the country, the study shows.

At the same time, health experts have tracked a sustained reduction in the number of younger RNs entering the field. The number of applicants to four-year nursing programs grew just 1.5 percent in 2020 compared with increases of as much as 8.5 percent in the prior two years, according to the Health Affairs Forefront study.

By the end of 2022, more than one-third of nurses said they were very likely to leave their jobs by the end of year. Nearly half — 44% — cited burnout and a high-stress environment as the reason for their desire to leave, according to Incredible Health. Nurses cited benefits and pay as the second leading reason for quitting their jobs.

“It’s pretty bad,” Smith Glasgow said. “I think covid really had an impact on nursing.”

She also notes that an unprecedented number of nurse leaders across the country are reporting plans to leave the industry.

“It’s a pretty significant issue that needs to be attended to right now,” Smith Glasgow said. “If we don’t attend to it right now, we are really going to have a problem in 2025.”

Thousands of nurses in New York City are on strike this week, citing low wages and exhaustion. The New York State Nurses Association reports staffing shortages have left some nurses caring for twice as many patients as is normal.

In search of improved work-life balance, nurses have increasingly left their bedside jobs for contracts with private nursing agencies, which tend to pay higher wages and offer more flexible, family-friendly hours. It is not uncommon for nurses to work alongside each other in one hospital, fulfilling the same duties with patients but earning significantly different wages.

“People have become very selective about where they will work and what they will tolerate,” Korin said. “That’s why you are seeing agency nurses staying in their agencies. They are only indebted to do what their contract says.”

Working alongside better paid agency nurses seldom helps morale among nurses, Korin said, but she does not begrudge those who make that decision.

“I’m thankful they are still practicing nursing,” she said. “I give kudos to anyone who is the new person on the block with little training. Unfortunately nurses working inside hospitals often feel, how come we can pay this nurse so much more money when I’m the dedicated person to this hospital?”

The solution, nurses say, comes down to better pay and work conditions.

“What can hospitals do short of paying more?” said Casey, a nurse in the hospital’s peri-anesthesia department. “It’s a simplistic answer but it is to pay them and recruit and retain staff.”

Casey’s SEIU Healthcare Pa. chapter recently ratified a three-year union contract with Penn State Health Milton S. Hershey Medical Center. The agreement includes significant wage increases and benefit enhancements for more than 2,200 registered nurses.

Even as hospitals boast historic profit levels, too often they focus on admitting patients and then figuring out how they will use nursing resources to care for them, Casey said.

“It’s difficult from a bottom line perspective to say the patients are out there. We have to take care of them,” Casey said. “Yes, but how do you care for them safely? Hospitals are like let’s get the patients in the door and we will worry about staff later. It has to go hand in hand. You have to care about staff in order to care about patients.”

Nurses note that they are the only healthcare professional that does not bill for services. Too often, they add, hospitals view nurses as a cost.

“I get that it’s difficult to pay great wages, competing wages, and stay afloat, but there has to be somewhere that they can cut… somewhere except for management rather than the staff at the bedside,” Casey said. “It’s difficult to see someone sit in a big office chair and say we need to cut corners when I’m already running around with a needle in one hand and a broom in the other. I have to draw blood and clean this room. Somebody else’s gotta tighten their belts.”

Waite is learning to balance good days with bad ones. Her passion for caring for people pushes her through.

“The ultimate reason why I got into nursing is to take care of people,” she said.

Korin believes a sure way to improve the outlook for nurses is for hospitals to reduce patient-nurse ratios.

“There are nurses who take care of obscene numbers of people and they know they can’t take care of them,” she said. “We are being asked to do impossible things in nursing everyday.”

Yet even as she has given serious thought to leaving, she perseveres.

“I love taking care of people,” Korin said.

Liz Engle turns to exercise, movies and time with her husband to recharge her batteries. With staff shortages and max capacities that’s not always an easy task and at times she considers quitting.

“I think it crosses most people minds pretty often,” she said. “I would be lying if I said l didn’t have those bad days but I come back to the reason why I became a nurse. I truly love what I do. We might be in a tough spot, but I don’t think I’d be satisfied doing any other profession. It would be hard to find someone in health care who didn’t have those feelings.”