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Hospital Nursing Has Not Returned to Pre-COVID Conditions: Time for a Different Approach
Karen B Lasater1,2, Matthew D McHugh1,2, Linda H Aiken1,2
1Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, PA.
Background:
Hospital nurse burnout, job dissatisfaction, and intent to leave were high before the COVID-19 pandemic and reached alarmingly new heights during the pandemic.
Objective:
Evaluate whether hospital nurses' job outcomes and evaluations of patient safety, quality of care, and hospital management responsiveness have returned at least to prepandemic levels.
Design:
Cross-sectional study of survey data from 50,044 nurses in New York and Illinois hospitals: prepandemic (December 2019-February 2020), during (April 2021-June 2021), and postpandemic (December 2023-March 2024).
Measures:
Nurse outcomes (ie, high burnout, job dissatisfaction, intention to leave employer). Hospital nursing resources (eg, unfavorable work environment, nurse staffing ratio). Hospital management responsiveness (eg, nurses' confidence in management to resolve clinical care problems).
Results:
Nurses' job dissatisfaction and intentions to leave their hospital employer rose significantly over time, with the highest percentages postpandemic-32.2% of nurses reporting job dissatisfaction and 27.4% intending to leave. Percentages of nurses with high burnout have remained high before (48.0%), during (51.0%), and after (48.5%) the pandemic. Nurses' evaluations of their working conditions are at their worst postpandemic: 49.2% reported unfavorable work environments, 61.5% reported not enough staff, and objective measures of staffing ratios on medical-surgical units were 6.0 patients-to-nurse, up from 5.7 prepandemic. Evaluations of patient safety, quality of care, and management responsiveness were significantly worse postpandemic.
Conclusions:
Job dissatisfaction and intentions to leave employment continue to rise even after the pandemic has receded, and more nurses lack confidence in their management to act in the best interest of patients. New policy approaches seem warranted, including setting minimum safe hospital nurse staffing requirements.
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