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This award-winning blog supplements the articles in Hospital Infection Control & Prevention.

Exodus: Emotional Suffering Drives Nurses From Field

By Gary Evans, Medical Writer

The seemingly never-ending pandemic has nurses suffering a cascade of negative emotions and leaving the field in an exodus expected to worsen with COVID-19 vaccine mandates.

According to a survey by the American Nurses Foundation (ANF) that netted responses from 22,215 nurses from Jan. 19 to Feb. 16, 2021, nurses felt such intense emotions as “betrayed” (12%), “guilty” (11%), and “like a failure” (10%). Nurses reported more than one emotional state, as the highest percentage answers exceeded 100%: exhausted (51%), overwhelmed (43%), irritable (37%), and anxious (36%).Only 1% of respondents felt suicidal, but that’s still 222 nurses thinking of taking their own lives.

A recent survey of 234 registered nurses in California found that that 15% of respondents — 35 individual people at various facilities — reported thoughts of suicide in the previous month.

“That is extremely distressing,” says lead author Alyson Zalta, PhD, associate professor of psychology at the University of California Irvine. The paper is the process of being published, but Zalta previewed a few of the findings.

In addition to patient care challenges, the denial and politicization of COVID-19 have taken a toll on nurses, she says.

“Nurses have been in an impossible position within the context of this pandemic and the decisions they have had to make,” she says. “The way our society has responded to this event has really been pretty damaging for nurses.”

Rather than burnout, Zalta prefers to describe this damage as “moral injury,” a condition somewhat similar to that experienced by soldiers in combat. In general, moral injury occurs to a person who witnesses, participates in, or fails to prevent some harmful event. This event may be well beyond their power to stop, but their ethics and moral code are violated and they are emotionally harmed.

“Nurses, for example, may have too many patients to care for at one time,” Zalta says. “While they are taking care of one patient, they realize a patient is coding in another room.”

As a result of such conditions, 13% of the nurses surveyed said they plan to leave the nursing field, adding to an escalating national nursing shortage that threatens to undermine patient care.

“Turnover is a major issue and seriously compromises the health of the workforce,” Zalta says. “We’re certainly seeing that there are work place issues, as well as the broader sociopolitical climate, that are driving distress.”

In another national poll of 1,000 healthcare workers conducted between Sept. 2-8, 2021, 18% said they had quit a job and 12% said they were laid off. In addition,19% said they were considering quitting and leaving healthcare altogether.

In a rather staggering statistic, labor officials report that more than half a million healthcare workers have left the field since the pandemic began.

“Employment in health care is down by 524,000 [jobs] since February 2020, with nursing and residential care facilities accounting for about four-fifths of the loss,” the Bureau of Labor Statistics recently reported.

For more on this story, see the next issue of Hospital Employee Health.

Gary Evans, BA, MA, has written numerous articles on infectious disease threats to both patients and healthcare workers. These include stories on HIV, SARS, SARS-CoV-2, pandemic influenza, MERS, and Ebola. He has been honored for excellence in analytical reporting five times by the National Press Club in Washington, DC.