Before the pandemic, Brittany Kennedy, a licensed practical nurse, was working for a family and their child, picking up shifts as she — and they — needed. But as the spread of COVID-19 began to stoke fears and force workers and families into isolation, Kennedy’s assignment ended, and she was thrust back to the frontlines in order to support herself financially.
The scene she was met with could only be described as a disaster.
“Anywhere I went, we didn't have any personal protective equipment,” says Kennedy, who primarily works in Philadelphia-area nursing homes. “We couldn’t care for these patients like we wanted to because we had to keep ourselves safe as well.”
Once PPE finally arrived, she remembers layering in gowns, N-95 masks, goggles, gloves and face shields in the hallways between patients’ rooms. In between every patient visit, Brittany would peel off layer after layer so she could wash her hands and sanitize herself as best as she could, before putting back on the same used PPE, due to the nationwide shortage.
Already brutal double shifts turned into triple shifts as other nurses walked away from the pressure and started skipping their rounds, forcing workers like Kennedy to stay on until proper relief arrived. It’s a common occurrence that nurses call being “mandated,” which refers to mandatory overtime. It’s strictly prohibited for hospitals to require mandatory overtime, unless there’s a healthcare emergency — like a pandemic.
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“It happens,” Kennedy says. “You’re already tired and worn out from going through this process, and then you have to do another eight hours.”
The understaffing of hospitals and nursing homes was nothing new to Kennedy and her fellow nurses, but the severity of the situation reached new heights during the pandemic, and this community of caregivers started to feel helpless.
The added strain caused many healthcare workers to lose the passion they previously had for the job. That, combined with the realization that they could make the same amount of money — if not more — on unemployment, spelled catastrophe for staff and patients alike.
“They were getting paid [the same] doing nothing versus working,” Kennedy says. “I know a few people who’ve said they’re not returning to long-term care because of how COVID has affected them. They’re just not doing it. It was a very, very stressful year.”
Typically, nursing schools graduate 188,000 new nurses each year, but by their second year in the workforce, 33% leave the bedside due to burnout, according to data from nursing agency IntelyCare.
Post-pandemic, those statistics have become even damning — the U.S. Bureau of Labor Statistics projects that 500,000 seasoned nurses are expected to retire between now and the end of 2022, creating a shortage of 1.1 million nurses.
It’s a mass exodus that has been accelerated nearly 20 years by the pandemic, according to David Coppin, founder and CEO of IntelyCare, a digital staffing agency for nurses. The culprits, Coppin says, are the very institutions that employ nurses.
“The nursing shortage is being driven by the healthcare facilities themselves,” Coppin says. “The way the nursing model is working is just broken — they can't handle it anymore. They feel like they’re constantly on call, even if they're technically not.”
Who cares for the caregivers?
Earlier this year, Erin Clifford was finishing up her last months as a nursing apprentice when she felt an oncoming panic attack during one of her hospital shifts. Recognizing the symptoms — shaky hands, a rapid heart rate, hyperventilation — she took herself down to the ER and checked herself in, where she was given a shot of the anxiety drug Ativan and told that she couldn’t drive, much less continue working.
Following the doctor’s orders, Clifford went home after filling in her colleagues, who were understanding of the situation. But her discussion with her nursing director was less accommodating.
“Her exact words were, ‘You left the floor short-staffed that day and you didn't find somebody to cover your shift?’” Clifford says. “I was taken back by that. It wasn't, ‘Are you okay? Did anything happen? Did you get hurt? Did a patient get hurt?’ Just general humanity — there wasn't any of that.”
Clifford only had two shifts left with that hospital in total — and for both, she called out. Now, she’s moving forward with her nursing career, and says that overall, she’s excited about the future — but the lack of empathy is a fresh memory, and she hopes to see change in the future.
“I don't want to say it's falling on deaf ears,” she says of nurses’ plea for a more equitable workplace. “But it's falling on ears who hear it and they see it and then they write it down, but when it comes down to it, they're so scared and they don't want to upset the people who give them their budget and their money. But that’s not what it’s about.”
Clifford and Kennedy aren’t alone in their burnout: 76% of nurses feel the same exhaustion. Of those who walk away from their profession, 59% cite insufficient staffing levels as their top reason for quitting, 56% the demanding nature of their job, 54% the emotional toll, and 51% because they don’t feel supported by their managers, according to a Mckinsey survey.
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“We're the ones getting our hands dirty,” Kennedy says. “When decisions are made by other people, it affects our lives and they're putting on more and more and more for us to do — it's not realistic. It has always been stressful, but now even more.”
A scramble for solutions
To keep nurses from being overworked, they must regain control of their schedules, says Intely’s chief clinical officer and registered nurse, Rebecca Love. If the industry keeps on its current trajectory, she warns, people are going to die.
“You saw it in Dallas, you saw it in Houston,” she says, referencing the nursing shortage Texas experienced during the pandemic that left 23,000 nursing positions unfilled, according to a labor analysis by the Texas Workforce Commission. “You're seeing emergency rooms that don't have enough providers to provide care. You’re seeing medical officers at hospitals standing up and saying, patients are going to die because we don't have enough providers.”
Beginning in April 2020, Texas spent $5.36 billion in federal relief funds to attract nurses away from their home states to support local facilities overwhelmed by COVID. Nearly a year and a half later, in August 2021, cases and deaths were still rising month-to-month in Texas.
“There is an incredible amount of burnout, stress and trauma on these providers that we’ve never seen before,” Love says. “People will say ‘Oh, but you're a nurse. You must deal with people who die all the time.’ And we do, but what we don't usually deal with is with this scale of death or the traumatic form in which people are dying in front of us.”
Now, as the pandemic is starting to subside and death rates have plummeted, it’s easy to assume relief for this workforce. But we’re only starting to understand the aftermath of COVID, Love says. Nurses have become painfully aware that they’re working for a system that is ill-equipped to support their needs.
“This situation is so absolutely astronomical in its severity,” Love says. “Hospitals are so focused on saving patients' lives that they're not coming up with good solutions on how to do it — and the truth is, [it’s because] we kept thinking there were always going to be more nurses.”
The industry isn’t just struggling to retain veteran nurses, but fresh graduates, too — nurses younger than 35 who have been at their current employer for less than a year are most likely to leave voluntarily, according to a new analysis by Press Ganey, a leader in healthcare consumer and workforce engagement. New hires specifically are at the greatest risk for turnover, due to weaker connections with their team, managers or organization.
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Creating more control
To remedy the issue, organizations like IntelyCare are fighting to put nurses back in the drivers’ seats of their own careers. The nursing agency gives nurses a pathway to becoming agency workers, which allows them to be considered as W2 workers with full access to benefits, but allows them to choose when and where they work via a digital app. Facilities send Intely their open shifts, and Intely sends them to corresponding nurses with matching availability.
These kinds of solutions can have immediate impact. Kennedy has been an Intely nurse for two of her years in healthcare, and although she still experiences regular bouts of burnout as an agency nurse, she does feel she has more flexibility and control, a luxury most nurses don’t. As an agency worker she’s not confined to one place, much less a schedule, and there’s a third-party team tracking her hours to ensure she’s not clocking in too much overtime.
Still, the pros of being an agency nurse doesn’t always outweigh the cons, and Kennedy admits she’s considered walking away from the profession she’s loved. Nursing, she says, is not for the faint of heart —and the industry can’t keep up with the current level of churn.
“The simple fact is that everybody can’t do this work,” she says. “And it's not the same as when I first started doing this, it's totally different. As much as I love being a nurse and helping people I'm at the point that I don't even know if I want to continue to be a nurse.”
But for now, Kennedy is moving forward with caution — because she can’t shake the passion she has for the work. She’s hopeful that the industry can change, that the landscape of care can change, and that more services will be made available to support her own needs as a worker.
“I do it for people's grandmothers and grandfathers that are dying, the parents that can't feed themselves,” she says. “That's who I do it for. And it's hard when you’ve got to work and you’re faced with so many obstacles but then at the end of the day, I'm here for my patients.”
