National nurse survey reveals significant increases in unsafe staffing, workplace violence, and moral distress
National Nurses United calls on Congress to pass federal safe staffing legislation
National Nurses United’s (NNU) new nationwide survey of more than 2,500 registered nurses reveals significant increases in staffing issues, workplace violence, and moral distress compared to NNU’s previous survey results released on Sept. 27, 2021. Hospital RNs also reported that their hospitals are still not adequately prepared for a Covid-19 surge.
This survey is the seventh national survey of nurses during the pandemic by NNU, the nation’s largest and fastest-growing union of registered nurses.
“We are now more than three years into the pandemic and not only is staffing worse, but workplace violence is increasing,” said Zenei Triunfo-Cortez, RN and a president of National Nurses United. “Nurses are experiencing alarming levels of moral distress and moral injury due to the unsafe working conditions. Since our last survey in September 2021, even more nurses have reported feeling more stress and anxiety as well as feeling traumatized by their experiences caring for patients.
“In addition, many nurses reported that their hospitals do not have surge plans or enough personal protective equipment in stock to protect staff during a surge,” said Triunfo-Cortez.
“It is unconscionable that some RNs are still reusing single-use PPE and putting their health and well-being at risk.
“Despite these challenges, nurses have continued to fight for safe working conditions and patient safety and they are organizing,” said Triunfo-Cortez. “During the pandemic, nurses at Mission Hospital in Asheville, North Carolina, Maine Medical Center in Portland, Maine, and Longmont United Hospital in Longmont, Colorado, organized and voted to join affiliates of National Nurses United. We have also been strongly advocating for federal RN-to-patient ratios legislation and for the Occupational Safety and Health Administration to issue a permanent standard to protect nurses and other health care workers from Covid-19 in the workplace.”
Here are the responses from 2,575 nurses, gathered from both NNU union nurses and nonunion nurses in all 50 states plus Washington, D.C. The results cover the period Feb. 2, 2022 to March 20, 2022.
Hospital RNs reported that staffing is worse: 69 percent reported that staffing has gotten slightly or much worse recently, a 20.2 percent increase from NNU’s September 2021 survey and a 47.8 percent increase from our March 2021 survey.
More than a quarter of nurses (26.5 percent) reported being “floated” or reassigned to care for patients in a clinical care area that required new skills or was outside of their competency, up from 17.8 percent reported in September 2021. Meanwhile, 46 percent of hospital RNs reported that they did not receive any education or preparation before being floated to units outside of their expertise, up from 44.3 percent reported in Sept. 2021.
Excessive overtime and use of travel nurses:
- 64.5 percent of hospital nurses reported that their facilities are using excessive overtime to staff units, up from 49.3 percent, a significant increase from our September survey.
- 72.3 percent hospital RNs reported an increase in the use of travel nurses in the prior month.
Workplace violence on the rise
Nearly half of hospital nurses (48 percent) reported a small or significant increase in workplace violence, up from 30.6 percent in September 2021 and 21.9 percent in our March 2021 survey. This is a nearly 57 percent increase from September 2021 and a 119 percent increase from March 2021.
Alarming evidence of moral distress and mental health
Covid-19 is still having a deep impact on the mental health of hospital nurses, who continue to face moral distress and moral injury at work. There are significant increases in all of the mental health impacts reported in our September 2021 survey.
- 66.8 percent of hospital RNs fear they will contract Covid, a 59.4 percent increase from September.
- Nearly three-quarters (74.6 percent) are afraid they will infect a family member, a 47.4 percent increase from September.
- Nearly 60 percent (58.4 percent) are having more difficulty sleeping, a 66.4 percent increase from September.
- 83.5 percent feel stressed more often than before the pandemic, a 56.1 percent increase.
- 77.2 percent feel anxious more often than they did before the pandemic, a 53.2 percent increase from September.
- 68.7 percent feel sad or depressed more often than they did before the pandemic, a 64.6 percent increase from September.
- More than half (56 percent) feel traumatized by their experiences caring for patients, a 65.7 percent increase from September.
- 23 percent sought treatment for a mental health condition related to caring for patients during the pandemic, a whopping 87 percent increase from September.
Personal protective equipment
- Only 71.8 percent of hospital RNs reported wearing a respirator for every Covid-positive patient encounter, up from 60.8 percent in our September 2021 survey. Meanwhile, 62 percent of hospital RNs reported having to reuse single-use PPE, an unsafe practice.
- Only 32 percent of hospital nurses report that their employer has sufficient PPE stock to protect staff from a rapid Covid surge. (For more on surge plans, see “Surge preparedness” section below.)
Exposure, testing, and screening
- Nearly a quarter (24 percent) of hospital RNs reported that their employer notifies them of Covid exposures in a timely manner. Meanwhile, 29 percent of hospital RNs reported that nurses are informed of exposures but not in a timely fashion. Prompt notification is essential for infection control.
- Access to testing is still an issue at some hospitals: 17.8 percent of RNs report that access to testing has declined since the beginning of the pandemic.
- Only 56.8 percent of hospital RNs report that every patient is screened for recent exposure history to covid, down from 61.7 percent in our September survey. Screening of visitors has also gone down since our last survey: 48.6 percent of hospital nurses reported that all visitors are screened for Covid signs and symptoms at their facility, down from 52.7 percent in our September survey.
- Only 23.8 percent of hospital RNs report that every visitor is screened for recent Covid exposure history at their facility, down from 38.5 percent in our September survey.
Woefully inadequate surge preparedness
Only 24 percent of hospital RNs reported that their employer has an overflow plan to place additional, trained staff to safely care for Covid patients on isolation. This is a decrease from our first Covid survey in March 2020 when 29 percent reported that there was a plan in place to isolate patients with possible novel coronavirus infection.
In 2020, NNU’s four surveys covered hospitals’ lack of preparedness for Covid-19 (March); government and employers’ disregard for nurse and patient safety (May); the devastating impact of reopening too soon (July); and hospitals’ and health care employers’ lack of preparation for the fall/winter surge, despite more knowledge about the dangers of the virus and effective measures to prevent spread (November). In 2021, NNU’s March 2021 survey highlighted the continuing disregard of hospitals and health care employers for the safety of nurses and health care workers. The September 2021 survey revealed that employers must do more to be fully compliant with the Occupational Safety and Health Administration emergency temporary standard to protect nurses and other health care workers.