COVID-19 has taken a huge toll on the healthcare system and has led to high levels of nursing burnout and staffing shortages. In this episode, Dr. Bjorn Mercer talks to APU nursing professor Dr. Stacey Malinowski about the current state of the healthcare system and how to address major nursing shortages across the country. Learn about healthcare challenges like compassion fatigue, moral distress, the aging nursing population, the lack of nurse educators, and insufficient clinical sites as well as some positive outcomes of COVID like the increased availability of telehealth options for medical care.
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Dr. Bjorn Mercer: Hello, my name is Dr. Bjorn Mercer. And today we’re talking to Stacey Malinowski, Assistant Dean in the School of Health Sciences. And today we’re talking about COVID and burnout. Welcome, Stacey.
Stacey Malinowski: Hi Bjorn. Thank you for having me.
Dr. Bjorn Mercer: Of course. This is an extremely important topic. Healthcare has, I’ll just say had a rough time of it over the last two years. Healthcare workers, I should say, have had a very, very rough time. And I think for those who do not interact with healthcare workers, they don’t quite realize that. And that leads us to our first question: COVID has been raging around the world for two years, 2020 and 2021. And so why is nurse burnout an issue for the healthcare sector?
Stacey Malinowski: So the pandemic certainly has added a whole new level of complexity to the concept of nursing burnout. And it has been an issue that we’ve been dealing with in nursing for a very long time. And this is due to several reasons. We have workplace violence, we have horizontal hostility and we have a nursing shortage that existed long before the pandemic even started.
And what’s interesting about healthcare workers is that you can see burnout in any industry, but healthcare workers in particularly really have to work through the concept of moral distress. And COVID has really shown a light on that concept.
During COVID, we know we’ve had a scarcity of resources, anywhere from personal protective equipment to ventilators and oxygen, and very difficult decisions have to be made on a daily basis in many care settings.
And on top of scarcity resources, you have all of these healthcare workers who came into healthcare with a sense of duty and obligation to help their patients, and now they’re being pulled into wanting to provide that care and cover these extra shifts despite all these limited resources, but they’re also facing increased personal risk. They have additional personal and family obligations that they are also having to juggle at the same time. So it’s really just making it difficult.
And when nurses are tired or burned out, we see that ripple across the whole healthcare community. Research has told us over and over again that high levels of burnout, high levels of stress, lead to decreased quality of care, poor quality of life for our patients, poor quality of life for the healthcare workers themselves, and increased absenteeism. So it’s a big vicious cycle.
COVID has led to increased stress, which leads to burnout, which leads to short staffing and, in return, healthcare organizations are now having to turn to supplemental staff, expensive travel staff. One of the most recent figures I found was that in 2020, current turnover rate for staff registered nurses was at 20%. And that was similar for all types of employees within the healthcare environment. And vacancy rates right now, 10% of all nursing positions are unfulfilled. So you can see where burnout is going to lead to more open positions, more vacancies, which can in turn lead to decreased care, being provided, decreased patient outcomes, so it is a big vicious cycle that we need to be concerned about.
Dr. Bjorn Mercer: And I’m glad you brought all that up because when I think of nurses, I have a lot of experience with nurses. My mom was a nurse, my wife was a therapist, so she’s an occupational therapist and at her hospital, as with every hospital and clinic, the backbone rests on nurses. Nurses do everything. There’s a variety of different types of nurses, full nurses, CNAs, everything like that. Everything that happens in a hospital or a clinic, a nurse does. The doctors come in, they’re great, whatever, but the nurse does everything.
So with COVID, all these healthcare workers were the first ones to see COVID patients. They’re the first ones to try to figure out how to do the PPE and how to really protect themselves, but they’re also putting themselves at great risk. So can you say a few words about just the risk that nurses were putting themselves through and their families through during COVID?
Stacey Malinowski: Well, unfortunately, it’s not the first time and it probably won’t be the last time. I can share from personal experience. While I’m not working with patients at the moment, we had the Ebola scare several years ago.
I was working as a nurse educator and clinical specialist at a healthcare organization and every day, the guidance on the use of personal protective equipment changed, literally every day. So it was exhausting every day to learn all the new updates, the new standards, the CDC guidance, because you want to do the right thing, you need to do the right thing, to make sure all of your staff is prepared.
So you have healthcare are workers that are working with changing guidance every day that want to do the right thing, that are trying to do the right thing, and it changes and you never know what that is. So you’re constantly at risk because the guidance keeps changing. And that’s what’s very frightening for a lot of healthcare workers, I think.
Dr. Bjorn Mercer: And it totally makes sense that the guidance does change, because protecting employees, nurses, everybody, they don’t know, and they’re learning as they go on. So it’s very, very difficult where on day one, it’s going to be perfect because it’s always going to slightly adjust.
Now, one of the things you also said was the nursing shortage. Now I remember working at community colleges years ago and there’s a nursing shortage. There’s a nursing instructor shortage. Why is there kind of an endemic shortage of nurses?
Stacey Malinowski: If I could answer that for you, I would probably be a very famous and popular person, but it’s just so multifactorial. One of the beautiful and great things about nursing is that there’s so many different types of nurses you can be.
And so a lot of nurses will come into nursing, they will work in the hospital for a short period of time. And then they’ll find that their passion lies somewhere else within nursing, within maybe community or public health, maybe it’s in nursing informatics. So you have of nurses that are constantly coming in, but they don’t always stay at the bedside. And so that’s where we’re really feeling the effect is the shortage of direct-care nurses.
We do have a very aging nursing population, and there’s consistently not been a pool of nurse educators to take all applicants that want to join. We also have insufficient clinical sites, so people want to come to nursing school, but schools can’t let them in because there’s nowhere for them to go to clinical. There’s nowhere to educate them. Our nurse educators are averaging in their upper fifties and they’re going to be retiring soon. So we need to focus as much on filling the bedside nurses as the nurse educator positions.
Dr. Bjorn Mercer: And I’m assuming, and I’m going to compare nursing to lawyers, if that makes sense. As a nurse, you can make a lot more money just being a nurse versus being a nurse educator. So the ROI doesn’t quite make sense if you’re thinking about peer salary.
Stacey Malinowski: Absolutely, especially if you consider a lot of direct-care nurses work three 12 hour shifts per week. That’s considered full-time. Then to go into academia where you are working, as we know, very long hours for a much lower salary, a lot of people aren’t able to make that change.
Dr. Bjorn Mercer: I’m really glad you brought that up because I’ve seen the nursing shortage in parallel, I guess you can say, from the different institutions that I worked at. And then also, of course, just seeing my mom being a nurse for decades.
And so this leads us to the next question is, how has healthcare been affected by the concept of the Great Resignation? Now, one of the things I want to throw on there is nurses, and I think all medical staff, have to deal with the fact that people die and people come in very sick. Or even other times that you see chronic issues and people and emotionally that is extremely difficult for people. And, again, for people who don’t work in healthcare, maybe they don’t quite realize that. But when you see somebody essentially suffer, I mean, that affects you.
Stacey Malinowski: It does, it does. So, again, we have our concept of moral distress. We have compassion fatigue that can set in over time with nurses. And as far as the Great Resignation, the healthcare industry is just about up there with the tech industry as having the highest rates of resignations across all occupations.
And earlier this year, we saw 4% increase in resignations in healthcare, and that’s all across nurses, social assistance positions, it’s everybody we need right now. We do know that approximately 22% of direct-care providers are planning on leaving the industry within the next year, which is even scarier. We’re going to have more positions to fill.
However, there is good news to it. We have noticed an increase in applications to nursing school. So those seem to be up about 5% over previous years, because a lot of people have seen what’s going on and they’re like, “What can I do? I want to do my part I want to help.”
And new nurses are really going to have a lot of really great opportunities to enter the workforce not only quickly, but to earn very competitive wages over what we would have traditionally, coming out of school.
Now, of course, there’s a downside to that. Statistics tell us that it takes about two months to fill any nursing position, and that’s just a general direct-care nurse. If you want to fill specialty positions, you’re looking four to six months. So critical care, operating room, those types of positions. And not to mention the cost to healthcare facilities. It can cost about $50,000 to train and replace one nurse. So the revolving door is very expensive to healthcare organizations.
Dr. Bjorn Mercer: And I can see how that revolving door is so critical because if I make a mistake, I’m just typing all day. It’s okay. If a nurse makes a mistake, it could be somebody’s life. And so, proper training and experience is so critical in the healthcare industry. How has technology shaped nursing care during the pandemic make and how will that continue in the post pandemic era?
Stacey Malinowski: Well, that’s a great question. And I think that if any one good thing has come out of COVID related to healthcare delivery, it’s the virtual healthcare technologies we’ve been seeing like telehealth. And this is something that many areas have struggled to implement over quite a long time now. And this has really created a rapid uptake.
And I know for many people, telehealth may not be the preferred method of how to see your doctor, but having that ability to remotely connect with your healthcare provider helps overcome so many barriers that we are seeing pre-pandemic.
So my hope is that for our 40% of Americans who have chronic health conditions and all those that don’t even know they have chronic conditions yet, they will now be able to seek consistent care from the comfort of their own home, which may be more likely to help them be compliant. Because non-compliance is one of our biggest issues with helping provide care for people with chronic health conditions. And I think we’re going to see a lot of chronic health conditions with those long COVID cases that we’re seeing. So telehealth is going to be a great option for people who just can’t make it out of the house.
Dr. Bjorn Mercer: And telehealth is a great option because honestly, with a lot of people’s medical issues, it doesn’t mean that they have to go into the office. They have to be seen, they have to have all this, but versus checkup and the doctor or the nurse practitioner or whatever, can help provide them or guide them in a way to really feel better. Now with post-COVID issues, do you see that affecting people’s health for years or is it even potentially decades?
Stacey Malinowski: I don’t think we fully know yet. I think it’s going to depend on the previous state of health, perhaps, for some of the patients who had COVID if they had chronic conditions beforehand. But I think it’s going to depend on the severity of illness that they had, but I would not be surprised if we do see people who suffer with these long-term complications, especially related to their heart and lungs for many, many, many years to come. I would not be surprised.
Dr. Bjorn Mercer: And, unfortunately, that makes sense. My wife and I had COVID and so I guess you could say almost a year past from having it, we don’t notice any issues and, knock on wood, we’ve won’t have any long-term issues. But COVID, it really stuck around with us for, it took a full month to recover and then another six months to really shake all of the ongoing issues. So it definitely lasted in us lot longer than we thought it would.
And so that brings us to the last question, is as a nurse, what tips would you give consumers sifting through all of COVID-related information and misinformation that is circulating?
Stacey Malinowski: That’s an excellent question. First and foremost, I think that everybody needs to consider their source when they’re obtaining COVID related information. And not only consider your source, but what’s your source’s source.
So, you have two primary mechanisms, really, that we see people obtaining information. There’s social media, which presents a lot of information and unfortunately, a lot of people will take things at face value. They’re not considering where that information, where that post is being reposted from.
SO I really encourage people to have their own arsenal of reliable sites for getting information. Yes, it may take a few extra minutes to go on your own and seek out this information, but I really think that it’s the prudent thing to do.
So, some websites that I really like that have the most updated and what I feel is the most unbiased information include the Centers for Disease Control and Prevention, World Health Organization, and I also really love to go to my county’s health department website. I live in Maryland. The State of Maryland website has a lot of very good and up-to-date information.
If you like to read at a little more technical level MedlinePlus, that is a health information library that you can Google, find online. And it’s curated by the National Institute of Health. And it has got not only a lot of COVID-related information, but it also has a lot of different languages available. And so I always recommend that to patients. And if you’re looking for information for children, healthychildren.org is the site that was created by the American Academy of Pediatrics, and that’s a reputable site as well.
The other thing to remember is your primary-care provider knows you best. So if you have questions, concerns, they’re really the best person who knows your whole health history. They know your medications, they know your family history. So if you have anything that’s concerning, I really encourage a conversation with them and they will provide you the most up-to-date information.
But, again, if you hear something that just doesn’t sound right, or if it sounds very alarming, consider your source, do your research, check it out. And especially before you repost that post, make sure you check that information to see if there’s any merit or fact to it.
Dr. Bjorn Mercer: And I’m glad you talked about that. Even just saying, check your information before you repost something. I think people are just so apt to just go through social media and to hit a like, or to repost something when in reality, anything you put out there, you should really be very careful in what you post because the difference between information and in misinformation is actually very, very subtle and we could all misinform ourselves or others unintentionally.
So here’s a question: Nursing and nurses are oftentimes the most trusted professionals in all of America for years and years and years. And so why do you think COVID has become so political? Now, of course, I’ll put it that politicians for the most part have had some of the lowest approval ratings in history over the last few years. And then so nursing and healthcare has had very high. And so how do you get such confusion when it comes to something like this?
Stacey Malinowski: That’s a very good question. I think, as with everything, timing. It’s been an interesting time between elections and COVID all happening simultaneously. I try to stay away from politics. And I honestly do. I try not to read anything about it. And I think a lot of healthcare providers, our first primary concern is for our patients and their health, their wellbeing, advocating for them.
And I know that I can just say that my goal is to just do what I can despite let’s say vaccine and I fully understand there’s some people who do not want it, choose not to have it, cannot have it. I’m not actively working in the healthcare setting, so I wanted to do something. So I volunteered at the mass COVID vaccine clinics within my community. And it was amazing there to see the people who had come in to get their vaccines and some were very happy to get it, and some felt as though they had been forced to get it. And my job is to smile, administer my vaccine, and provide the most factual information about that vaccine that I can.
Dr. Bjorn Mercer: That’s a perfect response. And it makes me think also that I think that sometimes people don’t realize that healthcare and science is not a perfect science. We learn more about what’s going on by observing and then we react to those observations by hopefully putting out better policies.
And just like you said, check with your primary care, check with your local healthcare provider, check with all those different things, all those different people, because at the end of the day, your local healthcare worker cares about the number one thing, which is helping people.
Now not to get, like you said, too political, but politics is not always about “helping people,” it’s about power. And so there could be a lot of misinformation out there because certain people want to make sure that their side wins or the other side loses and stuff like that. And when that is played out, everybody loses.
And so it’s really, really just important to focus on, like you said, where are your sources? What kind of quality information are you getting out there? And also giving people a little bit of slack, because as with any healthcare, when the original policy comes out, it doesn’t mean that it is perfect and it adjusts over time. So absolutely wonderful conversations, Stacey, any final words?
Stacey Malinowski: I think just an important thing for everybody to remember is that each person’s experience with COVID is completely unique to them. And so we need to be mindful of that. We need to do what makes sense for ourselves, our families, our communities. And an important part of that is being informed and making sure that we have that factual and correct information, and just remembering everybody’s experience is unique. And just because something happened to one person does not mean it’s necessarily going to happen to ours and just to be open and mindful.
Dr. Bjorn Mercer: That was perfect. And, today we were speaking with Stacey Malinowski about COVID and burnout and my name is Dr. Bjorn Mercer. And thank you for listening.