Nurse Well-Being and the Nursing Shortage — Are They Connected?

According to the American Association of Colleges of Nursing, the number of nurses employed in the U.S. is now approaching five million. So many nurses would probably not choose to enter the profession if they knew it might negatively affect their well-being. Yet from our recent nurse survey, we know that many nurses are leaving their jobs — or considering it — because they feel their well-being is suffering. The connection between nurse well-being and the nursing shortage is a contributing factor that healthcare organizations can work to improve.

Psychologist Abraham Maslow, in his famed hierarchy of human needs, theorized that humans’ most essential needs must be satisfied before they can focus on attaining higher goals. He put safety just after basic physiological needs such as air, food, and water. In the category of “safety,” Maslow included physical security, security of resources, employment, family, health, and morality. Without a feeling of safety and security, nurses may not be able to reach their full potential — or even perform their jobs at all. This theory shows a likely correlation between nurse well-being and the nursing shortage.

Nurses need protection from harm

The first of five pillars in the U.S. Surgeon General’s Framework for Workplace Mental Health and Well-Being is “Protection from Harm.” Without this pillar, the other four pillars — Connection and Community, Work-Life Harmony, Mattering at Work, and Opportunity for Growth — most likely could not fully exist. Protection from harm is so fundamental that we often take it for granted.

The Occupational Safety and Health Act of 1970 solidified physical workplace protections in the U.S. and gave rise to the concept of workers’ right to a safe and healthful workplace. But it took decades more to formally recognize that workers’ well-being has mental health requirements. In the Surgeon General’s framework, protection from harm entails both physical and psychological safety. Healthcare organizations must establish and maintain safety protocols for both types of threats to nurses’ well-being.

Physical safety hazards

Physical safety hazards for nurses can arise in several ways, such as the risk of contact with bloodborne pathogens through injuries from needlesticks and sharps, musculoskeletal injuries caused by adjusting or moving patients, slips, trips, and falls in the care setting, exposure to hazardous chemicals, such as cleaning agents or drugs, and exposure to infectious diseases.

Workplace violence

Healthcare organizations may not be able to predict or control unanticipated risks with widespread impact — such as a global pandemic — but they can take measures to prevent and mitigate forms of harm that originate close to home, such as workplace violence.

In our 2024 Nurse Salary and Job Satisfaction Report, we collected insights from 3,662 nurses across the U.S. and learned about the frequency that nurses encounter violence at work. We learned the following:

Verbal abuse

• Nearly a third of nurses (31%) had experienced verbal abuse from a colleague.
• Nearly two-thirds (64%) had experienced verbal abuse from a patient or family member.

Intimidation

• Over one-third of nurses had experienced intimidation from a colleague (34%) or family member (39%).

Physical abuse

• Nearly one-fourth of nurses (23%) had experienced physical assault or abuse from a patient or family member.

In addition, the report affirmed, “Healthcare professionals are expressing concern that workplace violence is exacerbating the nursing shortage.” Even when workplace violence did not directly affect them, our survey participants reported that incidents occurred regularly within their organizations, creating an environment of fear and uncertainty.

Of our survey participants, 12% reported weekly instances of violence, 10% reported monthly incidents, 8% reported quarterly incidents, and 7% reported yearly incidents. Organizations seeing frequent incidents could benefit from more strategies to combat this violence.

Mental health challenges

Threats to nurses’ mental health can occur in response to specific events or build up over time. Our survey asked questions related to nurses’ overall mental health and well-being, and we found that 17% reported that their work has a negative effect on their well-being, pointing to the need for strong mental health benefits and support. Without better support across healthcare organizations, both nurse well-being and the nursing shortage will continue to worsen.

Digging deeper, our survey looked at factors that positively affect nurses’ mental health and well-being. Here are a few of the 10 factors we asked about:

• Good work-life balance (67% of nurses reported)
• Effective, supportive leadership (59% reported)
• Manageable nurse-to-patient ratios or workload (50% reported)
• Good benefits (50% reported)

Compassion fatigue and moral injury

During and after the COVID-19 pandemic, the risks to mental health and well-being from an unsafe, stressful, or toxic workplace — combined with the risks of compassion fatigue and moral injury —underscored the fact that workplace well-being requires more than just physical safety measures.

The unrelenting burden of serving others in uncertain and highly demanding work environments can lead to a double impact of physical and mental exhaustion, and these impacts can make recovery doubly challenging.

Specific pain points

In our survey, we found some nurses experienced greater threats to their well-being. These were:

• Nurses in acute care and ambulatory settings were more likely to say that work has a negative effect on their mental health and well-being.
• Younger nurses were more likely to report experiencing burnout, moral injury, and compassion fatigue than other nurses.

What can healthcare organizations do to improve nurses’ well-being?

The data is clear. Nurse well-being is critically important, both to support nurses in their jobs and to improve retention — and the future of the nursing profession. Nurses are essential for the delivery of quality and safe care for all of us, yet they face many challenges in the work environment related to workload, stress, burnout, fatigue, and exposure to violence from patients, families, or even colleagues.

Here are recommended strategies for healthcare organizations to move the needle on both nurse well-being and the nursing shortage:

• Conduct regular risk assessments to identify the sources, types, and frequency of violence in acute care settings, including routine screening of staff to identify mental health risks.
• Develop and enforce policies and procedures that prevent, report, and respond to violence in the workplace.
• Provide training and education in a safe and open environment for nurses and other staff on how to recognize, de-escalate, and manage violent situations.
• Equip the acute care setting with security measures and devices, such as surveillance, cameras, alarms, locks, and panic buttons.
• Provide secure avenues for reporting as well as support and assistance for nurses who experience or witness violence, such as debriefing, counseling, and legal aid.
• Provide adequate staffing and resources to ensure a safe and manageable workload for your nurses.
• Offer flexible scheduling and adequate breaks to allow nurses to balance their work and personal lives.
• Provide opportunities for professional development, recognition, and career advancement.
• Establish a culture of support, respect, and collaboration among nurses and other healthcare professionals with zero tolerance for lateral violence.
• Implement wellness programs and interventions that promote physical, mental, and emotional health for nurses, such as stress management, mindfulness, exercise, and counseling.

How Relias can help

Did you know that professional development has been shown to increase nurse engagement and retention? Beyond compliance training, the ability of nurses to enhance their professional knowledge and achievement increases their levels of performance and satisfaction on the job.

Relias offers award-winning, accredited learning libraries for both clinicians and providers across the care spectrum.