After working on the frontlines of the COVID-19 pandemic for three years, nurses around the country are still struggling—and many are demanding better support and working conditions from their employers, according to a survey from Joslin Insight and the American Nurses Foundation (ANF), the philanthropic arm of the American Nurses Association (ANA).

Ready-to-use slides: The state of the nursing workforce

About the survey

For the survey, ANF and Joslin Insight polled 12,581 nurses from all 50 states and the District of Columbia between Nov. 1 and Nov. 25. The survey was the third annual assessment and 13th survey conducted by ANF since April 2020.

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The online survey was sent to nurses working in a variety of settings. For instance, 53% percent work in acute care hospitals; 12% work in primary, ambulatory, or outpatient care facilities; 6% work in community or public health facilities; and 6% work in schools of nursing.

Overall, 72% percent of respondents provide direct care to patients. Among the respondents, 91% said they are currently employed, with 78% saying they are employed full-time, and 4% identifying as a travel nurse.

Of the respondents, 71% identified as white, 11% identified as Black or African American, 5% identified as Hispanic or Latino, 4% identified as Asian, and 4% identified as mixed race. In addition, 41% of respondents were 55 or older.

How nurses are faring in the workplace

In the survey, 64% of nurses reported feeling stressed, and 57% said they were exhausted—and certain groups of nurses are faring worse than others. When ANF's researchers analyzed the data by age or tenure, they found that younger and less experienced nurses are struggling more with their emotional health than their more experienced counterparts.

For example, 32% of respondents with less than 10 years of nursing experience said they are either not or not at all emotionally healthy. Among nurses with 41 to 50 years of experience, just 8% said they are either not or not at all emotionally healthy.

Overall, the mean score for emotional health remains low, with a score of 3.3 on a scale of one to 5, marking a 6% increase from the January 2022 survey.

There is a persistent gap between different groups of nurses throughout the data. For example, nurses with less than 10 years of work experience reported feeling less valued, less supported, and less hopeful.

When asked if they felt anxious in the past 14 days, 61% of nurses under 35 said "yes," compared to just 33% of nurses 55 or older. In addition, 33% of nurses under 35 said they felt depressed in the past 14 days, compared to just 18% of nurses 55 or older. According to ANF, this trend has not changed since it was identified in 2021.

Meanwhile, the survey identified an increase in verbal abuse toward nurses in the workplace, with 53% reporting an increase in verbal abuse since the start of the COVID-19 pandemic.

When respondents were asked whether their organization has provided a way for them to report verbal abuse, 28% said "no" and 15% said they were "not sure." In particular, a higher share of nurses from large acute care hospitals said their employer does not have a system in place to report verbal abuse.

The survey also evaluated the state of racism in the workplace. Overall, 12% of all respondents said racism has increased since the pandemic, but 21% of nurses of color said racism in the workplace has increased.

When respondents were asked whether they have challenged racism in the workplace, just 22% said "yes" and 65% said "no." In addition, a higher share of nurses of color reported challenging acts of racism compared to respondents who identified as white

Nurses require additional support from their employers

According to ANF, the Survey of Perceived Organizational Support (SPOS) measures a workers' view of their organization's commitment to them, how their organization values their contributions, and whether they are concerned about their well-being.

To measure how nurses perceive the support they receive from their employer, ANF measured how much respondents agree with five indicators, with statements like "My organization really cares about my well-being" and "My organization responds to my complaints."

Notably, these scores have not improved over the last four surveys, with more nurses consistently strongly disagreeing with the statements. The SPOS data indicates that nurses still need more support from their organizations.

According to the survey, 84% of nurses say they are stressed or burned out. Overall, almost 50% said they were experiencing some level of burnout. Meanwhile, 21% said they felt like they were beginning to burnout, 22% said they were already burned out, and 4% said they were completely burned out and may need help.

In the past six months, 22% of nurses said they have changed positions. Moving forward, 19% of nurses said they plan to leave their position in the next six months.

"The staffing shortage has gotten even worse and most of the medical staff currently working are burned out and ready to leave. It's hard to stay positive in this type of environment. I'm at the point where I want to leave nursing, but I am unable to because I'm supporting my family," one of the survey respondents said.

When asked what is most important for work satisfaction, 58% of nurses said work-life balance, making it the number one answer. Among nurses under 35, 63% of respondents said this is most important for work satisfaction.

However, nurses also said compensation (41%), a safe work environment (33%), and doing meaningful work (30%), would help improve their work satisfaction.

When asked whether they feel their team is better prepared for a future variant, surge, or pandemic, only 30% of respondents said "yes," while 29% said "maybe" and 41% said "no."

According to ANF, concern about burnout among nurses is a key issue in healthcare today. In particular, the U.S. Surgeon General's Advisory on Building a Thriving Health Workforce report noted that "Burnout is associated with risk of mental health challenges, such as anxiety and depression…. While addressing burnout may include individual-level support, burnout is a distinct workplace phenomenon that primarily calls for a prioritization of systems-oriented, organizational level solutions." (Hollowell, Becker's Hospital Review, 1/26; American Nurses Foundation report, 1/24; American Nurses Association news release, 1/27)