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Nursing is in crisis. The pandemic is largely to blame. Here's what comes next

The pandemic has changed nursing, raising questions about the future of nursing and most immediately, who wants to even be a nurse. This crisis in nursing is causing nursing educators to quickly rethink how they train their students and making health systems rethink how they recruit and retain nurses.

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Associate Professor Erica Evans, left, demonstrates patient care techniques for nursing student Emma Purrer,<b> </b>in the School of Nursing &amp; Healthcare Leadership at Minnesota State University Moorhead, in Moorhead, Minnesota, Oct. 5, 2020.
Submitted / Dave Arntson / MSU Moorhead
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SIOUX FALLS, S.D. — The pandemic has beaten and battered many nurses into numbness.

Numb to the numbers. Numb to people. Numb to deaths.

That’s how Jodi Doering describes the scars of being a nurse during the COVID-19 pandemic, facing surge after surge of patients, including many who won’t leave the hospital alive.

Doering is a veteran nurse who is working as a travel nurse at hospitals in South Dakota. She’ll be a nurse until she dies, she said, invoking an old nursing joke. But the seemingly endless pandemic is making nurses ask the question: Do I even want to do this job?

“That’s a conversation that happens literally every shift amongst people, whether they’ve been there for six months or 30 years,” she said. “There’s a group of people who will do it till they die, because that’s what they’re meant to do, and there’s a group of people who maybe were going to do that until they die,and now it’s like, ‘I can’t do it anymore, I absolutely cannot watch these people suffer anymore.’”

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The pandemic has changed nursing, raising questions about the future of nursing and most immediately, who wants to even be a nurse. This crisis in nursing is causing nursing educators to quickly rethink how they train their students and making health systems rethink how they recruit and retain nurses.

The upheaval in nursing was topic No. 1 during a December meeting of nursing education leaders in Minnesota, said Carol Roth, associate professor and co-chair of Minnesota State University's School of Nursing & Healthcare Leadership, in Moorhead, Minnesota.

“What we ended up talking about was how this is just a massive crisis of our workforce,” she said. "It's more than just a shortage. It's also nurses who are choosing to leave the profession."

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Nursing students Titilola Kolawole, left, and Chantell Mindt rehearse patient care on Apollo, a realistic patient simulator faculty can program to respond to students like a human patient, at the School of Nursing &amp; Healthcare Leadership at Minnesota State University Moorhead, in Moorhead, Minnesota, March 1, 2021.
Submitted / Dave Arntson / MSU Moorhead

Many nurses — both young and old — are burned out and quitting, or considering it. They’ve borne the brunt of equipment shortages, missing coworkers, overflowing COVID wards, angry and difficult patients, and death after death after death.

A spring 2021 nationwide survey of nurses by Vivian Health, a health care career company, said 43% of respondents were considering leaving health care, and two out of three nurses said they felt more stressed about their jobs than a year previously, soon after the start of the COVID-19 pandemic. And that survey was conducted before the deadly surges from the delta variant and now the omicron variant.

"This survey confirms what has become plain in the past year: The health care workforce is in an upheaval," Vivian concluded from its survey.

Other nurses are seeking a change of scenery, taking easier jobs or eyeing much-needed, and therefore lucrative, temporary nursing gigs around the country — what’s known as travel nursing. But those jobs aren't any easier, and usually are most urgently needed at COVID hotspots.

Jessica Meyers, a travel nurse recruiter based in South Dakota, said she's made it a priority to check in on her nurses, making sure they're taking care of their mental health, or even talking through if doing the job is the right thing for them anymore.

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“We’re starting to see the strain in the people that have been saving us and been doing everything that they can to keep the public healthy, and I don’t blame them one bit," Meyers said.

This isn’t the Great Resignation. It’s more of an industry wide sigh of exhaustion and a cry for help.

While the pandemic spurred the nursing crisis, concerns about nurse staffing aren't new or unrecognized. The American Association of Colleges of Nursing identifies a number of pre-pandemic causes of a nurse shortage, including an aging population requiring more health care, already insufficient staffing, and nurse retirements with too few nursing school enrollments to cover the gap.

“I think when you look at the whole scheme of things, the nursing shortage has been coming," said Erica DeBoer, chief nursing officer at Sanford Health, a Sioux Falls, South Dakota-based health system with clinics and hospitals in the Dakotas and Minnesota. "It has been something that has been on the forefront for, really, more than 25 years. And so, when you think about what the pandemic has done, it’s accelerated some of that.”

Sanford Health is seeking to cover the gap by, among other strategies, working with nursing schools, recruiting international nurses and getting creative with its own "enterprise" float pool of nurses , who can move as needed between Sanford facilities, she said.

At Essentia Health, a Duluth, Minnesota-based health system whose footprint spreads from North Dakota across Minnesota and Wisconsin, it's become abundantly clear a nursing shortage is a short-term issue, said Chief Nursing Officer Rhonda Kazik.

“Now we’re saying, let’s assume this is going to be our new normal," she said. "How do we reset everything to actually meet this new need, demand and expectation, not only of our workforce but of our patient population? So we’re shifting — we’re shifting the tactics to get to a sustainable workforce.”

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Nursing student Jamie Erno uses a virtual reality headset to simulate various health care scenarios including patient care and communication with family members, at the School of Nursing &amp; Healthcare Leadership at Minnesota State University Moorhead, in Moorhead, Minnesota, March 1, 2021.<br/><br/><br/>
Dave Arntson

One crucial component, she said, is to"deepen the reach of our pipeline" to potential future nurses, working with high schools and even grade schools to get students thinking about a potential future nursing career.

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Essentia also deepened its relationships with nursing schools, most notably in a partnership with Minnesota State University Moorhead's School of Nursing & Healthcare Leadership, creating the Essentia Health Center for Nursing on the university's campus.

Its leaders say the partnership has paid dividends in the MSUM's new bachelor of science in nursing program, which will graduate its first official class this summer, with Essentia providing equipment and offering crucial on-site clinical experiences for students, among other contributions.

MSUM's Roth and Alicia Swanson, associate professor and bachelor of science in nursing program coordinator, said their program provides a deep and sustained education for prospective nurses in developing and practicing self-care and resilience strategies — strategies that the pandemic has shown are must-haves, both now and in the future of nursing.

“This COVID pandemic has only exacerbated something that has been existing for years, about burnout," Swanson said. "I think this is an opportunity to be, and do, better."

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Functioning suction, air and oxygen ports are arrayed in a hospital simulation room in the School of Nursing &amp; Healthcare Leadership at Minnesota State University Moorhead, in Moorhead, Minnesota, Oct. 5, 2020.
Submitted / Dave Arntson / MSU Moorhead

Jeremy Fugleberg is an editor who manages coverage of health (NewsMD), history and true crime (The Vault) for Forum News Service, the regional wire service of Forum Communications Co, and is a member of the company's Editorial Advisory Board.
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