Pre-pandemic, it wasn't uncommon for hospital nurses to have side gigs on their days off, be it paid or volunteer work.
"Because of the way their [schedules] are set up, they have always felt compelled to do something else," said Katie Boston-Leary, PhD, RN, referring to the typical three 12-hour shift weekly schedule for a nurse in the hospital setting. Dr. Leary is the director of nursing programs at the American Nurses Association and former chief nursing officer at the University of Maryland Capital Region Medical Center in Cheverly.
During her time as a CNO before the pandemic, Dr. Leary would make rounds to check in with nurses in the intensive care unit.
"That's when I started to hear from almost everyone that they had other things that they do outside of work," she told Becker's. At the time, side gigs mostly included volunteer work at places like the local women's shelter or pet shelter, as well as hobbies like improv.
Now, the side gig landscape has changed, with nurses using days away from the hospital to work on entrepreneurial endeavors. Part of that shift is, of course, inflation, and the need for additional sources of income. Data from the St. Louis Federal Reserve shows the percentage of employed people in the U.S. working multiple jobs has steadily increased from 4 percent in April 2020 to 4.8 percent in June 2022.
In some states, nurse salaries fall close to what the livable wages are, Dr. Leary said, citing the "2020 National Nursing Workforce Survey" from the National Council of State Boards of Nursing and the National Forum of State Nursing Workforce Centers. This leaves little room for saving, especially for nurses who are the primary household breadwinners, and is traditionally why many have felt compelled to get secondary jobs, she said.
In today's landscape, however, finance is hardly the sole element factoring into nurses' decisions to take on side hustles. Becker's heard from at least a dozen nurses who since the onset of the pandemic have taken on side hustles in hopes of reducing their hours at the bedside or eventually developing a revenue stream large enough to leave hospital nursing altogether.
And the nurses we heard from are just the tip of the iceberg. A survey of more than 2,500 nurses published in May by Trusted Health found nearly 60 percent of respondents reported they were actively looking for a job away from the bedside or outside of nursing completely (34 percent), had plans to do so within the next year (21 percent), or were planning to retire from the workforce (3 percent).
Over the last 13 years, Lorie Brown, RN, has helped hundreds of nurses start their own business. She worked as a nurse in hospitals for 12 years across California and Indiana and has since become an attorney.
"With your own business, unlike nursing where patients come with the room, nurses need to market their services to get clients," Ms. Brown said. "I say once a nurse, always a nurse. We just have a different kind of patient."
Staffing and patient safety
Several nurses Becker's heard from mentioned unsafe nurse-to-patient ratios as a contributor to reducing their hours or planning to leave the hospital setting.
California is currently the only state to have successfully legislated nurse-to-patient ratios, requiring hospital wards to maintain a ratio of 1 nurse for every 5 patients, while intensive care units must maintain a 1-to-2 ratio.
Libby, who asked that we use her first name, is a nurse in Alabama who spent 12 years caring for open-heart surgery patients in the intensive care unit. Last fall, she left her full-time job as a charge nurse at a larger hospital to take on a nursing instructor role. She also works about one night a week at a smaller hospital. Between both of those roles, she still works full-time.
"It's so much less stressful," Libby said. A key factor for her leaving the larger hospital last year was staffing.
"What really, really got me burnt out was that when it came down to canceling a surgery or not — when our hospital was full — it came down to 'Did we have a bed to do the surgery?' not, 'Do we have a nurse to take care of that patient?'" she said.
As a result, Libby said patient outcomes went down, citing rising pneumonia rates and readmission rates.
"If you don't have the time to do good nursing care, then the patients suffer," she said.
It was a frustrating and difficult decision to leave the larger hospital because "I love what I do — I love open-heart patients," she said. "Nurses kind of find their specialties and I feel like that's mine and I'm not doing, which has been kind of like an identity crisis. I'm not doing what I feel like I'm really good at," because of long-standing workforce and safety issues the pandemic has worsened.
Reyna, who asked that we use her first name, is a nurse in Massachusetts and experienced increased burnout once COVID-19 hit, citing "lack of PPE and nurse-to-patient ratios" as unsustainable for many nurses. She began Frontline Medical Group, a staffing agency, to combat workforce shortages in March.
"I want to offer a solution to the staffing shortage as a nurse, and from what I have gathered from my colleagues, changing the work environment gives them a break from burnout," she said. "Picking up a shift or two in a different working facility helps them reset. Or break the monotony of work. I want to offer solutions with the help of my colleagues."
Reyna still works full-time at her hospital as she builds her new business, but has stopped picking up overtime and plans to shift to part-time hours within a few months.
"I still truly love my job as a bedside nurse," she said. "I have no regrets. I [would] not trade it for the world. But to stay in the field, with today's burnout epidemic, for my well-being, working part-time [will] truly benefit me, and I'm [sure] the same goes for other nurses, too."
A former pediatric hospital nurse in Tennessee who asked to remain anonymous left her position in January. She manages an Airbnb and is working on building a mobile IV hydration business. Once the business is built out enough, she hopes to employ nurses and "give them freedom to work when they want to and practice safely with 1:1 or 1:3 [patient ratios.]"
She is currently working in a work-from-home nursing position, but eventually plans to leave that day job to fully focus on managing the Airbnb and the business, "which is looking pretty promising right now."
Chronic burnout
Despite wanting to return to the medical field, Theresa Brown, PhD, BSN, RN, wrote in a July 22 op-ed for Medscape that she is unlikely to return because of the "present form" of bedside nurses' work. Dr. Brown said years of overwork and underappreciation were "merely intensified by the pandemic."
Twenty-nine percent of nurses are considering leaving the profession, according to the 2022 "Nurse Salary Research Report." Amid these concerns, several states have considered strengthening or enacting legislation related to mandatory overtime for nurses to reduce burnout.
Bridgett Ann Miller Dixon, RN, a nurse at South Miami Hospital, has worked the night shift for 12 years. Once COVID-19 hit, her work became "increasingly stressful." That's when she purchased her own franchise of Let Mommy Sleep, a company that offers overnight care to postpartum mothers, she told Becker's.
"One key change my hospital could have made is by reaching out to individual nurses and have counseling sessions to help us to cope when COVID hit hard in the hospitals and we saw one too many body bags going to the morgue," Ms. Miller Dixon said.
Heather Walsh worked as a nurse in both hospital and school settings for 28 years.
"I was very torn when COVID-19 became our reality, as I felt compelled to return to hospital-based nursing to help in any way I could, but I also have a genetic disorder that affects my lungs and was uncertain of how I may be affected," Ms. Walsh said. "As it became more evident that COVID-19 would continue to impact our lives in so many ways for years to come, I began to research new trends in healthcare [and the] side gig economy."
Ms. Walsh's research resulted in her opening Ageless Aesthetics by HB Walsh, which she calls "an alternative to returning to work in a traditional healthcare setting."
"The decision to transition out of traditional healthcare was a fairly easy one when faced with the autonomy of making my own hours, being my own boss, being able to help people feel more confident, and earning the same salary as I would as a full-time hospital-based nurse in my first year in business," Ms. Walsh said.
Ms. Walsh doesn't have plans to return to hospital-based nursing, as she doesn't believe it will improve in the immediate future.
"Having been a part of the profession long enough to see many upheavals, shortages, changes in staffing and roles, I feel we will still need to go further into the negatives before the positive changes occur," she said. "Many nurses my age who have been in the field over 30 years have taken this opportunity to get out, and I don't believe they will come back under the current conditions. There are so many directions a nursing career can take that I expect this side hustle way of thinking to continue."