From novices to seasoned experts, the COVID-19 pandemic challenged all nurses in different ways. Facing a time of unprecedented turbulence in their careers, some baby-boomer nurses took the opportunity to retire early.
Stress and exhaustion, vulnerability to severe illness and fear of bringing the virus home to their families are just a few of the reasons baby-boomer nurses may have chosen to leave their jobs. But others stayed, despite the risks.
"To tell you the truth, I never even thought about retiring," said Nancy Brewer, BSN, RN, an experienced nurse at a hospital in Ohio that is part of Livonia, Mich.-based Trinity Health. "We have been through a lot of different things, a lot of different diseases, a lot of different isolation cases through my lifetime of being a nurse. So to me, it was just something else I had to step up to the plate for," she said, despite concerns about personal protective equipment supply, and potentially getting family members sick.
Graduates new to the field were up against additional challenges. Some nurses who entered healthcare at the height of the pandemic missed out on the normal level of support they would have received otherwise, as nurse managers were tied up taking care of patients.
"New grads came in, and because of the pandemic, during a really hard time, and said, 'This just isn't for me,' and so the turnover of the new grads was very rapid — within the first few months — much more rapidly than it was previous to COVID-19," said Kathy Sanford, DBA, RN, chief nursing officer at Chicago-based CommonSpirit Health.
Becker's spoke to Ms. Brewer along with two chief nursing officers to gain more insight about what made baby-boomer nurses work through the pandemic and the support these nurses offered new graduates entering the field amid the pandemic.
Nurse experiences
Jerry Mansfield, PhD, RN, became chief nursing officer for Columbus, Ohio-based Mount Carmel Health System in January 2020, around the time of the pandemic's start.
On his first day of work, a seasoned nurse there who had worked at Mount Carmel for more than three decades explained why she was still at the health system.
"She said it's serving the underserved in this community and meeting the needs of people in a very compassionate and caring way," Dr. Mansfield said.
He has continued to see that theme emerge throughout the pandemic during his two-year tenure as chief nursing officer.
Tenured nurses have told him the reason they work at Mount Carmel is because of the mission, the vision and the values, and that they would leave if the health system turned away from those.
During the pandemic, "every meeting, every incident command call, we always started with a reflection. The reflection could be something faith-based or have a spiritual underpinning from another nondenominational religious affiliation, could have been a quote from a famous person, could have been a prayer," Dr. Mansfield said.
"In those moments, sometimes that was the only moment you had to breathe during the day, and for us in this health system, it was a recentering on what our purpose was. I think that's why we are fortunate to have nurses who" have stayed, he said.
Another factor: Many of the 2,300 nurses at Mount Carmel also graduated from the Mount Carmel College of Nursing.
Therefore, "there is a deep connection between the college and the colleagues on the acute care delivery side really in all our delivery sites, and they stay because of the mission, vision, values, and I think that sustained them throughout the pandemic as well," Mr. Mansfield said.
CommonSpirit's Dr. Sanford also talked to nurses at her organization. There have been many reports about healthcare workers leaving their jobs, including a report released March 15 by analytics firm Elsevier Health showing 31 percent of clinicians participating in a global study said they were considering leaving their current role by 2024. Dr. Sanford asked experienced nurses at several of her facilities about what kept them from leaving over the last two years.
She said they all had the same message: "We're a team. We're a team on this unit. We're a team at this hospital. I could not leave my team members during a difficult time, so I put off my retirement. I could not retire early or leave my teammates. I could not leave the patients with so much need."
Nurses also cited the culture of their hospital as caring, with very visible leaders who visited them and were concerned about their welfare, according to Dr. Sanford.
A quote from one nurse: "You care about the organization when the organization cares about you."
Dr. Sanford also asked nurses why they thought some of their colleagues had retired, and most cited personal reasons such as caring for spouses, siblings, aging parents and grandchildren.
Overall in the U.S., caring for aging parents and sick spouses is a significant factor in Americans staying away from the workforce, The Washington Post reported April 4. The newspaper cited the Federal Reserve's latest Monetary Policy Report, showing that four times as many Americans are away from the workforce caring for spouses, siblings, aging parents and grandchildren than those who left the workforce to care for children during the pandemic.
"It wasn't that they were afraid to care for COVID patients. It was because most had personal reasons," Dr. Sanford said.
She said nurses also told her monetary incentives were appreciated, but their decision to stay "was about being here, doing the right thing for patients and supporting co-workers."
In reference to baby boomers, a nurse at a California hospital told Dr. Sanford: "I was already retired when the pandemic began, but I came out of retirement and returned to work. Why? Because I knew my patients and my fellow nurses needed me. I think baby boomers are idealistic, caring problem-solvers. I'm not the only one who couldn't stay away. There were others who came back to serve after their retirement."
Support for new nurses
Amid a tight labor market and challenging pandemic, experienced nurses have been tasked with supporting newer nurses, in addition to their own responsibilities.
Ms. Brewer of Trinity Health, who works mainly in surgery, said she would volunteer on the floor to help nurses prioritize tasks.
"A lot of them on the floors are younger nurses," she said, adding that they had to manage many different tasks when caring for COVID-19 patients. "If [patients] were having trouble breathing and in and out of isolation … trying to help [nurses] get through their day and stay organized is mostly what I did — mentoring them to learn 'this is important, let's work on this first and then maybe we can work on something else later.'"
She also stood in as a listening ear for patients when they weren't allowed to have family members visit.
"The new nurses that were actually scheduled for those patients didn't actually have time to sit there and do that. So just [being] that extra person up there to assist them with their duties and say, 'Hey I can sit here a minute and just stand at the doorway even.' Sometimes, you didn't even go in because of COVID-19, but you could just stand right there at the doorway and be a listening ear," Ms. Brewer said.
At Mount Carmel, added support has come partially through a centralized labor management pool.
Dr. Mansfield said the pool allowed clinical and nonclinical colleagues to volunteer into the pool and receive training for a variety of tasks that could include environmental services or outpatient areas and weren't as familiar to a worker who typically works on the acute care side.
"There was a real sense of camaraderie and folks working together to deal with these [COVID-19] waves, these surges that just kept coming when we already were short to deal with the volume we were experiencing," he said. "Our nurse managers, our clinical managers, directors of nursing stepped in to help with staffing as well. That's not ideal, but that's what we had to do to serve the patients who needed to be served."
Mount Carmel is also revamping its nursing residency program to include more role-playing and simulation experiences so new nurses gain insights into problem-solving within the clinical setting. That process began in January.
Additionally, the health system is recruiting for a critical care internship for the summer and a critical care fellowship.
Dr. Mansfield said the internship is for nurses who are in nursing school between junior and senior year to spend time in the Mount Carmel critical care units, while the fellowship is a much more concentrated experience where nurses spend 24 weeks in a structured orientation. The fellowship, which is open to college graduates, involves didactic learning, as well as training on how to work within a professional team.
"We're hopeful all programs will result in good first-year experience for nurses and then they'll stay," Dr. Mansfield said.
Outside of those programs, Mount Carmel is lowering its hiring age to 16 to work in either a nonclinical role or clinical support role.
At CommonSpirit, experienced nurses told Dr. Sanford they always try to be supportive to new nurses, but couldn't always give them the support they needed during surges because of how sick the patients were and because they didn't have the staff they would have liked to have or normally would have had. Overall, the health system's turnover rate about doubled among new nurses during the pandemic.
"I asked a few nurses about it, and they said the new grads because of COVID didn't get to do their clinicals in the hospital like they had," Dr. Sanford said. "They [new nurses] did their training in simulation labs, but that's not the same. So when they came out, they were not as prepared as new grads in the past. … Anytime you have new grads, they start as novices and it takes time for them to become an expert. We had these novice nurses coming out with the nurses on the floor taking care of patients at the height of when we had most COVID patients, so there wasn't a lot of time to spend with them."
As a result, CommonSpirit is accelerating plans in its five-year nursing strategy. This includes starting a national one-year residency program that incorporates virtual preceptors for new nurses to call and get support any time of the day, Dr. Sanford said. That program is starting this spring.
"We're excited about that because we also understand it's not just about getting out of school where in school you take care of one patient and have an extensive care plan for that patient," she said. "Out of school, you'll have four or five patients and you'll have people to supervise and you'll be coming into a new culture.
Dr. Sanford said CommonSpirit also began virtually integrated care this year so more experienced nurses can help less experienced nurses on the unit. The health system is forecasting that some nurses who might have retired because of being physically tired might want to stay with the health system through virtual nursing.
CommonSpirit is a 140-hospital system with more than 1,000 care sites in 21 states.