A sign during the COVID pandemic, Sept. 25, 2020 | Susan J. Demas
Nurses in Michigan are exhausted.
In the years leading up to 2020, they faced a fatigue largely emanating from what nurses have described as workplaces where they have been doing too much with too few people.
Then, the pandemic arrived. Immediately, it began to tug on the strings of everything that had been deteriorating — and, at this point, nurses say it seems as though everything is unraveling. Or, for some, has unraveled.
Now, Michigan’s nurses describe experiencing deep burnout fueled in large part by inadequate staffing and abusive workplaces — something that has driven health care workers across the country to strike and quit in droves. Faced with the emotional and physical fallout from this, and what seems like no end in sight, nurses are leaving their jobs in a state where there are thousands of nursing vacancies in hospitals across Michigan.
“What nurses did and have done during the pandemic to keep our communities safe and healthy is nothing short of extraordinary,” said Christopher Friese, a registered nurse and a professor of nursing and public health at the University of Michigan. “Now, we need the public to recognize that nurses need some TLC.”
Friese is the lead author of a newly published study from U of M researchers that reported about four in 10 nurses in Michigan said in March 2022 that they planned on departing their jobs in the coming year — including 59% of nurses 25 years old and younger. About 9,150 state-licensed nurses in Michigan participated in the study that was published in the peer-reviewed Medical Care journal.
In the study, nurses paint a picture of a health care landscape in Michigan that’s deeply concerning to leaders in the field who are urging hospital executives and lawmakers to increase support for workers struggling to keep their heads above water.
That additional support, they said, is crucial in a state where about 1,700 hospital beds in Michigan closed during the pandemic because of a lack of staffing and where there are about 27,000 job openings in Michigan hospitals — including 8,500 nursing job vacancies, according to the Michigan Health and Hospital Association (MHA).
“I can’t underscore the sense of urgency here; I am very worried,” said Friese.
Of the nurses who reported they planned on leaving their job in Friese’s study, the top three reasons they gave for doing so included inadequate staffing, administration that is unresponsive to their concerns, and an increase in violence at their workplace, including sexual harassment.
The overwhelming majority — 84% — of the nurses who participated in the U of M survey said they were emotionally exhausted. Sixty percent said there was inadequate staffing at their workplace, 43% reported emotional abuse at their job, 26% faced workplace bullying, 22% reported physical abuse, and 10% reported sexual abuse.
These numbers, Friese said, are staggering and significantly higher than in years past. Prior to the pandemic, “a bad year would be about 20% of nurses saying they plan to leave,” he said.
Friese isn’t the only one who’s worried. From academics like the U of M professor and Michigan State University College of Nursing Dean Leigh Small to union leaders, hospital nurses and lawmakers, there’s a growing chorus of voices saying: Nurses are in trouble. And that does not bode well for any society, especially one that is aging.
“Nursing is known as being a very compassionate and caring profession,” said Small, who was a pediatric nurse practitioner for more than 30 years and began working at Michigan State University not long after the pandemic hit in 2020. “Seeing the suffering and death that occurred with COVID was really drastic. We usher people through some of the most sensitive times in their lives. Seeing multiple deaths a day takes its toll emotionally on nurses.”
That emotional toll became the tipping point for an increasing number of nurses, whom Friese said have been working in hospitals that have been “running too lean” in terms of staffing for about a decade. In other words: nurses who were already stretched too thin at the start of 2020 have been leaving their jobs during a pandemic in which they were told they were heroes but were not provided with the workplace support that matched such a description, the U of M professor said.
“Most hospitals use a mathematical model to determine how they should staff; it’s in their best interest to run as lean as possible,” Friese said. “The problem is, they’ve set the staffing plan without direct input from nurses.”
That means that while hospitals may seem to save money by not having additional salaries, it’s an ultimately unsustainable model, Friese said. After all, hospitals cannot function without nurses — and, Friese said, health care facilities are spending significant amounts of resources on recruitment and training in the wake of high turnover rates.
“I understand it’s expensive, but if we do not start that hard work and show nurses we treat their concerns seriously and are working on a plan to improve, more and more nurses are going to leave,” Friese said.
‘We need legislative action’
For James Walker, a registered nurse who works at Munson Medical Center in Traverse City and serves as a Michigan Nurses Association (MNA) board member, the answer to the challenges roiling the state’s nursing field is rooted in legislative action.
“The study confirms what bedside nurses have been saying for years,” Walker said of Friese’s publication. “Sending millions of taxpayer dollars with no real strings attached to hospitals has not fixed this problem. Creating a revolving door of new nurses who ultimately leave because of unsustainable working conditions will not solve this problem.”
Walker believes the “only way to address the crisis in health care is through strong legislative action.
“Nurses and patients deserve laws that prioritize patients over profits, force hospitals to maintain safe staffing levels, and limit mandatory overtime,” he said. “Millionaire health care executives have proven time and again that they cannot be trusted to do the right thing on their own. We need legislative action now.”
While Friese said he hopes hospital “executives could get on this tomorrow and say, ‘We have a crisis situation,’” he’s not incredibly optimistic that will happen. Like Walker, Friese is turning to elected officials for help. The professor said he’d love to see Michigan follow in the footsteps of California — the first state in the U.S. to pass legislation requiring minimum nurse-to-patient staffing ratios in acute care hospitals. The California legislation was passed in 1999.
Friese and others in the nursing field, including the MNA, have pointed to the bipartisan Safe Patient Care Act bills that state lawmakers introduced in 2021 as an example of legislation that could result in significant changes for Michigan nurses.
Those bills, which never made it out of committee under a Republican-led state Legislature, would have limited the number of patients a nurse could be assigned, curbed forced overtime for nurses, and required hospitals to release their nurse-to-patient ratios. Co-sponsored by both Democrats and Republicans, that legislation included House Bills 4482, 4483, and 4484, and Senate Bills 204, 205, and 206.
What nurses did and have done during the pandemic to keep our communities safe and healthy is nothing short of extraordinary. Now, we need the public to recognize that nurses need some TLC.
– Christopher Friese, a registered nurse and a professor of nursing and public health at the University of Michigan
State Sen. Kevin Hertel (D-St. Clair Shores), the chair of the Michigan Senate Health Policy Committee, said he expects something similar to the Safe Patient Care Act to be reintroduced in a Legislature now led by Democratic lawmakers. November’s election led to Democrats taking control of both the state House and Senate for the first time in nearly 40 years.
“We should look at minimum staffing and make sure they have enough colleagues with them,” Hertel said.
“We’ve done a lot of work trying to dive into this issue of staffing and have had conversations with the parties involved and will continue to do that,” Hertel continued. “We want to find a solution to make sure our health care systems provide the care that’s needed to Michigan residents.”
Hertel noted that the $1.3 billion supplemental spending bill signed by Gov. Gretchen Whitmer in March included $75 million to recruit and retain health care workers — something he said will help to lessen the pressure burnt out nurses are currently facing.
When signing House Bill 4016, Whitmer said that $75 million may be used to increase wages for staff and provide workforce retention bonuses, as well as for programs that provide tuition assistance, student loan support, workforce grants, and training.
In addition to legislation addressing nurse-to-patient ratios, Hertel said he would like to explore providing further resources for nurses, like tuition assistance programs and reimbursement for school loans.
That additional support would be welcome, Friese said.
Friese would also like to see legislation that addresses violence in health care settings — something that workers said has soared under the pandemic.
“Why is it happening? It’s a little unclear, but we know it’s harder to get health care services,” Friese said of the rise in violence. “Primary cares are full; folks are in the ER [emergency room] for a long time. Everybody’s waiting, and 84% of nurses in our sample are emotionally exhausted. You put these forces together, and you can see why we’re having these issues.”
In previous interviews, health care workers said individuals outraged over hospitals’ pandemic policies, like mask requirements and visitor restrictions, have violently lashed out against those trying to save their lives.
Federal and state lawmakers have recently introduced legislation to curb violence against health care workers, but the bills have stalled. At the federal level, for example, U.S. Rep. Larry Bucshon, a Republican from Indiana, and U.S. Rep. Madeleine Dean, a Democrat from Pennsylvania, in 2022 introduced the Safety from Violence for Healthcare Employees (SAVE) Act.
H.R. 7961 would “criminalize assault or intimidations of hospital employees,” Bucshon’s office said in a press release.
The legislation would enhance “penalties for those who knowingly assault and intimidate hospital employees” as well as protections for those who “may be mentally incapacitated due to illness or substance use,” Bucschon’s office said.
That bill was introduced in June 2022; no action was taken on the legislation last term.
At the state level, former state Rep. Richard Steenland (D-Roseville) in 2021 introduced House Bill 5530, which would have required hospitals and public health departments to establish a workplace violence prevention program created with input from frontline workers; provide training and reporting procedures for employees; and track and disclose violence incidents.
That bill had bipartisan support, but never made it out of committee.
Changes in nursing education
Small, the dean of MSU’s College of Nursing, said changes to nursing education requirements in Michigan could also help to bring more nurses into the state’s workforce.
Currently, the Michigan Board of Nursing mandates that, for nursing students, one hour of simulation time — time that students spend in labs and other facilities simulating nursing care — is equivalent to one hour of traditional clinical time — time students spend in settings like a hospital. Other states, like Colorado, use a ratio of one hour of simulation time equals two hours of clinical time, which Small said she would like to happen in Michigan.
If that ratio was changed, Small said it would allow for schools to accept more nursing students because they wouldn’t need to rely on finding additional clinical sites for any influx of students, which she explained can be a significant challenge.
“Across the state, we could take in more students,” Small said.
“The pinch point is always where can we find clinical placement?” continued Small, who noted she has written to Whitmer about the desired change.
Norman Beauchamp, executive vice president for health sciences at Michigan State University, said he would like health care education to further expand into the more rural parts of the state. That wouldn’t solely pertain to nurses, but it could translate to an influx of nurses into areas that are medically underserved, Beauchamp said.
“If you can train people who come from those communities or train them in those communities, they fall in love with those places and want to stay there,” Beauchamp said.
Millionaire health care executives have proven time and again that they cannot be trusted to do the right thing on their own. We need legislative action now.
– James Walker, a registered nurse who works at Munson Medical Center in Traverse City and serves as a Michigan Nurses Association board member
Additionally, Small said her college is “trying to build resilience” among future nursing professionals. In other words, she’s trying to expose students to the stress of nursing in simulations that can be monitored by instructors who can then provide support for the students.
The dean added that the nursing school is also “trying to strengthen overall wellbeing here at the college” and has recently initiated a wellness committee that includes students, faculty and staff. With that support, Lee hopes to provide the necessary mental health resources for students going into an often stressful career.
All of these efforts, Lee and Beauchamp hope, will translate to a workforce with a greater number of nurses who can focus on their patients instead of exhaustion.
“People leaving the profession — the likelihood of that will continue until the shortage is addressed,”Beauchamp said. “Part of the risk is the shortage we face now, but also the shortage we’ll face in the upcoming years unless we find a solution to this.”
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