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Nurses: The backbone of our healthcare system

By Bipin Mistry, MD, Chief Medical Officer

At some point in our lives, likely every one of us will have occasion to be hospitalized.

The nurses who care for us are not only a great comfort, but they also play a pivotal role in ensuring we receive the care we need. However, as I reflect on National Nurses Week this month and the state of nursing in the U.S., I believe now, more than ever, the profession of nursing needs our support.

The backbone of healthcare

As a practicing physician, I couldn’t have done my job if I hadn’t been surrounded by teams of dedicated, knowledgeable and compassionate nurses.

While doctors are widely considered the ones in charge of someone’s care, it is the nurses who forge relationships with the patients and in the process, learn valuable details that often inform their care management.

Nurses are in and out of patient rooms all the time. Through these frequent interactions, they may learn a patient is struggling to care for themselves at home or suffering a personal loss, such as the death of a pet. They may also recognize which patients are at an increased risk of a fall. These and other factors influence their recovery and should be taken into consideration when planning for their care.

An outsized effect on advancing health equity

As stakeholders look to reduce disparities in outcomes, nurses are being recognized for the role they play in helping to advance health equity.

Through their interactions, they pick up information related to a patient’s social determinants of health (SDOH), the nonmedical factors that influence health outcomes.

SDOH have a major impact on someone’s ability to live a healthy life, accounting for 80 to 90 percent of the modifiable contributors that are linked to health and risk outcomes.

Nurses advocate for their patients by gathering information and connecting them with social workers, behavioral health therapists or other professionals, determined by the patient’s specific need(s).

Increasingly, health systems are including questions around social drivers in the patient intake process, which also helps nurses improve outcomes in the course of treatment.

Advancing health equity is a team sport, and nurses could be considered the quarterback for in-patient care.

Frontline frustration

It’s fitting that the theme for this year’s National Nurses Week (May 6-12) celebration is “You make a difference.” Indeed, they do. Nurses are the unsung heroes of healthcare.

While we honor nurses for their incredible work, it’s also important to recognize the challenges they face, particularly stress and burnout.

The COVID-19 pandemic shone a spotlight on the high levels of stress encountered by healthcare providers, including nurses who were at the frontlines of the worst public health crisis in more than a century.

They witnessed extreme grief and frustration as they fought to save the lives of patients, while at the same time trying to avoid catching the virus or taking it home to loved ones.  

Unfortunately, the pandemic brought out the worst in some people as they became combative over masks, treatments and vaccines.

Once again, the nurses bore the brunt of the abuse. Stress levels reached the breaking point, resulting in a mass exodus from the profession.

Shortage concerns

Approximately 100,000 registered nurses in the U.S. left the workplace due to the stresses of the pandemic, according to a survey by the National Council of State Boards of Nursing.

Another 610,388 registered nurses with more than 10 years of experience and an average age of 57 said they planned to leave the workforce by 2027 because of stress, burnout or retirement.

Of the nurses surveyed, 62 percent said their workload increased during the pandemic and nearly half said they felt fatigued or burned out. These concerns were seen most in nurses with less than 10 years of experience.

registered nurses in the U.S. left the workplace due to the stresses of the pandemic.

The McKinsey Global Institute projects a shortage of 200,000 to 450,000 nurses by 2025, due to older nurses retiring earlier than expected and fewer young people choosing a career in nursing.

Make no mistake, this shortage will impact everyone.

According to data from the American Association of Colleges of Nursing (AACN), the number of applications to nursing schools fell 5.3 percent in 2022, ending a 20-year period of enrollment growth in programs designed to prepare new registered nurses (RNs).

Taken together, this data raises serious concerns about the potential impact on the nation’s nursing supply.

Critical support is needed now

While industry groups are encouraging collective action to strengthen pathways into nursing, an equally strong effort must be made to improve working conditions and provide support to those already in the profession.

Early in my career, I would see nurses get frustrated, usually because they were overburdened and no one was listening to them.

Often, all they got from the healthcare organization was, “Here’s pizza because you missed lunch.”

That response seemed truly bizarre and completely inadequate.

In the halls of Congress, two Democratic lawmakers (Sen. Sherrod Brown of Ohio and Rep. Jan Schakowsky of Illinois) have reintroduced the Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act.

If it passes, the act will set minimum nurse-to-patient ratios for all hospital units and protect nurses who speak out against unsafe staffing standards. The bill mirrors California’s nurse staffing law, which puts limits on how many patients nurses can be expected to care for at once.

Meanwhile, the Biden Administration has directed the Centers for Medicare & Medicaid Services (CMS) to issue minimum staffing standards for nursing homes.

At the provider-level, hospitals and health systems are increasingly bringing in nurse’s aides or assistants to take some of the pressure off RNs and help them make more efficient use of their time.

They are also seeking to ensure patients with greater healthcare demands are evenly distributed among the nursing staff, so one or two nurses won’t end up disproportionately burdened by multiple heavy cases.

Other strategies include more flexible schedules – the opportunity to work 20 or 30 hours a week, rather than 40 or 60, for example.

Counseling and coaching also provide a release valve where they can vent or seek advice from others in the profession.

As artificial intelligence (AI) has grown more sophisticated, an increasing number of medical institutions are using chatbots and other platforms to gather patient histories and even monitor patient vitals like blood pressure and heart rate to identify when someone might be heading in an adverse direction, thus relieving some of the alert fatigue experienced by nursing staff. 

At Alight, the nurses on our Medical Ally team are given the space they need to deeply understand and guide participants. They are encouraged to:

  • Spend as much time with participants as needed
  • Form a 1:1 personal, dedicated relationship
  • Inquire about and solve challenges related to SDOH
  • Assess behavioral health issues or the potential for them and make connections
  • Bring in other clinicians on the Medical Ally team as needs change

I believe that giving nurses the ability to focus on the people in their care and reducing administrative burdens is key to pushing back against the frustrations that are taking passionate clinicians out of healthcare when we need them most.

Thanking nurses in our lives

We need to be cognizant of the struggles today’s nurses face and treat them with respect and care.

Recognizing their immense value and acknowledging burnout are the first steps in supporting these very important professionals who provide compassionate care for us and our loved ones every single day.

I encourage you to share your appreciation for the nurses in your life this month - and whenever you have occasion to be receiving care.

Bipin Mistry, MD
Bipin Mistry, MD
By Bipin Mistry, MD

Bipin Mistry, MD is Chief Medical Officer at Alight Solutions. He is board-certified in Internal Medicine and obtained his medical degree at Kings College School of Medicine and Dentistry, University of London and an MBA from Babson College. He is passionate about value-based care and issues connected to the advancement of health equity.