Nurse Burnout Has Soared During Pandemic, Survey Shows

Marcia Frellick

December 24, 2020

Nurses and advanced practice registered nurses (APRNs), when asked to rate their burnout before the pandemic and 6 months into it, reported levels that in some cases have quadrupled.

The Medscape Nurse Career Satisfaction Report 2020 received responses from 10,424 nurses and APRNs in the United States and shows that in every group, more nurses rated themselves as very or somewhat burned out compared with the pre-pandemic period. Definitions of burnout may vary widely among the nurse groups, but change in the highest levels of reported burnout was particularly striking.

Table. Comparison of High Burnout Levels Pre-Pandemic and 6 Months In

Type of Nurse % Very Burned Out Before Pandemic % Very Burned Out 6 Months In
Registered Nurse (RN)  4 18
Licensed Practical Nurse (LPN)  6 20
Nurse Practitioner (NP)  5 13
Clinical Nurse Specialist (CNS)  3 12
Certified Registered Nurse Anesthetist (CRNA)  3 10
Nurse Midwife (NM)  5 13


Survey authors note that those burnout numbers came in the summer, before the crush of patients in the fall began overwhelming hospitals nationwide.

Most Nurses Have Treated COVID-19 Patients

Most respondents, by the end of the summer, had cared for COVID-19 patients. CRNAs were the group most likely to have treated COVID-19 patients (73%) and CNSs were the least likely (38%).

Just 2%-6% of nurses and APRNs said they had tested positive for the virus. Of those, between 3% and 6% were then hospitalized. The others were either symptomatic and not hospitalized or asymptomatic and were off work or quarantined or listed "other."

For those who listed "other," survey authors said "it's possible that at least some of these nurses were asymptomatic but returned to work rather than quarantining. We didn't ask about this controversial practice because the issue didn't arise until later in the pandemic."

Nurses working in inpatient hospital care were the most likely to see COVID-19 patients (76%) followed by nurses at retail clinics (59%).

Among nurses providing care for COVID-19 patients, LPNs were the group most likely to test positive (10%). Nurses working in long-term care facilities were much more likely to test positive (11%) than nurses in other settings (4%).

The pandemic resulted in substantial furloughs, and CRNAs took the brunt of those with 34% furloughed, followed by NPs with 18%. Nurses older than 65 were more likely to be furloughed than younger nurses (23% vs 14%), and part-time nurses were more likely than full-time (22% vs. 13%) to be furloughed.

Except for CRNAs, just more than half of nurses and APRNs (from 49% to 59%) said they don't expect big changes in pay from the pandemic. From 33% to 41% expected COVID-19 to contribute to a decrease in pay.

CRNAs were much more likely to expect lower pay (59%). That may be related to fewer elective surgeries and fewer surgeries needing anesthesia.

COVID-19 Lowering Job Satisfaction

Roughly one third of nurses say COVID-19 is driving a drop in their career satisfaction. RNs, CRNAs, and nurse midwives agreed with that assessment at a rate of 35%. Those least likely to agree were CNSs, with 21% saying COVID-19 was taking a toll on their satisfaction. Only 4% to 14% of respondents overall said the pandemic had increased their career satisfaction.

Shortages of personal protective equipment were well-documented nationwide. Most RNs, LPNs, NPs, and nurse midwives in this report said they did not have adequate PPE at some point in the pandemic.

Interestingly, the survey authors say, "nurses represented by a bargaining unit more often reported having insufficient PPE (63%) compared with nurses without such representation (53%)."

Telehealth visits surged this year and 78% of nurses in non-hospital-based medical offices and urgent care clinics used that mode of care.

Nurse midwives (77%) and NPs (75%) were more likely than any other nurse group to use telehealth in the pandemic.

Biggest Fear: Infecting Loved Ones

Nurses were asked to rank their biggest fears associated with working during the pandemic, and top on the list was carrying the virus back to their families.

Table. Concerns About Working During Pandemic

Concern % Who Included it at the Top
Transmitting Infection to Their Families 66
Becoming Infected with Virus 47
PPE-Related Discomfort 38
Lack of Adequate PPE 37
Loss of Income 25
Higher Patient Load 23
Unfamiliarity/Fear of Making Mistake 16
Overtime Demands  9
Other  7


Despite COVID-19's tremendous challenges, between 93% and 98% of all nurses said they remained glad they chose nursing.

However, happiness with career choice apparently doesn't track with making the same career decisions if they could do it all over again.

"Among those who said they would choose nursing again, roughly 70% would choose the same educational route and less than 45% said they would choose the same practice setting," the survey authors write.

Marcia Frellick is a freelance journalist based in Chicago. She has previously written for the Chicago Tribune, Science News and and was an editor at the Chicago Sun-Times, the Cincinnati Enquirer, and the St. Cloud (Minnesota) Times. Follow her on Twitter at @mfrellick

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