Nursing Year in Review: Short Staffing, Strikes, and Suicides

As nurses entered the third year of an ongoing pandemic, they faced enormous professional and personal challenges. Fatigue, both mental and physical, settled in as the magnitude of post-vaccination COVID continued to cause global illness. Annual viruses also added to nurses' stress because both influenza and respiratory syncytial virus (RSV) cases increased and hospitalizations spiked.

The end of 2022 proved as challenging for nurses as the beginning of the year, with complex staffing and professional challenges unfolding.

Nurses in 2022 continued to face staffing and patient care issues. Although an influx of travel nurses across the United States filled holes in staffing during the early months of 2022, nurses found overall staffing to be a continuing challenge, especially nurse-to-patient ratios, which they realized could lead to them caring for higher levels of acutely ill and/or complicated patients.

A Startling Conviction

Nurses grew even more concerned after the jury conviction of a nurse indicted for involuntary manslaughter.

On March 25, RaDonda Vaught, RN, was found guilty of two felonies: criminally negligent homicide and gross neglect. The conviction was the result of Vaught administering the paralytic agent vecuronium rather than midazolam to a woman about to be scanned for a complex brain injury. Nurses around the country expressed anxiety and fear regarding their own culpability.

What would happen, they wondered, with their own medication errors when they controlled less of the work environment? Would nurses need to cover up mistakes to avoid legal action?

Could their own actions be seen as suspect, considering that medication errors occur, particularly when nurses are overburdened by inexperienced peers and larger nurse-staffing ratios.

Vaught was later sentenced to 3 years of supervised probation (no jail time).

Job on the Line

Early 2022 ushered in vaccine mandates for healthcare workers such as nurses.

Few healthcare actions have produced as much heated debate as did requiring nurses to accept the COVID vaccine or lose their jobs. Nurses, among others, debated on social media the efficacy of mRNA vaccines and subsequent boosters, which have been proven to be effective in reducing death and hospitalization for the COVID strain for which they were designed.

COVID vaccine refusal among about 40,000 nurses worldwide was only about 21%, according to a report last year, and most hospitals lost few workers because of the mandate.

By the end of 2022, vaccine mandates for nurses remained a hot topic as new COVID variations and increased case rates threatened nurse safety. In November, a coalition of 22 states petitioned for a repeal of the vaccine mandate. The petition was still pending as of late last year.

According to a recent Centers for Disease Control and Prevention report, only about 15% of the US population aged 5 years or older had received their updated booster shot, placing nurses at increased risk for the consequences of a winter wave.

Nurse Suicides

As nurses grew more exhausted from the pandemic, they reassessed their professional environment and workload, with about 1 in 5 nurses surveyed by Medscape Medical News considering a change in profession. Others (backed by nursing unions) walked off the job in protest of work conditions, with nursing strikes across the globe.

In addition, nurses were astonished yet not unduly surprised when a California nurse left duty during a night shift and remained missing for 2 days, with a tragic outcome. Michael Odell, RN, was believed to have died by suicide. His body was found by the Alameda County Sheriff's office in San Francisco. In April, a second male nurse (in an emergency room) died of a self-inflicted gunshot wound after sealing himself in a room away from patient care areas. Neither RN had given indications that they were at risk for self-harm.

But what was particularly compelling is that male nurses are not known to be at high risk for injuring themselves. Female nurses are significantly more likely than are physicians and male nurses to die by suicide, according to a 2021 report by JAMA Psychiatry.

What 2023 Holds

As nurses look to 2023 and beyond, there are many unsettled debates for the profession to resolve. In 2022, advanced practice nurses saw practice autonomy evolve and expand. Will that trend continue into the new year? And will further jurisdictions be added to the nursing licensure compact (NLC), allowing nurses to work in multiple geographic locations with a single "compact" license and set of continuing education requirements? The NLC agreement has grown to 39 jurisdictions.

The new year began with nurses continuing to battle rising COVID cases along with new strains and other communicable diseases on the upswing. Nursing unions also seem to also be maintaining pressure on healthcare organizations to improve personal and patient safety through strikes in the United Kingdom and United States. Meanwhile, nurse staffing, mental health, and workplace violence remain high on the list of priorities of the newest president of the American Nurses Association in 4 years.

It remains to be seen whether 2023 will usher in a new direction for worldwide nursing or whether the profession will witness much of the same as the pandemic rages on.

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