01 Sep Nursing is a job that is physically and mentally taxing. It requires focus and attention. (It is also extremely rewarding!) As with all thing there are extremes that need balance.? The
Nursing is a job that is physically and mentally taxing. It requires focus and attention. (It is also extremely rewarding!) As with all thing there are extremes that need balance.
The NCSBN conducted research to identify the personal and professional characteristics of nurses experiencing heightened workplace burnout and stress.
Step one: Read the article attached below
Step two: Formulate a professional, well thought out post answering the following questions:
Describe something that came from the research.
As a profession, what can we do going forward to make positive changes in nursing? (This must be supported by a research article)
What effective health practices do you plan to do for yourself, as you begin your nursing career to reduce stress and hopefully prevent burnout?
How might this affect patient care and ultimately outcomes? (there is a large amount of data on this)
This can be written in paragraph or bullet point format as long as each item is addressed in complete sentences and proper grammar.
References must be dated within the last five years. They must be cited properly in the body of the work and listed at the end in APA formatting.
4 Journal of Nursing Regulation
Examining the Impact of the COVID‑19 Pandemic on Burnout and Stress Among U.S. Nurses Brendan Martin, PhD; Nicole Kaminski-Ozturk, PhD; Charlie O’Hara, PhD; and Richard Smiley, MS
Background: The COVID‑19 pandemic has amplified long‑standing issues of burnout and stress among the U.S. nursing
workforce, renewing concerns of projected staffing shortages. Understanding how these issues affect nurses’ intent to leave
the profession is critical to accurate workforce modeling. Purpose: To identify the personal and professional characteristics
of nurses experiencing heightened workplace burnout and stress. Methods: We used a subset of data from the 2022 National
Nursing Workforce Survey for analysis. Binary logistic regression models and natural language processing were used to
determine the significance of observed trends. Results: Data from a total of 29,472 registered nurses (including advanced
practice registered nurses) and 24,061 licensed practical nurses/licensed vocational nurses across 45 states were included
in this analysis. More than half of the sample (62%) reported an increase in their workload during the COVID‑19 pandemic.
Similarly high proportions reported feeling emotionally drained (50.8%), used up (56.4%), fatigued (49.7%), burned out
(45.1%), or at the end of their rope (29.4%) “a few times a week” or “every day.” These issues were most pronounced among
nurses with 10 or fewer years of experience, driving an overall 3.3% decline in the U.S. nursing workforce during the past 2
years. Conclusion: High workloads and unprecedented levels of burnout during the COVID‑19 pandemic have stressed the
U.S. nursing workforce, particularly younger, less experienced RNs. These factors have already resulted in high levels of
turnover with the potential for further declines. Coupled with disruptions to prelicensure nursing education and comparable
declines among nursing support staff, this report calls for significant policy interventions to foster a more resilient and safe
U.S. nursing workforce moving forward.
Keywords: Workforce, burnout, stress, pandemic, COVID‑19, nursing shortage
For decades, scholars have warned of looming nursing short- ages across the United States, citing an aging workforce and long-standing issues of burnout and stress stemming from
high patient-to-nurse ratios, low pay, and concerns regarding work- place safety. The surge in patient volume and acuity driven by the COVID-19 pandemic compounded many of these pre-existing issues. Simultaneously, prelicensure nursing education programs were forced to rapidly re-invent themselves in response to clini- cal site disruptions, potentially affecting the supply and clinical preparedness of new nurse graduates. This combination of factors has led to unprecedented levels of burnout among newly licensed and tenured nurses alike. We used a subset of data from the 2022 National Nursing Workforce Survey to identify potential indi- cators of stress and burnout among the current nursing work- force to better target resources, tailor solutions, and inform policy decision-making.
Background The overall number of registered nurses (RNs) in the United States has steadily risen over the past decade (NCSBN, 2023; U.S. Bureau of Labor Statistics, 2022), but the number of employed RNs per capita in each state varies widely (U.S. Bureau of Labor Statistics, 2022; United States Census Bureau, 2022). Even within single jurisdictions, regional differences exist (Scheidt et al., 2021; NCSBN Environmental Scan, 2023). Long-standing concerns over nursing shortages existed prior to the pandemic (Buerhaus et al., 2007; Snavely, 2016; Marć et al., 2019), but COVID-19 appears to have accelerated this trend and exacerbated many pre-existing workforce issues (Haas et al., 2020), such as nurses’ experiences of burnout and stress (Aiken et al., 2002; McHugh et al., 2011; Aiken et al., 2018). Emerging evidence suggests that between 22%–32% of the nursing workforce is actively considering retiring, leaving the profession, or leaving their current position in the near future (Smiley et al., 2021; Berlin, Lapointe, Murphy, & Wexler, 2022; Nurse.com, 2022; Smiley et al., 2023). Within specific subsets of the profession, such as critical care, the picture is even bleaker, with
www.journalofnursingregulation.com 5Volume 14/Issue 1 April 2023
an estimated 67% of nurses indicating that they plan to leave their current position in the next 3 years (Ulrich et al., 2022).
Although the COVID-19 pandemic has exacerbated many of these trends, it is often not the root cause of the problem, nor are the issues isolated to the United States. The main drivers of nurses’ intent to leave are frequently identified as more durable issues or problems, such as insufficient staffing levels, desire for higher pay, not feeling listened to or supported at work, and the emotional toll of the job (Lasater et al., 2021; Galanis et al., 2021; Murat et al., 2021; Berlin, Lapointe, & Murphy, 2022). In fact, when ranked, McKinsey research found that financial considerations and plans to retire or return to school often played bigger roles in nurses’ decision-making than the pandemic (Berlin, Essick, et al., 2022). Furthermore, scholars have found that intent to leave is typically influenced by a multitude of factors, including individual char- acteristics such as job satisfaction and frequency of experienc- ing “moral distress,” and work environment characteristics, such as appropriate staffing, quality of care, safety, etc. (Aiken et al., 2022; Ulrich et al., 2022). Surveys have found that these experi- ences translate internationally as well, with substantial proportions of nurses in France, Singapore, Japan, and the United Kingdom indicating they also plan to leave direct care for many of the same reasons (Berlin, Essick, et al., 2022).
Fissures in the U.S. healthcare system were apparent from the start of the pandemic, with multiple reports identifying criti- cal staffing shortages from the onset of COVID-19 (Spetz, 2020) and throughout surge events driven by variant strains of the virus (Office of the Assistant Secretary for Planning and Evaluation, 2022). Distressingly, emerging evidence suggests the pandemic has even stalled the decades-long workforce growth trend, with data now showing that a decline in the RN population by approximately 100,000 may be primarily due to a 4% dropoff in the number of RNs younger than 35 years (Auerbach et al., 2022). While it is not yet clear whether the trend of younger nurses pausing or leaving nursing “is a temporary or more permanent phenomenon” (Firth, 2022), there is reason for concern. Some researchers now project a gap of 200,000 to 450,000 nurses by 2025—a gap partly driven by a decreased supply of the absolute RN workforce but also amplified by increased in-patient demand from or related to COVID-19 and an aging population (Berlin, Essick, et al., 2022).
In addition, many healthcare facilities closed their doors to clinical experiences to reduce the spread of COVID-19 and pre- serve their limited supplies of personal protective equipment early in the pandemic (Dewart et al., 2020). As a result, many preli- censure nursing programs faced enormous difficulty in securing traditional in-person clinical placements, directly affecting the sup- ply and preparedness of new nurse graduates (Emory et al., 2021; Lanahan et al., 2022). In response, most nursing programs shifted their face-to-face lectures to online platforms and their traditional clinical placements to simulation-based and virtual simulation- based experiences (Benner, 2020; Innovations in Nursing Education, 2020; Kaminski-Ozturk & Martin, 2023; Martin et al., 2023). The
scope and speed of this pivot presented particular challenges for faculty and administrators in the health professions, as the rapid development and implementation of online and simulated curri- cula often ran counter to their own academic training (Booth et al., 2016; Seymour-Walsh et al., 2020). Despite many challenges (Michel et al., 2021; Smith et al., 2021), some evidence suggests pre- licensure nursing students maintained learning outcomes (Konrad et al., 2021). However, others have documented the need for more hands-on training and the frustration of new nurse graduates over the apparent mismatch between their clinical experiences and their role entering the clinical setting during a global health crisis (Crismon et al., 2021; Emory et al., 2021; Bultas & L’Ecuyer, 2022; Lanahan et al., 2022).
Taken together, the U.S. nursing workforce is at a critical crossroads (NCSBN, 2023). To better inform and target policy solutions with the goal of fostering a more sustainable workforce, we analyzed a subset of data from the 2022 National Nursing Workforce Survey to address two primary research questions: 1. What are the personal and professional characteristics of nurses
experiencing heightened workplace burnout and stress? 2. How do nurses’ experiences of burnout and stress inform their
intent to leave the profession?
Methods Survey Sample
All RNs, advanced practice registered nurses (APRNs), and licensed practical nurses/licensed vocational nurses (LPNs/LVNs) with an active license in the United States and its territories were eligi- ble to be survey participants. The bulk of the sample was drawn from Nursys, NCSBN’s licensure database. This database contains basic demographic and licensure information for RN and LPN/ LVN licensees. For Georgia, the licensee list and addresses were purchased directly from Medical Marketing Service, Inc. Separate RN and LPN/LVN samples were drawn at random and stratified by state. As nurses can hold multiple single-state licenses, an initial review of all data was undertaken to de-duplicate license counts for individual practitioners by assigning licensees a single home state based on primary address.
Study Design
The core of the National Nursing Workforce Survey is comprised of the National Forum of State Nursing Workforce Centers’ Nurse Supply Minimum Data Set, which was approved in 2009 and updated in 2016 (The National Forum of State Nursing Workforce Centers, 2016). However, the survey instrument also includes sev- eral custom items for a total of 39 questions across the following six domains: (1) COVID-19 Pandemic; (2) License Information; (3) Work Environment; (4) Telehealth; (5) Nurse Licensure Compact; and (6) Demographics. Items specific to respondents' experiences during the COVID-19 pandemic and work as travel nurses dur- ing the past 2 years were added for the 2022 cycle. The survey
6 Journal of Nursing Regulation
was initially fielded on April 11, 2022, via direct mail outreach in partnership with Scantron, a leader in assessment and technology solutions, and hosted online via Qualtrics (Provo, UT). The sur- vey remained open for approximately 6 months, with two sched- uled mail reminders at weeks 10 and 20 and regular weekly email reminders for online surveys. A comprehensive overview of the survey methods, including the sampling strategy, and detailed national results will be available in a forthcoming publication of the 2022 National Nursing Workforce Survey as a supplement to the Journal of Nursing Regulation. Prior to commencing any outreach, the study was approved by the Western Institutional Review Board.
Dependent and Independent Variable Coding
The Maslach Burnout Inventory-Human Services Survey (MBI- HSS) is a reliable, and valid survey instrument comprising three domains: Emotional Exhaustion, Depersonalization, and Personal Accomplishment (Maslach et al., 1997). Nurses completing the 2022 National Nursing Workforce Survey were asked to complete 5 Likert-scale items originating from the Emotional Exhaustion domain, which has a Cronbach’s alpha of .90 (Iwanicki & Schwab, 1981; Gold, 1984). Respondents were asked to indicate how fre- quently they feel emotionally drained, used up, fatigued, burned out, or at the end of their rope using a seven-point scale, where 1 meant “never” and 7 meant “every day.” After a review of the distribution of raw responses and to simplify interpretation, each dependent variable was collapsed to identify and isolate respon- dent characteristics that aligned with a reported frequency of “a few times a week” (6) or “every day” (7). In addition, for the primary independent variable (years’ experience), receiver operator charac- teristic (ROC) curves were generated for each of the five included outcomes to identify, as possible, a general inflection point at which respondents’ sentiments appeared to consistently shift regarding experiences or drivers of burnout and stress. In aggregate, this cut point emerged at approximately 9 to 10 years of experience, so 10 years was selected to simplify the analysis and readers’ interpreta- tion of the results.
Data Analysis
A descriptive summary of the sample includes counts and pro- portions for categorical variables, while continuous variables are expressed as means and standard deviations or medians and inter- quartile ranges (IQR), as appropriate. For most descriptive mea- sures, there was minimal variation by license type, so sample-based estimates are reported. Where notable differences emerged, they are presented. Univariable and multivariable binary logistic regression models were used to compare respondents’ experiences of stress or burnout. An alpha error rate of p ≤ .05 was considered statistically significant and all analyses of structured survey items (e.g., fixed- item, check all that apply, etc.) were conducted using SAS version 9.4 (Cary, NC).
Analysis of unstructured data was performed using the Natural Language Toolkit (Bird et al., 2009) and gensim (Řehůřek
& Sojka, 2010) packages in Python 3.10. Data were first pre-pro- cessed, removing punctuation, numbers, and stop words (domain general and domain specific). Common bigrams, trigrams, and quadgrams were identified. Frequently used abbreviations and their fully spelled-out forms were also collapsed, and word tokens were lemmatized using the WordNet Lemmatizer. To extract recurrent themes identified in the responses, a Latent Dirichlet Allocation (LDA) probabilistic model (Blei et al., 2003) was employed.
The LDA model assumes there are a set number of latent topics—where a topic is a probability distribution across words found in the dataset—and each individual response has its own probability distribution across these latent topics. The LDA model can generate a response by sampling a topic based on the response’s probability distribution and then sampling a word based on the probability distribution of that topic. The model searches across possible topics to maximize the likelihood of generating the observed dataset. These topics group words that are commonly used together. LDA models were run using gensim for a range of topics; in the present article, we chose to use five-topic mod- els because they performed better on the U Mass Coherence met- ric than models with other topic thresholds (Mimno et al., 2011). Because coherence metrics do not necessarily align with coherence as observed by humans, several five-topic models were evaluated and compared for final inclusion. An alpha error rate of p ≤ .05 was considered statistically significant, and all analyses were conducted using the scipy.stats package (Virtanen et al., 2020) in Python.
Results Sample Summary
A total of 54,025 respondents across 45 states were included in the sample. The sample was roughly evenly divided between RNs (50.0%, n = 26,749) and LPNs/LVNs (45.0%, n = 24,061), with APRNs (5.0%, n = 2,723) constituting a smaller subset. Respondents were on average 51 years old (M: 51.4, SD: 14.4) and reported a median of 19 years of experience (IQR: 9–34), with minimal variation by license type. A majority of respondents self- identified as female (92.5%, n = 48,546), non-Hispanic (95.%, n = 49,465), and White (79.9%, n = 41,728). In general, LPNs/ LVNs tended to be more racially diverse (75.2% White) compared to RNs (82.5%) and APRNs (85.8%). While most respondents reported full-time employment in nursing (66.3%, n = 35,382), only 4.6% (n = 2,006) indicated they engaged in travel nursing. APRNs reported the highest rate of full-time employment (75.7%), while the full-time employment rates among LPNs/LVNs (66.3%) and RNs (65.7%) were more comparable. The median reported sal- ary for LPNs/LVNs was $50,000 (IQR: $38,000–$60,000) com- pared to $75,000 (IQR: $58,000–$95,000) for RNs and $110,000 (IQR: $87,500–$140,000) for APRNs.
More than half of the sample (62.0%, weighted n = 3,002,301) reported an increase in their workload during the COVID-19 pandemic. Similarly, high proportions reported feel-
www.journalofnursingregulation.com 7Volume 14/Issue 1 April 2023
ing emotionally drained (50.8%, weighted n = 2,352,775), used up (56.4%, weighted n = 2,601,572), fatigued (49.7%, weighted n = 2,296,545), burned out (45.1%, weighted n = 2,080,380), or at the end of their rope (29.4%, weighted n = 1,353,809) “a few times a week” or “every day.” Nurses with 10 or fewer years of experience consistently reported a 28% to 56% increase in their frequency of feeling emotionally drained (OR: 1.41, 95% CI: 1.36–1.47), used
up (OR: 1.50, 95% CI: 1.44–1.56), fatigued (OR: 1.56, 95% CI: 1.50–1.63), burned out (OR: 1.43, 95% CI: 1.38–1.49), or at the end of their rope (OR: 1.28, 95% CI: 1.23–1.34) compared to their more experienced counterparts (all p < .001, Table 1). Nurses who reported an increased workload during the pandemic displayed a similar pattern: emotionally drained (OR: 3.31, 95% CI: 3.19–3.44), used up (OR: 3.32, 95% CI: 3.19–3.45), fatigued (OR: 2.99, 95%
TABLE 2
Multivariable Results for Respondents Who Reported a Frequency of “A Few Times a Week” or “Every Day” Across all Outcomes
Years’ Experience | Increased Workload Interactiona
Emotionally Drained
Used Up Fatigued Burned Out End of Rope
≤10 y | Yes All p < .001 All p < .001 All p < .001 All p < .001 All p < .001
≤10 y | No (Ref) 3.13 (2.85, 3.43) 2.93 (2.68, 3.21) 2.67 (2.44, 2.93) 2.77 (2.52, 3.04) 2.47 (2.21, 2.76)
11+ y | Yes (Ref) 1.13 (1.07, 1.20) 1.18 (1.11, 1.25) 1.23 (1.16, 1.31) 1.18 (1.11, 1.25) 1.10 (1.03, 1.17)
11+ y | No (Ref) 4.14 (3.85, 4.45) 4.23 (3.93, 4.54) 3.86 (3.59, 4.15) 3.66 (3.40, 3.94) 3.10 (2.84, 3.38)
Note. Ref = reference. Multivariable model n ranges from 29,941 to 30,060 observations across all five dependent variables. Dependent variables were collapsed
to identify and isolate respondent characteristics that align with a reported frequency of “a few times a week” or “every day” across each of the five outcomes.
Results presented as odds ratios and 95% confidence intervals. a In addition to years’ experience and increased workload, each model further adjusted for respondents’ self‑reported sex, ethnicity, race, salary, and license
type, as well as indicators for full‑time nurse employment, direct patient care, and travel nurse designation.
TABLE 1
Descriptive Summary for Respondents Who Reported a Frequency of “A Few Times a Week” or “Every Day” Across Each Emotional Exhaustion Outcome
Emotionally Drained
Used Up Fatigued Burned Out End of Rope
License Type
LPN/LVN 48.1% (10,774) 52.9% (11,770) 47.3% (10,532) 41.9% (9,328) 27.7% (6,154)
RN 48.6% (12,169) 54.5% (13,584) 47.5% (11,845) 42.6% (10,613) 27.8% (6,922)
APRN 45.3% (1,196) 50.3% (1,328) 40.5% (1,070) 36.5% (962) 20.9% (550)
Years’ Experience
≤10 y 53.4% (7,400) 59.8% (8,258) 53.8% (7,444) 47.3% (6,552) 30.3% (4,182)
11+ y 44.7% (13,568) 49.7% (15,024) 42.7% (12,903) 38.5% (11,640) 25.3% (7,628)
Travel Nurse
No 47.8% (19,537) 53.3% (21,711) 46.6% (19,026) 41.0% (16,710) 26.2% (10,649)
Yes 59.8% (1,192) 65.1% (1,290) 60.1% (1,195) 54.4% (1,079) 37.2% (739)
Increased Workload
No 30.4% (5,663) 35.5% (6,572) 30.7% (5,697) 27.1% (5,021) 17.6% (3,255)
Yes 59.1% (18,238) 64.6% (19,836) 57.0% (17,519) 51.0% (15,681) 33.4% (10,247)
Direct Patient Care
No 44.0% (5,200) 48.3% (5,682) 41.7% (4,910) 36.9% (4,345) 23.4% (2,758)
Yes 50.0% (15,578) 56.0% (17,380) 49.4% (15,354) 43.4% (13,487) 27.9% (8,646)
Notes. APRN = advanced practice registered nurse; LPN/LVN = licensed practical nurse/licensed vocational nurse; RN = registered nurse. Data presented as
unweighted % (n). Dependent variables were collapsed to identify and isolate respondent characteristics that align with a reported frequency of “a few times a
week” or “every day” across each of the five outcomes.
8 Journal of Nursing Regulation
CI: 2.88–3.11), burned out (OR: 2.80, 95% CI: 2.70 – 2.92), or at the end of their rope (OR: 2.35, 95% CI: 2.25–2.46) (all p <.001). Consistent univariable patterns also emerged by license type (RN, LPN/LVN vs. APRN), for those providing direct patient care, and for those who reported engaging in travel nursing (all p < .001). Trends related to years’ experience and increased workload held on multivariable analysis after further adjustments for respondents’ self-reported sex, ethnicity, race, salary, and license type, as well as indicators for full-time nursing employment, direct patient care, and travel nurse designation. Furthermore, a meaningful interac- tion between years of experience and increased workload emerged. Nurses with 10 or fewer years of experience who also reported an increased workload during the pandemic were between two and a half to more than three times more likely to report higher fre-
quencies of feeling emotionally drained, used up, fatigued, burned out, or at the end of their rope compared to similarly inexperi- enced nurses with normal workloads (all p < .001, Table 2). Even compared to more experienced nurses with comparable workloads, early career respondents with high workloads still reported a 10% to 23% increase in feeling emotionally drained, used up, fatigued, burned out, or at the end of their rope (all p < .001). The most pro- nounced differences emerged when comparing early career nurses with higher workloads to their more experienced peers with nor- mal workloads. In this comparison, early career respondents with high workloads were more than three to four times more likely to report higher frequencies of feeling emotionally drained, used up, fatigued, burned out, or at the end of their rope (all p < .001).
TABLE 3
Free Response Topics and Keywords
Subjective Topic % (n) of Responses
Keywords Representative Responsea
COVID‑19 Stress 20.2% (3,783)
home, covid, working, worked, resident, people, clinic, job, vac‑ cine, agency, stressful, forced, family, mask, hospital, vaccination
During COVID‑19, homecare nursing was never addressed as a high risk job. Paramedics, hospital staff, and other essential work‑ ers seem to get addressed and considered for vaccines but I was told by my physician that I was not eligible for the vaccine when it came out. It was and still is like playing Russian roulette going into patients’ homes, not knowing if they have been exposed or not. PPE equipment was not always available, and every assisted living facility had different rules for homecare to follow.
Unsafe Staffing/ Work Environment
23.2% (4,338)
staff, covid, stress, pandemic, short, staffing, anxiety, med, load, covid‑19, always, leaving, regula‑ tion, increased, short staffed, ra‑ tio, facility, heavy, mandated, supply, burnout, job
The amount of extra work I have been required to perform at work without financial compensation is outstanding. My working environment is unsafe for both staffing and lack of security. There have been many times I thought I was in danger or a patient was in danger. These situations have led to me having anxiety and even full‑blown panic attacks every morning when I clock in. I am terrified for my own safety, as well as for the patients I see every day.
Underappreciated 22.6% (4,219)
feel, management, underpaid, overworked, administration, em‑ ployer, shortage, underappreciat‑ ed, support, under appreciated, burned out, burnout, lack, re‑ spect, feeling,
It isn’t the job, it is the lack of respect from everyone, especially when it comes from patients/clients and/or their support groups. I believe that there are fewer and fewer people wanting to be in healthcare due to the demands of what it takes to care for others. So when there are less people taking care of others as a health‑ care professional, it puts more pressure and demands on a limit‑ ed workforce.
Retirement/Career Change
16.5% (3,086)
retired, license, burnout, 2020, busy, part time, back, stress, tired, shift, job, years ago, pandemic, illness, breathing, covid, exercise
I am retired and a widow. I’m active in church and help with my grandkids. I keep my LPN license because who knows. It would have to be light and low stress to return.
Compensation 17.5% (3,275)
pay, increased, increase, load, paid, enough, workload, short_ staffing, wage, staff, raise, staff‑ ing, poor, short_staffed, job, trav‑ el, incentive, too much, salary, ethic, stress, burnout, decreased, rate, money, need, ratio
Burn out, short staffed, not enough pay, and yet they want to cap nurses on wages, but you don’t see them capping physician pay or lawyer pay.
a Responses were lightly edited for punctuation and journal style.
www.journalofnursingregulation.com 9Volume 14/Issue 1 April 2023
Free-Response Analysis
Subjective characterizations were developed for each of the five topics included in the results (Table 3). This was achieved in two ways: first, by analyzing the set of words that were most frequent and salient for each topic, and, second, by identifying the 15 most representative survey responses. Topic 1, labeled COVID-19 stress, typically involved acute stressors relevant to the pandemic, rang- ing from both anti-vaccination and anti-public health intervention sentiments to more commonplace concerns about PPE shortages, vulnerability to COVID-19 infection, and long-haul infections. Topic 2 was characterized by stressors that may have predated but ultimately were exacerbated by the pandemic, such as staff- ing shortages, unsafe work environments, and workplace violence. Topic 3 was represented by more emotional responses, including respondents’ sense of feeling underappreciated and disrespected by patients and superiors. Responses that scored high for Topic 4 were focused on retirement and other types of career change, usually with the sentiment that stress and burnout were bad, but now that the respondent was no longer working in that environment, it was much better. Finally, Topic 5 was predominantly characterized by complaints about compensation levels.
There was fair saturation across all five topics based on respondents’ license types (Figure 1). However, select themes appeared to resonate more with certain groups. For example, dis- cussion of compensation was more common among APRNs, while unsafe staffing and work environments appeared more often in RNs’ narrative accounts, as did issues related to retirement or career change. Stress related to COVID-19, including both work- place and personal concerns, was more concentrated among LPNs/ LVNs. Across all groups, issues related to feeling underappreciated emerged.
When compared against respondents’ years of work experi- ence, even clearer patterns emerged, providing valuable interpreta- tive context (Figure 2). There was a significant and positive linear relationship between reported years’ experience and topics one and four. In other words, more experienced nurses were more likely to self-report higher levels of burnout and stress specifically due to the pandemic and were more likely to share free-text comments regarding retirement or career change as a result. By contrast, an inverse relationship emerged between years of experience and top- ics two, three, and five. Thus, less experienced nurses, in particular those with <5 years’ experience, but also 5 to up to 15 years expe- rience, were most likely to report unsafe staffing or work environ- ments and feeling underappreciated. This less experienced cohort was also significantly more likely to raise concerns regarding com- pensation levels as well. Although these topics also emerged among more experienced nurses, they were significantly less pronounced.
Discussion The U.S. nursing workforce is at a critical crossroads (NCSBN, 2023). Many of the problems currently confronting the nursing pro-
fession long predated the global health crisis (Aiken et al., 2022). Nonetheless, the COVID-19 pandemic has amplified these con- cerns, and current evidence has identified unprecedented levels of stress and burnout among the key
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