Healthcare faces an era of unprecedented challenges – including persistent workforce shortages projected to exceed 300,000 full-time registered nurses by 2036; increasing healthcare demands such as more complex patient health issues and extended hospital stays; and an aging healthcare workforce with nearly 50% of registered nurses over 50 years old. These systemic challenges not only strain the healthcare system but disproportionately impact nurses who are on the frontlines of patient care and feel the profound effects firsthand.

Workforce shortages, particularly in nursing, have led to increased workloads and burnout. Over 80% of nurses report feeling burned out within their first year, and reports show an alarming number of nurses leaving the workforce due to feeling burnt out (51%) and inadequate staffing levels (39%). These challenges can have far-reaching negative outcomes, with more patients added to a nurse's workload leading to further burnout and increased risk of medical errors. Addressing the long-standing challenges—such as burnout and understaffing –in nursing is critical to retaining and supporting your nursing workforce.

The good news is that nurses are eager for positive change, but leaders need to understand their specific needs and pain points in order to implement effective solutions. Innovative approaches to supplement the dwindling workforce, such as leveraging automation and virtual nursing, can help alleviate the demanding workload on frontline nurses and offset workforce shortages. By addressing these systemic issues head-on, healthcare systems can improve nurse wellbeing, staff retention, and ultimately, patient outcomes.

Overview of Nursing Catalyst 2024 RN Survey on Safe Staffing, Care Transformation Sentiment

In Summer 2024, Nursing Catalyst surveyed 403 bedside nurses to understand their perspectives on organizational strategies to bolster safe staffing. Survey participants represented a range of ages, years of experience, clinical specialties, and AMC and union statuses.

Researchers supplemented the survey data by collecting further qualitative feedback during four focus groups with frontline nurses and nurse managers (n=41).

The goals of this research were:

1. to determine RN sentiment about current staffing levels and preferences among organizational strategies to maintain safe staffing

2. to gauge RN receptivity to and concerns about new models of clinical practice, including virtual nursing, artificial intelligence, and team-based care

3. to understand what sources of information about nursing news and practice RNs trust, and

4. most importantly, to identify opportunities for nurse executives and other health system leaders to better communicate with their frontline.

This article will outline data from our frontline nurse survey assessing nurses’ confidence in their organization’s ability to maintain safe staffing levels and provide recommendations for nursing leaders on how to boost frontline nurses’ confidence in their organization.

Findings from this research will be published in a series of articles spanning the next several months.

Frontline Nurses have Low Confidence in Their Organization’s Ability to Provide Safe Staffing

Frontline staff have expressed a significant lack of confidence in their organization’s ability to maintain safe and effective staffing levels. Results from the survey reveal under 1 in 10 (7%) of frontline nurses reported they feel positive about their organization’s ability to achieve or maintain safe staffing in the next year, while nearly half (46%) reported feeling some degree of negative outlook regarding safe staffing at their organization.

This low level of confidence is likely fueled by frontline nurses feeling extensively disconnected from critical organizational strategies and decision-making processes addressing safe staffing challenges. Nurses’ express frustration about a lack of transparency regarding leadership's specific plans and concrete actions being taken to improve and sustain safe staffing levels across the organization.

The data shows that only 7% of nurses feel very informed, with over half (57%) feeling neutral to not at all informed, indicative of a significant information gap. Frontline nurses rely on transparency and communication from leadership to understand the organization's approach to managing staffing challenges.

When frontline nurses do not have information directly from their system or leadership on safe staffing decisions and strategies at play, it can lead to misperceptions around organizational priorities and negative feelings towards leadership and nursing more broadly.

Consistent Negative Sentiment Toward Staffing Practices

The challenges around nurse staffing and workload have only been exacerbated by the COVID-19 pandemic. As one nurse explained, “Ever since covid we have more responsibilities and more duties as a nurse... if we don't have supply then the demand increases, and responsibility increases as well. We have very low staff...there's more work [these days] than there are nurses.”

Frontline nurses consistently express concerns with their unit’s current staffing levels, pointing out an unmanageable and growing workload that has led to fewer nurses on the unit. This sentiment is not new however, as one nurse stated, “There are many times it feels like more gets added to our workload for a shift with less support.” Another nurse voiced similar frustration, observing, “I feel when there is a staffing shortage or time crunch, it's all about task. Patient’s gets pushed to the side.”

| There are many times it feels like more gets added to our workload for a shift with less support." - Frontline RN

While staffing shortages have been a persistent challenge in the nursing profession over the past several decades, nurses remain receptive to innovative strategies that could effectively address these ongoing workforce challenges, demonstrating a strong desire for meaningful solutions and transparent communication about organizational decisions. Findings from a series of focus groups with frontline RNs show that nurses view safe and sufficient staffing in relatively straightforward terms. For the frontline, it's not about a preference for specific solutions (such as mandated nurse-to-patient ratios), but rather about feeling supported and empowered to deliver high-quality patient care by their leadership. When prompted as to how they define safe staffing, nurses consistently expressed desires to have adequate time with each patient, maintain their own wellbeing through uninterrupted breaks, and feel confident they aren't compromising care quality due to being overstretched.

Emerging Perceptions and Sentiment Surrounding Safe Staffing Concerns

Nurses remain largely uninformed about broader organizational priorities, relying instead on unit-level conversations and limited insights. These informal perceptions suggest that their system is attempting to solve safe staffing challenges primarily through recruitment rather than retention and meaningful workforce incentives. Additionally, nurses perceive that productivity takes precedence over patient care quality. These perceptions significantly impact nurses' views of staffing decisions and their sense of organizational commitment.

The first major disconnect between frontline nurses and their organizations centers on the perceived prioritization of recruitment over retention. Nurses consistently report that their organizations appear more focused on attracting new talent as a means to solving staffing challenges, rather than retaining experienced staff. "Treat the staff that you've had for 10-15-20 years [better] and try to retain them," one nurse shared, highlighting the frustration of existing employees who often feel overlooked. This perception can create a troubling dynamic where existing nurses feel undervalued despite their tenure of dedicated service, ultimately exacerbating the healthcare system's persistent staffing challenges. When experienced nurses feel unappreciated, they are more likely to seek opportunities elsewhere, which not only depletes the workforce of valuable expertise but also perpetuates the cycle of staffing shortages.

The second key issue revolves around how staffing decisions are made. Nurses express deep concern that productivity metrics take precedence over patient acuity and care quality in staffing decisions. This perception of prioritizing financial considerations over patient care and nurse wellbeing has intensified calls for mandated nurse-to-patient ratios to ensure safe staffing levels over alternative staffing solutions like virtual nursing or AI.

These dual challenges – the perceived prioritization of recruitment over retention and productivity over patient care – impact nurse satisfaction and retention. When experienced nurses feel both undervalued and unable to provide the level of care, they believe patients need, they become more likely to seek opportunities elsewhere. As one nurse succinctly stated, "Focusing on strategies for retention are important and so overlooked." These workforce dynamics directly contribute to ongoing safe staffing challenges, creating a cyclical problem where understaffing leads to increased burnout, which in turn drives more nurses away from the profession, further compromising patient care and healthcare system stability.

Despite the current challenges in staffing, survey data reveals a glimmer of hope: frontline nurses are more open to innovative strategies as solutions to their concerns than the traditional narrative may suggest. Contrary to perceptions of resistance, nurses demonstrate a proactive and forward-thinking approach, showing a willingness to consider creative solutions that address their core professional challenges. As one nurse shared during the focus groups, "I think the most valuable thing our senior leadership could do is to listen to our concerns and create a feasible solution." This sentiment underscores an opportunity for healthcare leaders to rebuild trust and address nurse concerns meaningfully.

The good news is that frontline nurses' needs are straightforward and focused on tangible improvements. Healthcare leaders have clear opportunities to address staffing concerns through actionable steps that nurses are more open to than leadership may realize.

Focus group and survey findings reveal that nurses seek meaningful action on their core staffing priorities. Beyond surface-level concerns about retention and recruitment, nurses fundamentally want to create a work environment that enables high-quality patient care. Their priorities center on developing sustainable staffing models that allow them to provide attentive patient care, take necessary breaks, and maintain a manageable workload, goals that can be achieved through retention efforts rather than simply increasing staff numbers. Confidence in leadership, as described by nurses, involves transparent communication and visible efforts to improve their well-being.

Changing the narrative around safe staffing begins with more transparent communications, open dialogue, and information sharing with frontline staff. By creating clear channels of communication, healthcare leadership can help nurses understand the broader strategies being developed, moving beyond simplistic approaches like just hiring more personnel. By improving communication, responding effectively to feedback, and implementing actionable solutions, healthcare leaders can build trust and create an environment more conducive to addressing staffing challenges.