A repeated cross-sectional study of nurses immediately before and during the COVID-19 pandemic: Implications for action

Abstract

Background: The shortage of nursing care in US hospitals has become a national concern.

Purpose: The purpose of this manuscript was to determine whether hospital nursing care shortages are primarily due to the pandemic and thus likely to subside or due to hospital nurse understaffing and poor working conditions that predated it.

Methods: This study used a repeated cross-sectional design before and during the pandemic of 151,335 registered nurses in New York and Illinois, and a subset of 40,674 staff nurses employed in 357 hospitals.

Findings: No evidence was found that large numbers of nurses left health care or hospital practice in the first 18 months of the pandemic. Nurses working in hospitals with better nurse staffing and more favorable work environments prior to the pandemic reported significantly better outcomes during the pandemic.

Discussion: Policies that prevent chronic hospital nurse understaffing have the greatest potential to stabilize the hospital nurse workforce at levels supporting good care and clinician wellbeing.

Keywords: Burnout; Nurse understaffing; Pandemic; Patient safety.

Figure 1

Changes in nurse employment status, prepandemic and during the pandemic. Notes. Survey data collected by the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing. Prepandemic data were collected between December 15, 2019 and February 24, 2020. Data during the pandemic were collected between April 13, 2021 and June 22, 2021. A chi-square statistic (L² = 7.05 with 4 d.f., p = .133) testing the independence of the numbers in the five employment status categories across two time points is insignificant, indicating no overall change.