Being a Nurse in the 21st Century: Risks and Challenges

By Ogundele Adejoke Sakirat://

Depending on specialty and location, nursing staff turnover is one of the most serious problems of the profession. Nurses are changing careers due to the risks and problems they encounter at the workplace. This short paper aims to discuss specific challenges and risks that they experience in the work environments. The research incorporates findings from previously published journal articles and academic sources to emphasize and provide evidence of the problems today’s nurses have to face and overcome. Although nurses account for the largest human resource in healthcare, the 21st-century nurse struggles with long working hours, workplace violence and hazard, staff shortage, an aging population, educational insufficiencies, and personal health problems.

The 12-hour long shifts for nurses have been applauded for providing a better work-life balance than 8-hour shifts do. However, nursing is a job that includes both mandatory and voluntary overtime. When such overtime is factored in, nurses can work for up to 16 hours in a shift (Rhéaume & Mullen, 2018). The need for overtime can arise from under-staffing, staff absenteeism, or scheduling problems. Extended working hours lead to fatigue and accumulation of sleep debt.

These vices are associated with lower motivation, attention and memory lapses, compromised problem solving, faulty judgment and information processing, empathy loss, confusion, poor communication, and diminished reaction time (Rhéaume & Mullen, 2018). These inadequacies will ultimately affect patients’ safety, occupational accidents and injuries, and poor ratings for the hospital.

The healthcare setting comprises people in need and caregivers who do anything to help. As such, it is the last place workplace violence would be expected to occur. However, nurses in the 21st century are exposed to verbal abuse, physical assaults, and attack threats. They mostly face consumer-related violence, relationship-based assaults, and patient harassment (Babiarczyk et al., 2020). Most physically violent cases are reported in the emergency department, mental health facilities, and nursing homes. Nurses in other healthcare settings report more verbal than physical assault. Hospitals are linking the rising workplace aggression to nursing shortages (Babiarczyk et al., 2020).

Patients might become aggressive if they want to leave the hospital against the doctor’s advice, are in significant discomfort or pain following treatment, or are in a condition that requires them to be physically restrained. On other occasions, nurses might be assaulted while trying to intervene in an altercation between two patients.

In addition to workplace harassment and violence, nurses face hazardous risks while helping patients at hospitals. The workplace hazards can be physical, chemical, or related to the transmission of diseases (Babiarczyk et al., 2020). Physical hazards in nursing could lead to musculoskeletal disorders and often arise from the lifting involved in repositioning and transferring patients, awkward work postures, and extended standing and walking. Nurses impacted by patient aggression in emergency rooms, psychiatric wards, and geriatric units end up with physical injuries, disability, psychological trauma, and even death (Babiarczyk et al., 2020).

The hygienic condition of the work environment might expose nurses to chemicals such as sterilizing agents, lead to latex allergies, radiation exposure or place them at risk of contracting infectious diseases like Hepatitis B or HIV. Another significant hazard risk is the buildup of emotional and mental stress resulting from the extended shifts, emergent situations, and caring for terminally ill patients.

The nursing shortage has been a recurrent problem in healthcare for several decades. The 21st century has a unique challenge because several factors are in play, unlike previously when fewer people chose nursing as their career. The Bureau of Labor Statistics estimation indicates that the deficit will rise to a million nurses by 2022 (Haddad et al., 2020). Today, the causes of nursing shortage include a lower supply than demand for nurses, an aging workforce, and an aging population. As the baby boomers reach golden years, one in every five Americans is expected to be a senior citizen by 2030. Aging also affects the nursing workforce, with over one-third of the nurses above 50 years old (Haddad et al., 2020). As the population that needs care increases, more nurses are retiring from practice. Nursing schools lack the resources to release enough new nurses to cover the deficit created by the retiring nurses.

The aging population provides a twofold problem to the nursing fraternity: reducing the workforce and increased demand for home care nurses. As mentioned earlier, the baby boomers will be retiring from practice in large numbers, creating hospital staff shortages. By 2030, they will be reaching the over 65 year’s age bracket and hence, need elderly palliative care (Haddad et al., 2020). The demographics of the country will shift to have senior citizens as the majority of the population.

These older people will require more nursing staff in nursing homes and geriatric centers. This challenge is fast approaching and unique for the 21st-century nursing profession. As the demand for nurses increases, the few working ones will be overstretched to meet patient needs. Although hospitals will offer better remuneration packages to entice new nurses, the stress levels involved might lead to burnout, job dissatisfaction, and high turnover.

The education preparedness of nurses must match the increasing demands, risks, and challenges of the profession. Alignment of training with the increasing complexity of the healthcare setting requires curriculum enhancement. According to Fawaz et al. (2018), “the gap between education and the approach of practice for the 21st century has been rapidly widening.” When transitioning from graduates to practicing nurses, challenges include lack of expert coaches and instructors during internships, performance anxiety, workforce age variations, and a high number of patients with comorbidities and complications. In addition to nursing educators’ shortage, administrators must empower the instructors with emerging educational technologies, including eLearning and simulation applications. The best educators must train nurses to produce strong competencies for practice.

The most positive impact nursing gives to the practitioner is the joy of caring for people in need and ultimately restoring or saving lives. However, the challenges discussed in this paper show how challenging the whole experience can be, which takes a toll on the nurses’ emotional and mental well-being. When nurses are the subjects of workplace violence, work for extended hours, and hazards, their personal lives are distraught.

Even during the pandemic, De Kock et al. (2021) found that nurses are at the highest risk of reporting adverse mental outcomes compared to other care providers. The factors that lead to mental distress among nurses include infection fears, heavy workload, concerns about family, underlying illnesses, and lack of support. Nurses’ well-being is under threat as the 21st-century challenges overburden the limited number of professionals in practice.

In conclusion, the 21st century’s nurses must face the challenges and risks of working in today’s fast-paced and complex healthcare system. Although there are many problems in the profession, the major ones include long working hours that extend beyond the usual 12-hour shifts and staff shortages occasioned by an aging population and workforce. There are challenges relating to educational insufficiency due to educators’ shortage and the inability of the nursing school to adapt the training to practice. Workplace violence and hazards place nurses at risk of physical, verbal, and psychological assault or injury during their work hours. Further research should be conducted to establish permanent solutions to the nursing shortage, solving most other challenges discussed in this paper.

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