Healthcare organizations continue to feel the effects of the COVID-19 pandemic, including prolonged workforce shortages, rising labor costs, and increased staff burnout.1 Although nurses routinely experience job-related stress and symptoms of burnout, the COVID-19 pandemic exacerbated the challenges of this high-intensity role.
As part of an ongoing, collaborative research effort, the American Nurses Foundation (the Foundation) and McKinsey surveyed more than 7,000 nurses in April and May 2023 to better understand mental health and well-being in the nursing workforce (see sidebar “About the research collaboration between the American Nurses Foundation and McKinsey”). The survey results revealed that symptoms of burnout and mental-health challenges among nurses remain high; the potential long-term workforce and health implications of these persistent pressures are not yet fully understood.
In this report, we share the highlights of our most recent survey and trends over the past few years. As healthcare organizations and other stakeholders continue to evolve their approaches to these important issues, this research provides additional insight into the challenges nurses face today and highlights opportunities to ensure adequate support to sustain the profession and ensure access to care for patients.
Current state of the nursing workforce
Although many organizations have taken steps to address the challenges facing the nursing workforce, findings from the joint American Nurses Foundation and McKinsey survey from May 2023 indicate that continued action is required. Nursing turnover is beginning to decline from its 2021 high but remains above prepandemic levels.2 Intent to leave also remains high: about 20 percent of surveyed nurses indicated they had changed positions in the past six months, and about 39 percent indicated they were likely to leave their current position in the next six months.3 Intent to leave was roughly 41 percent among nurses who provide direct care to patients, compared with 30 percent for nurses not in direct-patient-care roles.4
Surveyed nurses who indicated they were likely to leave cited not feeling valued by their organizations, insufficient staffing, and inadequate compensation as the top three factors influencing their decisions.5 Insufficient staffing was especially important to respondents with less than ten years of experience6—a population that will be critical to retain to ensure future workforce stability.
Key survey insights on mental health and well-being
Our joint research highlighted the magnitude of the health and well-being challenges, both physical and mental, facing the nursing workforce. More than 57 percent of surveyed nurses indicated they had been diagnosed with COVID-19, and 11 percent of those indicated they had been diagnosed with post-COVID-19 conditions (PCC or “long COVID”). Additional research may be needed to fully understand the impact of PCC on nurses, but in the meantime, employers could consider augmenting their PCC services for clinicians.
Research conducted by both the Foundation and McKinsey over the past three years has identified sustained feelings of burnout among surveyed nurses—a trend that continued this year.7 Reported contributors to burnout include insufficient staffing, high patient loads, poor and difficult leadership, and too much time spent on administrative tasks. In our joint survey, 56 percent of nurses reported experiencing symptoms of burnout, such as emotional exhaustion (Exhibit 1). Well more than half (64 percent) indicated they feel “a great deal of stress” because of their jobs. Additionally, although there have been slight improvements year over year in respondents’ reports of stress, anxiety, and feeling overwhelmed, reports of positive emotions such as feeling empowered, grateful, and confident have declined.8
Our results indicate that mental health and well-being vary by nurse experience levels (Exhibit 2). Less-tenured nurse respondents were more likely to report less satisfaction with their role, had a higher likelihood of leaving their role, and were more likely to be experiencing burnout.
Despite these sustained and high levels of burnout, approximately two-thirds of surveyed nurses indicated they were not currently receiving mental-health support (a figure that remained relatively consistent in Foundation surveys over the past two years), and 56 percent of surveyed nurses believe there is stigma attached to mental-health challenges.9
Reasons cited by nurse respondents for not seeking professional mental-health support have remained consistent over the past two years,10 with 29 percent indicating a lack of time, 23 percent indicating they feel they should be able to handle their own mental health, and 10 percent citing cost or a lack of financial resources (Exhibit 3). For nurses with ten or fewer years of experience, lack of time ranked as the top reason for not seeking professional mental help.
Despite slight improvements to the most severe symptoms over the past six to 12 months, reported levels of sustained burnout and well-being challenges have remained consistently high since we began assessing this population in 2021. Moreover, research indicates that burnout has several adverse, long-term health effects; for example, it is a predictor of a wide range of illnesses.11 These health conditions incur not only personal costs but also societal and organizational costs because they influence productivity, employee retention, presence at work, and career longevity.12
Actions stakeholders can take to address mental health and well-being
To address these sustained levels of burnout, stakeholders will need to take steps to support nurses’ mental health and well-being. They will also need to address the underlying structural issues—for example, workload and administrative burden—that affect the nursing profession and that have been consistently acknowledged as root causes of burnout. Simultaneously reducing workload demands and increasing resources available to meet those demands will be critical.
A variety of interventions could address the drivers and effects of adverse nursing mental health and well-being, bolstering support for individuals, organizations, and the healthcare system at large. Various stakeholders are deploying a number of initiatives.
Applying process and operating-model interventions
Addressing the underlying drivers of burnout could help to prevent it in the first place. Research from the McKinsey Health Institute shows that the day-to-day work environment has a substantial impact on the mental health and well-being of employees.13 Process and operating-model shifts—in the context of ongoing broader shifts in care models—could enable organizations and care teams to evolve working practices to better support job satisfaction and sustainability.
In our most recent collaborative research, almost a quarter of surveyed nurses believed their teams were not working efficiently; more than 43 percent reported that they had poor or marginal control over their workloads and that their day-to-day work was hectic and intense.14 Evaluating and addressing structural aspects of the job that contribute to workload—for example, by identifying opportunities to delegate activities and enable nurses to use technology—could help support these themes.15 However, providing these resources without also addressing the underlying structural drivers contributing to mental-health and well-being challenges is insufficient and can unintentionally appear to place the burden for solving problems on employees themselves. Both individual-level supports and collaborative efforts to drive structural change are required.
In addition to addressing workload challenges, employers could provide flexible work options—for example, in shift length, start time, shift commitments, and virtual activities16—to better enable employees to recharge from high levels of demands and to reduce conflicts with demands outside of work.
Finally, employers could take steps to reduce the administrative burden on nurses. More than a third of nursing respondents in our joint survey felt they spent excessive time working on electronic health records on breaks or after shifts, and 45 percent reported this activity adds frustration to their day.17 Employers can look for opportunities to delegate some documentation to nursing scribes, reduce documentation requirements, or use AI to aid with documentation to help reduce this burden.
Increasing availability, awareness, and accessibility of evidence-based resources
When nurses experience symptoms of burnout or other mental-health and well-being challenges, evidence-based resources need to be available. In addition, employees need to know these resources are available, and they need to feel comfortable accessing them within the organization’s cultural context.
Investments in resources for mental health and well-being span the continuum—from mental healthcare for those experiencing clinical symptoms to well-being support tools and programs to promote healthy behaviors and mitigate sources of stress. On the higher-acuity end of the continuum, providing employees with free or subsidized access to professionally provided therapy or counseling services could help reduce the barriers employees face in getting the care they need. On the lower-acuity end, providing access to resources and training on mental-health literacy, self-monitoring, and adaptability skills could help nurses identify and mitigate sources of stress.
Investments in awareness and accessibility are important to ensure available resources are used. Roughly 19 percent of surveyed nurses who indicated they had not sought mental-health support in the past 12 months cited lack of knowledge, lack of resources, fear of losing their job, or concern about colleagues finding out as reasons for not seeking support.18 To reinforce their support, employers can take steps such as establishing support networks for communities and allies, providing forums to share stories of mental health, and introducing avenues for peer-to-peer support. Additionally, resources such as a behavioral-health concierge can help all employees (including nurses) navigate, find, and access care and support.
Accessibility of resources within the organization’s cultural context is also important, given that stigmatization of beliefs, behaviors, and policies can prevent people from feeling able to seek help when they need it. Because mental-illness stigma includes self-stigma, public stigma, and structural stigma, companies can take a holistic approach to root it out,19 including with education, leadership role modeling, and policies addressing discriminatory behaviors.20 They can also provide information about free support resources, such as those provided by the American Nurses Foundation and the American Nurses Association (see sidebar “Resources available through the Foundation”).
Bolstering skills and capabilities
Efforts to address structural issues can be advanced by investing in training opportunities to help individuals and teams proactively support their own mental health and that of their colleagues. Training areas could include workplace mental-health intervention; critical skills for leaders and managers, such as conflict resolution and bystander intervention; and resilience and adaptability training to inculcate mindsets and behaviors across the organization that ultimately support employee mental health and well-being.
Toward a healthier future for nurses
Tackling these sustained challenges for mental health and well-being will be critical for addressing near-term workforce shortages and ensuring the health and well-being of the nursing profession in the long term. In our joint survey, many surveyed nurses indicated they chose the profession because they wanted to make a difference—by helping improve patients’ lives and care for patients in their most vulnerable moments. They value their colleagues and the care and trust of their teams. However, with less than half of surveyed nurses feeling satisfied with their jobs, they clearly need more in return to sustain them in the profession. There isn’t a one-size-fits-all approach to tackling some of the sustained well-being challenges that face nurses, but now is the time to bring additional energy and commitment to tackle the multifaceted drivers of symptoms of burnout and to support the profession in improving sustainability and fulfillment for years to come.
