In the last article we introduced the toxic nursing culture death spiral. In this one, we’ll be breaking down how nurses and advanced practice nurses are responding.

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Welcome back to the Nurses Investing For Wealth mini-series on Surviving Nursing. This is where I’m sharing with you the big picture look you need to be able to turn your nursing salary into work optional freedom once and for all. 

This post is part five in a nine part continuing education series on Surviving Nursing. 

Part one - "I Hate Being a Nurse." I get it, and it doesn't have to be this way.

Part two - Surviving Nursing Part 1: Why Self-Care Is Not Enough

Part three - Surviving Nursing Part 2: The Financial Path

Part four - Money and the Nursing Exodus Part 1: Everyone’s Missing the Point 

Part five - Leap From Career Misery To Financial Clarity, Confidence, Space & Ease w/ Maureen, ARNP

Part six - Money And The Nursing Exodus Part 2: Finances In A Burnout Role

Part seven - The Truth About Toxic Nursing Culture–How to Escape the Death Spiral

The cost of the toxic healthcare environment

People commonly ask, “wouldn’t it cost too much to fix the toxic culture in nursing environments?” 

The real question is, why aren’t more resources being invested in ending the toxicity? 

Toxicity in healthcare is

• burning all of us out, 
• negatively impacting patients 
• and causing headaches for administrators. 

If you wonder if the problem is money – if there aren’t enough financial resources to create a better situation for nurses on the frontline – then let me draw your attention back to the fact that the U.S. spends more on healthcare than any other country in the world and has worse population health outcomes. 

When I hear that changes can’t be made because it’s too expensive, it makes me vomit in my mouth a little. The problem is not being able to pay nurses or afford safe and sustainable work environments. 

The problem is an obscene amount of administrative waste inside an inequitable system that’s built to funnel money to a few top leaders. 

As a healthcare provider, ethically it seems clear that any urgent cost saving focus should be on reducing waste and more equitable distribution of the money being made… NOT asking front line carers to keep sacrificing their wellbeing. 

So it’s not a lack of money that’s preventing us from ending the toxic nursing culture death spiral. 

In fact, not addressing toxicity in nursing is what’s costing businesses money.  

Business research suggests that it does not make financial sense to continue the practices that are driving the death spiral.   

• Worker retention saves organizations money. 
• More productive individuals save money. 
• Better advocacy saves money. 
• Fewer medical errors saves money.
• Preventing strikes saves money. 

In addition, not focusing on these things has contributed to the boom in agency, locums, and travel nursing. 

Nurses fed up with toxic environments are more likely to leave their full time staff positions and work with agencies. 

Short staffed hospitals are required to hire them to fill the staffing gaps they create. 

And because agency nurses are paid more than staff nurses, hospitals say this is a driver of increasing costs.

The paradox is that shortsighted organizational efforts to save money are contributing to a financial death spiral, and are ultimately increasing costs. 

But it would seem that organizations prefer to focus on controlling people rather than the environments where the people work and this is why we see 

• Administrators pushing to keep wages down. 
• Nurses growing weary from toxicity and quitting
• And the result is a nursing exodus and unstable workforce. 

Nurses naturally leave to go to other organizations where pay is higher and in hopes that the work environment is more sustainable.

What are a few concrete ways that nurses are responding to the toxic nursing environment?

Travel Nursing

In the midst of all of this, travel nursing and locum tenens work have become attractive to many nurses. The number of travel nurses doubled during the pandemic. 

Nurses have had to make a choice to do what’s best for them because of organizational mismanagement.

And organizations are feeling this as an acute pain point as they scramble to respond to high staff turnover, foot extra costs of recruitment and onboarding in exchange for staff who are less familiar with organizational processes and have lower productivity. 

It's like trying to mop up a flood without fixing the burst water main, only to wonder why the water keeps pouring in.

Travel nursing has a legitimate place, and nurses should have it as an option. However, we shouldn’t feel like we have to travel nurse in order to survive in the healthcare field. 

Ask any nurse and they’ll tell you the best investment is the one that will solve toxic work cultures in the first place. But the will of nurses is constantly getting overpowered by the likes of the American Hospital Association who could be found asking Congress to cap travel nurse pay as recently as 2022 rather than focus efforts on fixing the root causes.

All of this is not just bad business. It’s bad for nurses. And it’s the worst for patients. 

Quitting

In the modern healthcare environment, a lot of nurses are giving up and leaving, and deciding that the cost of working as a nurse is not worth the benefits. A paper by Auerbach and colleagues in Health Affairs Forefront reported findings from 2021 that the total number of registered nurses working in the U.S. dropped by 100,000, the largest amount in 40 years, with younger nurses leading the exodus. 

And Berlin and colleagues predicted that by 2025, the U.S. healthcare system could suffer a shortfall of up to 450,000 nurses, or 20% fewer than required for patient care.

Nurses have also shifted to agency and locum tenens work–some even creating their own staffing agencies to establish freedom from hospital employment.

People often think of this as a financial move, because agency nurses are paid more than staff nurses. But this finding took me by surprise: 

Travel and locum nurses employed by agencies generally report higher job satisfaction. And it’s not just because of higher financial compensation. 

The Sloan Management Review study’s top 5 rated employers were all agencies! They determined that  

 “...issues around solving nurses’ problems and open, honest communication had a larger sentiment gap between the two groups. By focusing on nurses as clients, staffing agencies excel at practices that improve satisfaction beyond simply paying higher wages.” 

Other benefits of agency work include feeling less immersed in workplace conflict and toxic cultures. Short-term contracts provide a time limit on suffering if you end up in a bad job. And contractual work produces less of a sense of workplace entrapment–the root cause of nursing burnout which I wrote about in Part 2 here. 

The limitations of agency work

Travel nurses might be happier, have better working relationships with their employers, and have more freedom over their schedule, and might earn more money.

However, travel nursing still requires exposure to toxic cycles inside organizations. At least one study found that travel nurses and locums are more likely to report feeling emotionally drained, used up, fatigued, burned out, and at the end of their rope. 

Even with higher pay and better employers, nursing work continues to be unsustainable at baseline. This is true for nurses across the board.

How are nurses’ actions affecting the situation?

Some people will tell you that leaving, traveling, and unionizing are part of the problem. 

But that’s wrong. To me, that feels like victim blaming.

Among nurses who are staying in their jobs, many are fighting for better conditions. In recent years, nursing employers have seen more unionization activity and strikes after a long period of stagnation. 

Nurses I work with at Nurses Investing For Wealth are actively seeking out clarity and confidence around their money situation so they can escape nursing - or at least cut back their hours. They see this as a path to mental and emotional wellness, increased personal safety, ending physical exhaustion, prioritizing family, and pursuing their passions.

This is how nurses are figuring out how to survive. 

Nursing actions in response to the modern crisis might cause headaches for healthcare leadership, but doing the right thing often does. Nurses who want to make a difference in a broken system and provide good patient care should find ways to do it. 

Striking and quitting shows that there’s a problem with the organization, not with the nurses themselves. 

Not with you.

These decisions put pressure on an already stressed system, it’s true, but pressure is a driver of change. Fighting a toxic system is more likely to improve it than finding ways to continue to coexist within it. 

Sometimes that fight is through advocacy. Other times it’s through quitting. 

Smart organizations who are committed to high quality patient care should collaborate with nurses who are seeking to survive in the midst of this crisis. When that happens, it leads to greater loyalty, less strikes, and better staff retention.

Disrupt the toxic nursing cycle–Set your financial survival plan.

I’ve talked a lot about what data says is happening, and what research suggests will likely help inside this series of articles. 

But there’s something big missing. 

That’s the power that nurses gain by having their finances ready to take big career risks and pivot away from nursing when needed. 

I’m a nurse and a nurse practitioner. This year I’ve been a nurse for half of my life. I’ve been working in hospitals since I was a 16 year old candy striper–became a CNA at 18, a nurse at 22, a FNP at 28.

All of the feelings and experiences I’ve talked about in this series are familiar to me personally. 

• I started out feeling stuck in toxic environments because of debt and financial struggles. 
• I’ve worked in unsustainable, unhealthy environments. 
• I’ve worked with my union and as a policy advocate at state and national levels with the Washington State Nurses Association and the American Nurses Association.
• I’ve served as President of the King County Nurses Association.
• I’ve worked contracts as a travel nurse and locum NP.
• I’ve worked part-time, full-time, overtime, unpaid time. 
• And, I’ve burnt out and quit nursing (for 5 years).
• When I returned, it was just 10 hours a week with one goal: to keep my license active.

My own motives around money have always been driven partly by anxiety about how unsustainable nursing has felt to me throughout my career, recognizing that if anything happened to my license, my livelihood would go with it.

I’ve heard countless stories from colleagues, nursing friends, members of professional associations and boards that I’ve served. I’ve heard about career ending injuries, retaliation, assaults, scapegoating, and layoffs. 

I’ve heard from colleagues who are desperate to get out or take extended time away, but feel trapped because they don’t have the financial resources to do that. 

There’s the nurses who come to me panicked because they are ready to retire but find out they don’t have enough.

And there’s the regular nurse throughout her career who is getting their sick time questioned and PTO declined feeling like her options are limited.

I have focused on saving and investing since I was 22 years old in part because I’ve always had a sense that my career (and therefore my income) was precarious…despite a plethora of open job postings. 

It’s why I set out to build an evidence based money strategy for myself. 

It gave me financial independence and is what allows me to continue to exist in the nursing world. 

Being financially independent

• Ended the feeling of being trapped in toxic nursing culture. 
• Gave me the option to work part time and to quit when I needed to. 
• Allowed me to set boundaries around work and to avoid overtime. 
• Made me a confident advocate not just for myself, but also or my colleagues, and may patients
• Helped me never fear retaliation. 

There’s no doubt in my mind that my workplace needs me more than I need them. Losing my job wouldn’t mean the loss of my livelihood as a financially free nurse…because my investments pay me more each year than my nursing salary. (I know, mind blown! I’m still shocked that this is my reality - but it can be your reality too!).

Now I work because I want to, not because I have to. And that’s what I want for you too.

I am here to share this freedom with you.

You deserve it. 

The more financially free nurses we have as colleagues, the more powerfully we can dismantle our surrounding toxic work environments and create better healthcare systems. 

This is why I say one nurse’s financial freedom is another nurse’s power.

If you relate, and if you’re ready to set up your own money strategy for financial freedom, then do this now:

Visit this link. Click the button at the top of the page that says, “Get The Free Video.” Enter your email address and then check your email. 

You’ll get immediate access to my free training where you’ll see exactly How to Become Work Optional in One Hour a Month.

You’ll learn who you can trust to get help with your money and How to Boost Your Net Worth by 5, 6 & 7 Figures With This Expert-Beating Investing Strategy Made Especially For Nurses. 

You’ll also learn how to get your employer to pay you to do it!

In the next article, I’m going to tell you more about my personal nursing journey and how I set myself up for financial freedom. You’ll see that I wasn’t destined to be wealthy and why I still feel like it’s a miracle that it happened to me. I’m not holding anything back.

I’ll see you there or in the free training…maybe both! 

By the way, thank you for being here. I’m excited to see you become independently wealthy and make nursing work optional. 

Studies and articles cited in this post

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Aya M. Hegazy; Manal M. Ibrahim; Wafaa A. Shokry; Hayam A. El Shrief. "Work Environment Factors in Nursing Practice". Menoufia Nursing Journal, 6, 2, 2021, 65-73. doi: 10.21608/menj.2021.206247

Black, Lisa M. PhD, RN, CNE. Original Research: Tragedy into Policy: A Quantitative Study of Nurses' Attitudes Toward Patient Advocacy Activities. AJN, American Journal of Nursing 111(6):p 26-35, June 2011. | DOI: 10.1097/01.NAJ.0000398537.06542.c0 

Boyce, H. (2023) “Registered nurses’ pay projected to increase $13 an hour by 2033,” Atlanta Journal-Constitution. Available at: https://www.ajc.com/pulse/registered-nurses-pay-projected-to-increase-13-an-hour-by-2033/LYEIE2ST5FADNEYMRGJVPTTHTU/ (Accessed: 14 March 2024).

Dall’Ora, C., Ball, J., Reinius, M. et al. Burnout in nursing: a theoretical review. Hum Resour Health 18, 41 (2020). https://doi.org/10.1186/s12960-020-00469-9

Fraga, B. et al. (2023) “Large Catholic health care system engaged in union busting, union claims,” National Catholic Reporter. Available at: https://www.ncronline.org/news/large-catholic-health-care-system-engaged-union-busting-union-claims (Accessed: 14 March 2024).

Greiner AC, Knebel E, editors. Health Professions Education: A Bridge to Quality. Washington (DC): Institute of Medicine (US) Committee on the Health Professions Education Summit; National Academies Press (US); 2003. Chapter 2, Challenges Facing the Health System and Implications for Educational Reform. Available from: https://www.ncbi.nlm.nih.gov/books/NBK221522/

Hut, N. (2023) “Healthcare Labor Union activity gains steam: The consequences for hospitals and Health Systems,” HFMA. Available at: https://www.hfma.org/finance-and-business-strategy/healthcare-business-trends/healthcare-labor-union-activity-gains-steam-the-consequences-for-hospitals-and-health-systems/ (Accessed: 14 March 2024).

Isham, A., Mair, S., Jackson, T., “Worker wellbeing and productivity in advanced economies: Re-examining the link,” Ecological Economics, Volume 184, 2021, 106989, ISSN 0921-8009, https://doi.org/10.1016/j.ecolecon.2021.106989. (https://www.sciencedirect.com/science/article/pii/S0921800921000471)

Janes, Gillian PhD∗; Mills, Thomas PhD∗; Budworth, Luke PhD†; Johnson, Judith PhD∗; Lawton, Rebecca PhD∗. The Association Between Health Care Staff Engagement and Patient Safety Outcomes: A Systematic Review and Meta-Analysis. Journal of Patient Safety 17(3):p 207-216, April 2021. | DOI: 10.1097/PTS.0000000000000807

Lee, J. (2022) “Travel nurses’ gold rush is over. now, some are joining other nurses in leaving the profession altogether.,” NBCNews.com. Available at: https://www.nbcnews.com/health/health-news/travel-nurses-gold-rush-now-are-joining-nurses-leaving-profession-alto-rcna45363 (Accessed: 14 March 2024).

Muthuri, R.N.D.K., Senkubuge, F. & Hongoro, C. “Determinants of happiness among healthcare professionals between 2009 and 2019: a systematic review.” Humanit Soc Sci Commun 7, 98 (2020). https://doi.org/10.1057/s41599-020-00592-x

Neal, A. and Bombardieri, M. (2022) “How to ease the nursing shortage in America,” Center for American Progress. Available at: https://www.americanprogress.org/article/how-to-ease-the-nursing-shortage-in-america/ (Accessed: 14 March 2024).

NNU: High and rising rates of workplace violence and employer failure to implement effective prevention strategies is contributing to the staffing crisis." Contify Life Science News, 22 Jan. 2024, p. NA. Gale OneFile: Health and Medicine, link.gale.com/apps/doc/A780156224/HRCA?u=anon~d99cce47&sid=sitemap&xid=2a05f142. Accessed 13 Mar. 2024.

Nsiah, Comfort et al. “Barriers to practicing patient advocacy in healthcare setting.” Nursing open vol. 7,2 650-659. 19 Dec. 2019, doi:10.1002/nop2.436

OECD (2024), Life expectancy at birth (indicator). doi: 10.1787/27e0fc9d-en (Accessed on 25 March 2024.) https://data.oecd.org/healthstat/life-expectancy-at-birth.htm 

“The Role Of Administrative Waste In Excess US Health Spending, " Health Affairs Research Brief, October 6, 2022. DOI: 10.1377/hpb20220909.830296

Sharpnack, P.A., (May 31, 2022) "Overview and Summary: Nurses’ Impact on Advocacy and Policy" OJIN: The Online Journal of Issues in Nursing Vol. 27, No. 2, Overview and Summary.

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Sull, D. and Sull, C. (2023a) “Explore how nurses rate their employers,” MIT Sloan Management Review. Available at: https://sloanreview.mit.edu/article/nursing-satisfaction-index/?utm_source=release (Accessed: 14 March 2024). 

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