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Tough Working Conditions in Nursing
Introduction
Nursing focuses on caring for people to enhance their well-being and overall quality of
life. Primarily, it entails health promotion, disease prevention, and care for the people, families,
and communities through advocacy, campaign for a safe environment, and involvement in
activities such as education, policy promotion, and management that enhance wellbeing. The
emergence of modern nursing dates to the time of Florence Nightingale, the mother of
professional nursing in the contemporary world. It is essential to acknowledge that vast
challenges have surrounded the nursing profession since the time of history until now. Tough
working conditions in nursing as a major issue is dominant in the current practice, as in the past
years, leading to other issues related to poor care outcomes and performance and patient safety
problems.
It is essential to acknowledge that the primary purpose of the nursing profession is
enhancing employee and patient safety, improve the quality of care, and achieving positive
patient outcomes (Er & Sökmen, 2018). Notably, the nurses can provide quality services if the
work environment offers essential conditions that support this intention. Therefore, failure to
address the inadequacies of the work environment yields an unsafe health environment that
disregards the quality of care and employee and patient safety. Er and Sökmen (2018) confirms
that a healthy working environment constitutes the practices that focus on attaining maximum
nurse health and wellbeing and improving patient outcomes and overall performance. However,
achieving this type of environment supportive of nurse wellbeing is extremely difficult, as per
the current and historical evidence, posing a hindrance to attaining desirable employee
productivity. Therefore, tough working conditions for caregivers related to excessive workload,
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long working periods, irregular work hours, moral distress, poor work relationship, incivility,
etc., are common issues in the nursing environment.
The idea of promoting a working environment in nursing dates back to the era of Florence
Nightingale, who defined a healing environment as which the patients find warmth and
happiness. She further affirmed that such an environment should prevail for caregivers
responsible for patient care and still have adequate infrastructure to enhance safety and positive
health outcomes (Er & Sökmen, 2018). Therefore, the problem of tough working conditions was
present in past times and still dominates contemporary practice. It is essential to acknowledge
that tough working conditions in nursing are related to the systems that disregard the role of the
employees in achieving institutional goals and overall satisfaction in the workplace. As a result, a
harsh working environment entails practices disregarding the nurses’ wellbeing, quality of care
and outcomes, safety, and overall institutional support, alienating them from the profession.
Harsh working conditions have been a historical problem in nursing, with traditionally
identifiable issues still prevalent in modern practice. It is essential to acknowledge that since the
initiation of professional nursing in the United States, healthcare facilities have committed
themselves to balancing the excessive demand for care against the available resources in patient
care. One of the major and long-term problems the nursing profession faces is the shortage of
registered nurses to serve the demand for care services (Whelan, 2017). Workplace problems
began to occur almost immediately after the professionalization of nursing in the late nineteenth
century. The hospitals ran the train schools and provided care to the patient, and by 1900 there
existed at least 600 hospital-based nursing schools in apprenticeship across the United States
(Whelan, 2017).
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A considerable workplace issue arising during the late nineteenth and early twentieth
centuries was the problem of inadequate pay to offer nurses acceptable levels of annual income.
It is essential to acknowledge that during this period, financial impediments were a significant
issue limiting care only to people who could afford private nurses, a problem that plagued the
system (Whelan, 2017). The clients’ financial burden was further shifted to the nurses as the
nurse fee was insufficient to meet their needs and match the acceptable annual income. All this
period, the nurses worked as independent contractors rather than employees, making them
unqualified for the measures to cushion them from the financial burdens. Whelan (2017)
confirms that it is until the end of the Great Depression that nurses experienced an uneasy
transition from independent contractors to employee status. Therefore, hospitals demonstrate a
significant disregard for rectifying the poor working conditions.
Whelan (2017) reveals that during the 20th century, hospitals faced a dilemma with the
nurse shortage, failing to address the dissatisfaction experienced by the nurses. The shortage
problem extended into the 1960s and beyond (Whelan, 2017). Therefore, studies acknowledge
that historically, the nursing profession has faced challenges related to inadequate income, lack
of sufficient motivation strategies, and staff morale, alongside the shortage problem that remains
“a thorn in the flesh” even in the contemporary nursing practice. It is essential to acknowledge
that the dominant challenge within the nursing practice that appear to bread other issues in the
workplace relates to the imbalance between the demand for care services and the supply, which
translates to staff shortage. Therefore, the problem expands to reduce morale, satisfaction, etc.
Nevertheless, the technological advancements in the late twentieth century heightened the
complexity of care as the demand for nursing care increased, but the supply remained dimmed.
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It is essential to acknowledge that regardless of the extensive efforts by the government,
such as the enactment of the Affordable Care Act 2010 and efforts to improve the working
conditions in the workplaces, the nursing profession faces the same historical challenge of harsh
working conditions. Whelan (2017) confirms that the contemporary nursing environment faces
the same problem of shortage, low staff morale, and unsupportive workplace in the profession as
in previous years. Therefore, it would be deducible that the harsh working condition has been a
status quo, confirmed by numerous empirical findings.
In present-day nursing, a study exploring the condition in practice at the hospitals before
covid-19 confirmed the presence of an array of harsh working conditions that were adverse in
practice. For example, at least 40 percent of the registered nurses experienced burnout, 1 in 4
were dissatisfied, and at least one in five had plans to leave within one year (French et al., 2022).
In nursing homes, 1 in 3 nurses planned to leave their work within one year (French et al., 2022).
On the working conditions, French et al. (2022) found that nurses reported elements of a poor
working environment characterized by staff shortage, unsupportive administrators, missed
nursing care, delayed functions, and performing non-nursing roles. A section of 68 percent rated
the workplace below excellent, and at least 41 percent defined the workplace as unfavorable for
patient safety (French et al., 2022). Therefore, these findings reveal challenges of job
dissatisfaction, burnout, and high staff turnover in nursing.
Notably, the understaffing problem is a significant problem facing the nursing profession
in modern practice, undermining employee safety, quality of care, and positive health outcomes.
The nursing shortage is one of the thorniest issues in contemporary practice, with the increasing
demand and a slowly growing supply to match the need. States like California, Texas, New
Jersey, South Carolina, Alaska, Georgia, and South Dakota indicate a vast deficit between the
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high demand for nursing services and low supply. However, evidence suggests that the current
shortage might be just the tip of the iceberg compared to the predictable shortage as the issue of
retirement drain has remained dominant in the United States. A significant proportion of
experienced nurses are retiring, with studies predicting the retirement of more than one million
registered nurses from the workforce between 2015 and 2030 (The University of St. Augustine
for Health Sciences, 2021). These trends match the outcomes by French et al. (2022) that nursing
shortage is a significant issue in the workplace, heightening employee dissatisfaction and safety
concerns.
It is essential to acknowledge that the harsh work condition in nursing poses imminent
challenges to nurse, performance, and the patients as a whole. Therefore, the prevalent shortage
of skilled nurses affects overall care and heightens the risk during service delivery. Job stress is a
common phenomenon in the current nursing practice; the outcome of both pandemics and
beyond that trigger life-altering decisions. A significant problem of harsh working conditions in
the modern era relates to the long-working hours that impede the work-life balance. Besides, the
ongoing budget tightening has pushed several health care facilities into cutting the staff levels,
steering an imbalance in the workloads for the nursing staff remaining in those facilities (The
University of St. Augustine for Health Sciences, 2021). Fawaz et al. (2018) provide similar
evidence confirming that a significant problem in 21st-century nursing relates to the increasing
deficit in the staff and educators. As a result, the working place turns difficult for the nurse,
translated to less attention to detail, more stress, and limited work-life balance that result in
incomplete communication, poor performance, brain strain, compromised quality, and reduced
patient safety.
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Llop-Gironés et al. (2021) confirm that nurses are integral players in providing care and
optimizing health services worldwide, especially during the covid-19 pandemic; promoting a
positive and supportive work environment is a vital requirement to enhance outcomes and safety.
However, nurses’ current employment and working conditions worldwide are precarious, and the
covid-19 pandemic has further highlighted their vulnerability to global health-damaging factors.
Substantial evidence during the covid-19 pandemic confirms that current working conditions in
nursing are associated with poor mental and physical health (Llop-Gironés et al., 2021). It is
essential to acknowledge that under regular employment, the nurses and other health care
workers in the nursing profession are at a heightened risk of mental health issues related to
burnout, stress, anxiety, or sleep disturbance (Llop-Gironés et al., 2021). Ultimately, there is
limited attention to the nurses and their experiences in nursing practice, posing a threat to nurses,
patients, and institutional performance.
Studies acknowledge that various factors contribute to elevated stress and burnout among
health care workers, which include workloads, long shifts or working hours, lack of
psychological safety, moral conflicts, and inadequate social support (Søvold et al., 2021). The
lack of control over work, poor work-life integration, insufficient resources, and burnout were
central problems with the nursing environment, adversely affecting the quality of care, patient
safety, and care outcomes. With the contemporary issue of the covid-19 pandemic, studies
confirm that nurses are at higher risk than physicians of experiencing mental health challenges
due to the increased workload and exposure to work-related hazards (Søvold et al., 2021). These
findings match the study results by Razu et al. (2021), confirming that the shortage of health care
workers is a prevalent phenomenon alongside other issues such as workload and long working
hours, resulting in fragmented communication and frustration or job dissatisfaction.
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French et al. (2022) confirm that most of the registered nurses in the hospitals define their
workplaces as characterized by operational failures, with their work being interrupted or deferred
due to the staff shortage. At least 88.3% of nurses in the workplace confirm that challenges of
interrupted work due to insufficient human resources, and 81.5 % noted displeasure with
performing non-nursing roles such as housekeeping and transportation. Other issues that French
et al. (2022) reveal include missing supplies, equipment, or medications, incomplete orders, and
inadequate time to promote care. As a result, the harsh working conditions confirm the
dominance of patient safety issues, the problem with quality and outcomes of care, burnout, and
dissatisfaction.
On employee motivation, Llop-Gironés et al. (2021) confirm that nurses are highly
vulnerable to low morale, poor working conditions, and the challenges of work-life balance,
impeding their overall progress in terms of health and quality of life. This inference relates to the
assertion by Søvold et al. (2021) confirming that there are challenges to achieving psychological
safety in nursing, making the nurses highly vulnerable to both mental and physical health
problems. In most places, such as Mexico, the nursing workplace is characterized by severe
issues, including a significant proportion of nurses lacking a written contract, low pay, and lack
of social security and social benefits (Llop-Gironés et al., 2021). It is essential to acknowledge
that such situations have worsened in modern practice, with other challenges related to long
working hours, lack of social protection, job security, and minimum wages being demotivating
factors.
A common phenomenon for nurses across the globe, especially during the covid-19 era,
include long working hours, resulting in burnout, staff dissatisfaction, and lack of a positive
work-life balance. Therefore, the nursing environment experiences some dominant challenges
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dating back to the time of the emergence of modern nursing. Thus, with this thorough
examination of the working condition in nursing, it is deducible that with the increasing
sophistication of the health care practices, the nursing environment experience more
sophisticated challenges.
Conclusion
A primary focus of nursing is to enhance their well-being and overall quality of life.
Besides, health promotion, disease prevention, and care for people, families, and communities
are a priority in nursing practice. However, harsh working conditions remain prevalent, resulting
in poor care outcomes and performance and patient safety problems. Some of the workplace
challenges for nurses are historical, dating back to the nineteenth and twentieth centuries.
Notably, the issue of a nurse shortage, excessive workload, inadequate pay, long working
periods, irregular work hours, moral distress, poor work relationship, and incivility, among
others, remain central issues in modern practice. As a result, the tough working conditions in
nursing relate trigger other challenges related to low staff morale and an unsupportive workplace,
which has remained a status quo even in contemporary practice. Numerous studies confirm that
the tough working conditions in nursing undermine employee safety, quality of care, and positive
health outcomes, heightening dissatisfaction, elevated stress, and burnout among practitioners.
As a result, a primary target should be cultivating a supportive environment that accounts for the
caregivers’ needs and necessities for growth.
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References
Er, F., & Sökmen, S. (2018). Investigation of the working conditions of nurses in public hospitals
on the basis of nurse-friendly hospital criteria. International Journal of Nursing Sciences,
5(2), 206-212. https://doi.org/10.1016/j.ijnss.2018.01.001
Fawaz, M. A., Hamdan-Mansour, A. M., & Tassi, A. (2018). Challenges facing nursing education
in the advanced healthcare environment. International Journal of Africa Nursing
Sciences, 9, 105-110. https://doi.org/10.1016/j.ijans.2018.10.005
French, R., Aiken, L. H., Fitzpatrick Rosenbaum, K. E., & Lasater, K. B. (2022). Conditions of
Nursing Practice in Hospitals and Nursing Homes Before COVID-19: Implications for
Policy Action. Journal of Nursing Regulation, 13(1), 45-53.
https://doi.org/10.1016/S2155-8256(22)00033-3
Llop-Gironés, A., Vračar, A., Llop-Gironés, G., Benach, J., Angeli-Silva, L., Jaimez, L., Thapa, P.,
Bhatta, R., Mahindrakar, S., Scavo, S. B., Devi, S. N., Barria, S., Alonso, S. M., & Julià, M.
(2021). Employment and working conditions of nurses: where and how health
inequalities have increased during the COVID-19 pandemic?. Human Resources for
Health, 19. https://doi.org/10.1186/s12960-021-00651-7
Razu, S. R., Yasmin, T., Arif, T. B., Islam, M. S., Islam, S. M., Gesesew, H. A., & Ward, P. (2021).
Challenges Faced by Healthcare Professionals During the COVID-19 Pandemic: A
Qualitative Inquiry From Bangladesh. Frontiers in Public Health.
https://doi.org/10.3389/fpubh.2021.647315
Søvold, L. E., Naslund, J. A., Kousoulis, A. A., Saxena, S., Qoronfleh, M. W., Grobler, C., &
Münter, L. (2021). Prioritizing the Mental Health and Well-Being of Healthcare Workers:
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An Urgent Global Public Health Priority. Frontiers in Public Health.
https://doi.org/10.3389/fpubh.2021.679397
The University of St. Augustine for Health Sciences. (2021, May 25). The 2021 American
Nursing Shortage: A Data Study. University of St. Augustine for Health Sciences.

The 2021 American Nursing Shortage: A Data Study

Whelan, J. C. (2017). Workforce Issues. University of Pennsylvania School of Nursing.
https://www.nursing.upenn.edu/nhhc/workforce-issues/
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