Nursing and a Broken System

Submitted by Sue McWilliams DNP, MSN, RN

Tags: career guidance healthcare system healthcare workers nursing staffing shortages

Nursing and a Broken System

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Sue McWilliams DNP, MSN, RN is an Assistant Clinical Professor at the School of Nursing at Northern Arizona University.

Over the past six years, one of my roles, aside from teaching, has been to provide career guidance to soon-to-be graduating nursing students. The process starts when they put in their request for their final clinical rotation. Typically, I start the conversation with questions about what they want to do as a nurse. Are they planning to stay in the state, have a hospital system identified, and have a specific specialty?

Six years ago, the conversation would have been about how they could position themselves to get into a specialty area, such as Labor & Delivery or a critical care area since most hospitals are looking to fill Acute Care positions. Today, due to the number of nurses who have left healthcare due to the pandemic, they don't have to wait to get some of the coveted spots in Labor & Delivery, Pediatrics, or critical care. They don't have to pay their dues working in an Acute Care unit, hoping that an opening in a specialty care unit will come along. For most young nurses, this is excellent news. Yet, I worry about what they may be facing.

Despite the need for nurses and all of the available positions posted on any hospital website, hospitals still have not figured out that nurses are the backbone of healthcare.

Here are the pinch points, nurses are still facing staffing shortages and twelve-hour shifts that turn into 14 hours shifts. Nurses are frequently verbally and physically assaulted by patients and families (, 2021). Some hospitals enforce mandatory overtime, some are suing nurses for leaving to go to another hospital system (Medina, 2022). Now nurses could be facing potential criminal charges resulting from medical errors (Kelman, 2022). The result is nurses who are suffering from moral distress, compassion fatigue, and leaving what is considered the most trusted profession (Gaines, 2022).

For a long time now, nurses have been calling for changes to the system. There are non-profit and governmental organizations working on making health care a safer space. Nursing unions and the American Nurses Association have pushed for mandatory nurse-patient ratios, legislation to protect nurses against violence. In early 2000 National Academy of Medicine published Crossing the Quality Chasm (National Academy Press, 2001) and To Err is Human (Kohn, Corrigan, & Donaldson, 2001). Crossing the Quality Chasm discusses the concern of the workforce, referencing the nursing shortage. To Err is Human purports that it is not bad people, but the system contributes to medical errors. Yet, the system remains broken.  

The National Academy of Medicine recently hosted Clinician Retention in the Era of COVID: Uniting the Health Workforce (March 2022). Health care professionals from all sectors participated in a half-day meeting to discuss the problems of the growing number of health professionals who are leaving health care. Leaders from all professional organizations presented what they are doing to help retain healthcare workers and why they think there continues to be a steady stream of healthcare workers leaving. At the end of the day, there was no magic solution, but the conversation is still ongoing to create solutions.

The concern is that we have been discussing these issues for twenty years or more, and we have not made significant progress. The pandemic has only made the problems more pressing. Without a sufficient workforce, especially of nurses, what is an already broken system may collapse.


  • Staff. (2021, October 11). Nurses say violent assaults against healthcare workers are a silent epidemic. Retrieved March 28, 2022, from
  • Gaines , K. (2021, January 19). Nursing ranked as the most trusted profession for 20th year in a row. Retrieved March 28, 2022, from
  • Kelman, B. (2022, March 25). Former nurse found guilty in accidental injection death of 75-year-old patient. NPR. Retrieved March 28, 2022, from
  • Kohn, L. T., Corrigan, J. M., & Donaldson, M. S. (2000). To err is human: Building a safer health system. National Academy Press.
  • Medina, E. (2022, January 24). Judge lifts order preventing Wisconsin Hospital workers from starting New Jobs. The New York Times. Retrieved March 28, 2022, from
  • National Academy Press. (2001). Crossing the quality chasm: a new health system for the 21st Century.