Policy and Economic Factors

(Canva, 2024b)

Created By: Sara Desgranges, RN

Current Policy and Economic Factors Precipitate PTSD

There has been an influx of economic and policy-related factors that have created a demanding and overwhelming environment for healthcare workers. This combination of factors has intensified the toll that nursing takes on mental health. Becoming more evident is the pressure that growing nurse shortages are having on healthcare. There are fewer nurses, yet the expectation is that fewer nurses, will somehow, still manage the ever-increasing patient load.

To suggest an increase of nurse to patient ratios, or the expectation that nurses will work additional hours/shifts is not realistic. Bill S.1567, that was introduced to Congress in 2021, proposed to regulate safe nurse staffing across the country, however, there has been no progression of the bill or hope that it will ever be passed and implemented now (S.1567, 117th Congress, 2021). Currently there are no federal laws or mandates guiding standards for healthcare staffing and instead it is left up to individual states to dictate.

The emotional, mental, and physical strain associated with stress of this magnitude leads to nurse fatigue and burnout. A nurse that is overwhelmed is less resilient and susceptibility is increased, leading to further deterioration of mental health and PTSD. Then, factor in the increased workload and the fact that nurse compensation is not at all reflective of a nurses level of effort and commitment. The additional financial stress leads to exacerbation of issues as well and is also a factor in the decline in mental health.

Nurses are frequently being told to “take care of themselves” yet there is not a great deal of actual support in those words. As a result nurses face a real dilemma of symptomatic PTSD and the lack of support from the healthcare agency they’re a part of (Qian et al., 2022).

Whether it's due to economic constraints or lack of investment by management, mental health programs within the workplace are, for the most part, nonexistent and without some sort of programming nurses are left to cope on their own.

Healthcare Policy

While it is necessary for healthcare policies and laws to exist, they are typically designed to be in the best interest of the patient. At what point will what is in the best interest of nurses be made a priority? After all, it is not in the best interest of a patient OR a nurse to have inadequate numbers of nurses staffed.

Health policy shortfalls can lead to

inadequate staffing which leads to
- increased patient mortality rates
- increased rates of patient readmissions
- increased length of stay

(McHugh et al., 2021)

As of 2023, only California has mandated ratios across all units within a facility and even then these ratios are excessive, at 1:6 (Roberts, 2023). There is an obvious lack in policy and governance.

Who is checking up on healthcare facilities to ensure they are following the policies that have been set, and how frequently? And if a facility is found to be noncompliant, what is the fall out, if any?

These factors are partially to blame for the state of disarray that we now find our healthcare system in. Without policy change and improved oversight of our healthcare systems, there will be no significant change. Nurses are already over stressed, burned out, and experiencing PTSD. This situation cannot continue as-is and still expect to attract new nurses to bridge the nursing deficit. There is going to need to be some creativity withing the organizations to be able to meet the needs of nurses while also providing the best and safest care to patients (Haddad, 2023).

(Illinois University, 2022)

(Canva, 2024a)

Economic Factors

Healthcare policy and economic issues often lead from one to the other, creating a cycle of strain. Economic pressures lead to understaffing, and nurses must work even harder, while policies, or lack thereof, fail to prioritize mental health which further exacerbates the existing situation. This combination leaves nurses vulnerable, feeling isolated, overwhelmed, and unsupported, increasing their risk of PTSD.

Economic factors that contribute indirectly to a nurse’s mental health

nurse salaries and benefits
funding of healthcare systems
supply and demand of nurses
economic downturns
cost of living

(Tamata & Mohammadnezhad, 2022)

Nurses continue to give to others but are receiving less and less in return. Healthcare is not a normal industry where typical supply and demand exists. Nurses are not receiving more pay because they are giving more, taking on more patients, and working more hours. Insurance companies aren’t compensating facilities any differently, the gap there is also widening (Morris, 2022).

What can be done to address these issues

economic investment in staffing
adequate compensation
systemic policy change
mental health support
safer working conditions
recognition of the emotional toll of healthcare

Without identifying and addressing these issues at the core, improvement in nursing satisfaction, wages, PTSD, and a decrease in the high-stress work environment won’t be likely.

([Nurse coping on a window], 2021)

Angelina Case Study

Due to current healthcare policies, and the condition of the economy, Angelina’s story is going to slowly become the story of most nurses. Nurses can continue to voice their disdain, but in the end, when there is no quantifiable change, it creates a feeling of hopelessness and generates doubt of whether there will ever be change. Angelina is incredibly lucky that she has a great support system in her coworkers and that when she wasn’t able to advocate for herself, they were there to be her voice. Something that may be of benefit to Angelina would be to encourage the formation a nurse’s union, if there is not already one in her facility. It is often helpful and encouraging to have your feelings supported by others and to collectively have your voice heard.

References

Canva. (2024a). DreamLab. [money and healthcare generated with AI prompt]. https://www.canva.com/dream-lab

Canva. (2024b). DreamLab. [money and healthcare generated with AI prompt]. https://www.canva.com/dream-lab

Haddad, L. M. (2023, February 13). Nursing shortage. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK493175/

Illinois University. (2022). Topline findings on nurse staffing, moral distress, and labor shortages. [Bar Chart]. Retrieved February 1, 2025. https://illinoisupdate.com/wp-content/uploads/2022/06/pmcr-ilepi-registered-nurses-in-crisis-final.pdf

McHugh, M. D., Aiken, L. H., Sloane, D. M., Windsor, C., Douglas, C., & Yates, P. (2021). Effects of nurse-to-patient ratio legislation on nurse staffing and patient mortality, readmissions, and length of stay: A prospective study in a panel of Hospitals. The Lancet, 397(10288), 1905–1913. https://doi.org/10.1016/s0140-6736(21)00768-6

Morris, G. (2022, November 4). 4 things nurses should know about the current economy. NurseJournal.org. https://nursejournal.org/articles/nursing-inflation-economy/

[Nurse coping on a window]. (2021). [Image]. Retrieved February 1, 2025. Bridges To Recovery. https://www.bridgestorecovery.com/blog/navigating-ptsd-and-burnout-for-covid-19-healthcare-workers/.

Qian, J., Wang, W., Sun, S., Liu, L., Sun, Y., & Yu, X. (2022). Interventions to reduce post-traumatic stress disorder symptoms in health care professionals from 2011 to 2021: A scoping review. BMJ Open, 12(1). https://doi.org/10.1136/bmjopen-2021-058214

Roberts, A. (2023, October 3). The states with nurse-patient ratio laws. NurseJournal.org. https://nursejournal.org/articles/nurse-patient-ratios/

S.1567 - 117th Congress (2021-2022): Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2021 | Congress.gov | Library of Congress. congress.gov. (2021). https://www.congress.gov/bill/117th-congress/senate-bill/1567/text

Tamata, A. T., & Mohammadnezhad, M. (2022). A systematic review study on the factors affecting shortage of nursing workforce in the Hospitals. Nursing Open, 10(3), 1247–1257. https://doi.org/10.1002/nop2.1434

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