By experience and by gossip, every nurse has a list of problems in the unit they work at that they know by heart, don’t they?
The heavy hitters are typically unsafe staffing, burnout, disrespectful patient behavior, nursing pay, and lack of agency. In reality, these problems are not just “part of the job” to be ignored and endured—they are significant barriers to safe care and often open the door to nursing burnout and moral injury.
But what is the biggest problem that affects nurses?
The truth is that there is no single “biggest” problem in nursing today, because each represents a systemic failure. Nurses can advocate for change, but how can they protect themselves and their licenses in the meantime? Let’s take a deeper look at what every nurse is struggling with right now.
The physical and mental toll of unsafe staffing
Unsafe staffing and burnout are powerful and consequential in medical settings. Moral injury is arguably worse than burnout. Moral injury is an emotional wound from being forced to violate core ethical beliefs. For nurses, providing sub-optimal care due to resource constraints or unmanageable patient loads can be a devastating compromise.
Not just the staff is affected; patient safety is at risk when the professional who should be completely focused on their care is stressed, tired, or distracted.
In a scoping review of 38 studies titled “Fatigue in Nurses and Medication Administration Errors,” the authors found that in 82% of studies, fatigue was a contributing factor to medication administration errors and near-miss events.
When a nurse is running on an “empty tank,” they struggle to provide the care they were trained to give. In these circumstances, try these tips:
- Paper trail: Consistently use "Assignment Despite Objection" (ADO) or "Safe Staffing" forms. It doesn’t change the shift, but it protects your license and creates a data point for future advocacy.
- Strategic rest: Practice "micro-rest"—intentional 60-second breathing exercises between tasks to lower cortisol levels during a chaotic shift.
- The "shift reset": Implementing a strict 5-minute transition ritual after your shift to leave the trauma at the door.
Nursing pay vs. inflation
Every clinician feels the pain when gas and grocery prices rise. It is hard to maintain your peace of mind when you get pizza parties instead of cost-of-living adjustments.
To address that, you need to know your market value first.
Research local nurse salary data to get informed. As a worker, you have the right to request a direct meeting with managers to ask questions about labor budget allocation in the current market.
When you understand your value, you can assess the circumstances and consider negotiating your pay.
Lack of respect and patient behavior
Do you know of a single nurse who has not had a negative experience with a patient or family member?
Sadly, workplace violence in healthcare is a frequent problem for nurses. It does not have to be physical to be abusive.
The reality is that nurses often have the most contact with patients and, therefore, are easy targets when they are frustrated with the healthcare system. That doesn’t make it okay. Nurses are often told to “just document and move on.” The disrespectful behavior needs to be taken seriously and addressed calmly:
- Firm workplace boundaries: Practice "The Broken Record" technique for de-escalating aggressive families (e.g., "I know you are frustrated, but I cannot continue this conversation until we can speak calmly").
- Set the "clinical tone": Early in the shift, set boundaries with families. "I am here to provide the best care for [Patient Name]. To do that, I need our communication to remain professional."
- Peer support: Utilizing "debriefing" sessions with coworkers to validate the lack of respect shown by others. Don’t vent to your family at home—they won't fully get it. Spend 10 minutes with a trusted coworker to validate the experience so you don't carry the "disrespect" home.
The struggle for agency
We all know. The suggestions previously mentioned help you survive a shift, but they do not fix the exhaustion that comes from being stuck managing a cycle you did not create.
Leveraging flexibility
Per diem jobs are a good option for taking a break from traditional W-2 employment or formal, long-term contracts with agencies that obligate you to stay in healthcare facilities that place their burdens on a limited workforce.
PRN and on-demand platforms are not immune to all nursing problems, but they do act as a personal pressure-relief valve in the following ways:
- Reduce exposure: Choose a different location for your future shifts if a facility has a toxic administration or consistently unsafe ratios.
- Restore balance: Decide when to work so you can "recharge" from burnout on your own terms, not a facility's.
- Respect choices: Find environments where your specific skill set is highly valued and your clinical autonomy is respected
- Reset your mental health: Take a break without having to ask for permission.
Recognize that respect is a 2-way street; if it isn't given, you aren't obligated to stay in that specific environment, and that is liberating.
Your career, your terms
Nurses are living in an era where they can decide whether they want to keep working every day in the same place, dealing with the same problems, or change it up with a more flexible way to work to protect their mental health.
The "biggest problem" in nursing is that the system expects you to be a hero without giving you the tools to stay healthy. Remember, you can’t fix the whole system today, but you can change how you interact with it.
Explore local shifts, set your own schedule, and find a work-life balance that works for you on Nursa.
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