2023 Survey of Registered Nurses shows nursing crisis is upon us; California Nurses Association backs up legislation to tackle crisis


Hannah Saunders


AMN Healthcare recently published their 2023 Survey of Registered Nurses (RNs) that illustrates the magnitude of the nursing crisis that the country is facing—which RNs expect will worsen over the next five years. Nursing advocates in California are continuing to promote legislation that would help address the challenges outlined in the survey.

The survey reveals how since 2021, RN career satisfaction and the percentage of nurses who are likely to encourage others to enter the nursing field have dropped, while feelings of burnout have risen.

AMN has conducted RN surveys since 2009. The arrival of COVID-19 in March of 2020 led to a spike in patient demand, hospitals became overwhelmed, and RNs experienced great harm to their wellbeing and mental health. The 2023 survey polled over 800,000 RNs in the US from Jan. 5th to Jan. 18th, and received 18,226 completed questionnaires, with 11,918 of these coming from staff nurses.


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“After remaining stable at 80-85% for more than a decade, career satisfaction among nurses dropped 10 percentage points from 2021,” the AMN 2023 RN Survey stated. “Nurses’ satisfaction with quality of care they provided declined 12 points. Feeling emotionally drained rose 15 points. Worry that their job is affecting their health increased 19 points. The percentage of nurses likely to encourage others to become a nurse dropped 14 points.”

While 90% of CEOs think that nursing shortages are the most pressing challenge, 15% of hospital-employed nurses from the survey said they planned to continue working in their current position for the next year, while the remaining 85% of RNs are considering a new place of nursing employment, such as working as travel nurses, part-time or per diem, taking a job outside of direct patient care, returning to school, or leaving nursing altogether. 

Image: AMN Healthcare 2023 Survey of Registered Nurses.

“CNA [California Nurses Association] was instrumental in the fight for California’s nurse-to-patient staffing ratios law, which was the first of its kind in the nation, and continues to serve as a model for other staffing legislation,” CNA told State of Reform. “Staffing is so key because it connects to all the other issues nurses face. We’re also very active on workplace violence prevention, which also saw a recent introduction of federal legislation.” 

This year, NNU is in strong support of the Workplace Violence Prevention for Health Care and Social Service Workers Act, which was introduced to Congress on April 18th. The Bureau of Labor Statistics Census of Fatal Occupational Injuries shows that between 2011 and 2020, at least 80 hospital workers died as a result of violence in their workplace.

If signed into law, the bill would address violence in the healthcare field by requiring the Occupational Safety and Health Administration to create federal workplace violence prevention standards in a variety of workplaces, including hospitals, residential treatment facilities, and substance use disorder treatment centers, among others.

The AMN survey also showed that issues relating to mental health and wellbeing among RNs dramatically increased since 2021. Four in five RNs surveyed said they experience high levels of stress, which is up 16 points from 2021. About nine in 10 RNs said the nursing shortage is worse than it was five years ago, which is a 37 point increase from 2021. 

Image: AMN Healthcare 2023 Survey of Registered Nurses.

Additionally, 94% of respondents agree that there is a severe or moderate nursing shortage in their area, with half of the respondents having said that the shortage is severe. Within the next five years, 80% of respondents said that they expect the shortage to greatly or somewhat worsen.

“We support a number of legislative efforts in California that will boost nurse recruitment and retention by making hospitals safer, patient care better, and working conditions more tolerable,” CNA said.

CNA is in support of several healthcare-related Assembly bills. AB 747 would end employer-driven debt and indentured care. According to CNA, California’s worker protection laws have prohibited the use of exploitative employment contracts, which has resulted in the use of deceiving job-based financial agreements, or employer-driven debt, to retain employees in unsafe and unfair working conditions. AB 747 would make employer-mandated debt that includes minimum work requirements illegal, and would ban non-compete employment provisions.

AB 1001 would create hospital standards to ensure hospitals have adequate staffing levels, with staff trained to respond to patients who may experience behavioral health emergencies. CNA believes that dedicating properly trained and licensed hospital employees to respond to behavioral health emergencies would assist immediate care needs of patients, while addressing increasing rates of workplace violence in emergency departments. 

CNA is also in support of AB 1007, which would create workplace protections from surgical smoke in hospitals. Medical procedures generate surgical smoke, which contains toxic chemicals, gasses, vapors, infectious particles, and possible malignant and viable cancer cells, which can lead to respiratory irritation, infectious disease exposure, and asthma exacerbation. If passed, AB 1007 would require California’s Occupational Safety and Health Standards Board to adopt occupational safety and health standards, and would require the removal of harmful surgical smoke in various therapeutic procedures within acute care settings.

During earlier days of the COVID-19 pandemic, select professions did not have to prove that certain injuries or diseases were a result of their employment when first filing a workers’ compensation claim, also known as workers’ compensation presumptions. AB 1156 would make it easier for RNs to access the workers’ compensation system, which currently protects frontline workers such as EMTs, paramedics, firefighters, and police officers—which are all male-dominated fields. CNA believes that if AB 1156 were signed into law, it would be a vital step towards achieving economic and gender equality.

While these bills are still being heard by the legislature, RNs continue to face challenges and stressors daily. 

“Reducing stress and improving mental wellness is closely correlated with higher career and job satisfaction,” Christin Stanford, VP of client solutions for AMN Healthcare told State of Reform. “Nurses who reported greater career satisfaction also said their employer’s mental health programs were effective and that they worked intentionally to address their mental health and wellbeing. To address the important needs of nurses and their mental health, it is critical that there is an adoption of the wellness programs that are offered by healthcare organizations.”

Respondents’ feelings of effectiveness regarding their employers’ programs for mental health support have declined since the 2021 survey. Of the one in five RNs who utilized the programs:

  • 8% felt that the programs were extremely effective, compared to 17% in 2021.
  • 16% of respondents felt the programs were very effective, compared to 29% in 2021.
  • 30% felt the programs were moderately effective, which is the same as 2021.
  • 27% felt the programs were slightly effective, compared to 15% in 2021.
  • 19% felt the programs were not effective, compared to 9% in 2021.

Survey respondents said the best strategies for reducing stress among RNs include incorporating more input from nurses in decision-making processes, creating a safer working environment, increasing salaries, reducing patients per nurse, and increasing support staff.

“Healthcare organizations should continue to focus on retaining the talent they have through mental health program engagement,” Stanford said. “In addition to wellness and recognition programs, the real key is enhancing daily work life through flexibility, clinical autonomy, and mobility. The key to addressing nurse burnout is enabling them to do what they were trained to do, which is provide quality patient care.”