CV and Stroke Nursing Challenges Addressed in AHA Scientific Statement

Improvements in workload policies, salaries, mentoring, and a greater degree of autonomy are among the changes needed to preserve the workforce of nurses across a variety of roles in clinical and academic cardiovascular and stroke care, a scientific statement from the American Heart Association suggests.

Nursing burnout or intent to leave the profession were prevalent issues before the pandemic that have worsened and reached a critical juncture that can’t be ignored, say Nancy A. Pike, PhD (Sue & Bill Gross School of Nursing, University of California, Irvine), and colleagues in the statement.

“The pandemic impacted not only healthcare workers but also teachers, students, and the ability for nurse scientists to perform human subjects research. Another effect of the pandemic [is that it has] brought to light the acceptance of working from home, finding careers where you don’t have to work nights, weekends, or holidays, and reducing work stress,” Pike said. “This may account for many younger nurses leaving the profession or finding remote or other nursing positions that optimizes work-life balance. We need continued efforts to promote a healthy work environment to sustain the nursing profession in all roles to meet the workforce needs.”

The year 2021 marked the single largest loss of nurses from the workforce in four decades, with more than 100,000 leaving that year alone. Currently, those still in the workforce who have the highest turnover intention and lowest rates of job satisfaction and emotional well-being are nurses ages 35 and younger. Adding to those problems are difficulties getting new nurses into the profession due to educational programs lacking sufficient capacity and being forced to turn away thousands of candidates each year.

The scientific statement, published online December 18, 2024, in the Journal of the American Heart Association, stresses the need to continue to raise awareness that “we are not out of the woods yet,” Pike said, adding that the issues facing the profession could get worse in the next 5 to 10 years with an increased number of senior nurses and teachers retiring before the situation starts to improve.

“Cardiovascular and stroke nursing is one of the largest nursing specialties that require highly skilled and experienced nurses,” she said. “With a lack of senior nurses to precept newer nurses, there is the potential that we may see an impact in patient outcomes.”

Nursing Roles, Stressors, and Interventions

While some drivers of burnout or intent to leave the workforce were specific to the pandemic, others like excessive workload, long work hours, perceived low compensation, exposure to death and suffering, moral distress, and working in high-pressure environments have always been around. Additionally, many of these stressors are not unique to CV and stroke nursing.

In the document, Pike and colleagues highlight four categories of stress-inducing factors (patient care, organizational, academic, and research) that apply to nurses in clinical, academic, and scientist roles.

Within each of those roles, they also identify interventions and offer suggestions for addressing well-being, stress, and burnout. For staff nurses and clinicians, they note that known preventive measures that have shown success include mindfulness training and communication techniques, especially in relation to end-of-life care. Also potentially important to consider are group therapeutic interventions that focus on coping mechanisms, team building, and social support.

“There is a strong inverse association between burnout and resilience (the ability to bounce back in the face of stress and challenges), which protects nurses from emotional exhaustion and contributes to personal accomplishment,” Pike and colleagues write. “In creating a culture of resilience with targeted interventions such as using gratitude in clinical rounds and safety huddles, appreciative inquiry and recognition activities have been shown to reduce job turnover and improve nursing engagement, as well as nursing and patient satisfaction.”

Flexibility in scheduling is another action item that the statement notes has been positively correlated with protecting nurses from emotional exhaustion. Other helpful initiatives may include self-care and mind-body wellness workshops, peer network support, and working with nurses to redesign their jobs to better suit their strengths and passions.

For academic educators, stressors are often linked to issues such as teaching expectations, online teaching that limits the ability to separate work and home life, maintaining competence, lower salaries compared with clinical and private sector settings, and workload imbalances. There also can be hierarchical limitations for promotions and tenure, as well as differences in power dynamics between educators and incivility between students and faculty that impact job satisfaction and desire to remain in the field over the long term.

As with staff nurses and clinicians, the scientific statement urges organizations and institutions to focus on fostering well-being among their nursing faculty and implement support measures to help in navigating the academic landscape.

“These programs should encompass the adoption of flexible work practices, implement work–life policies, facilitate streamlined access to mental health resources, and consider broadening the academic performance evaluation criteria or metrics,” Pike and colleagues say.

Championing Wellness and Addressing Salary Gaps

To TCTMD, Pike said a renewed emphasis on nursing wellness is emerging.

“Key strategies to improve work-life balance, provide more support for research, and offer professional development opportunities to retain existing faculty include enhancing work environments and opportunities for professional growth, bolstering teaching resources and providing increased research support, mentorship, and fair compensation,” she said. These measures, she added, “can help ensure the resilience of this critical workforce and the quality of care they provide.”

Finally, nurse scientists working in CV and stroke care are perhaps hardest hit by the nationwide nursing faculty shortage in the United States, leading to heavy teaching loads on top of research responsibilities. Because many of these roles rely on research funding, stressors related to funding and protected time for research and publishing can impact job satisfaction and concerns for job security.

“The academic nurse scientist role encompasses more than moving science forward, often resulting in role strain, role stress, and burnout,” the statement notes. Some things that may help include institutional mechanisms such as startup funding to support research productivity, an office of research support, interdisciplinary collaboration, a reduced teaching load, and research or teaching assistants.

One common denominator among all nursing roles that is a main contributor to stress and burnout is low salaries, which Pike said are likely to see increased pressure for improvement due to a growing nurse faculty shortage, with potential solutions including legislative initiatives to boost pay, increased funding for nursing education programs, and a greater focus on attracting and retaining qualified nurse educators by offering competitive salaries and better working conditions.

“Keeping the public aware of this issue could lead to more support for funding to improve nurse faculty salaries,” she said.

A bipartisan bill called the Nurse Faculty Shortage Reduction Act of 2024, sponsored by Rep. Suzanne Bonamici of Oregon, aims to address the pay gap between clinical nurses and nurse educators by providing funding to increase educator’s salaries.

“However, addressing the pay disparity might continue to have challenges in nurse educators due to public university budget cuts or constraints across the country,” Pike noted.