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Abstract
ECRI boldly called out the impact of precipitating workplace factors stemming from electronic health records (EHRs), time pressures, heavy patient workload, patient complexity, rapid change, and limited resources on a workforce largely comprising high achievers.4 They emphasized the importance of listening to clinician concerns, leveraging change at the system level to address the underlying causes such as improper resource allocation, and ending the treatment of employees as “cogs in a wheel.” Workplace elements solidly coupled with emergency nurse burnout and turnover include difficult work schedules and shift work, inadequate support by leadership, and escalating workplace violence toward staff.7,8 Layer on frustrations caused by a lack of essential supplies and equipment, barriers to patient flow, inadequate staffing relative to demand, and ever-increasing regulatory burdens. COVID-19 added the threat of infectious disease contagion, potentially without adequate or appropriate personal protective equipment, and worsened the nurse-specific trauma of caring for scores of critically ill and dying patients in a time of insufficient and even rationed resources.9-11 The system dysfunction that created the conditions for nursing burnout and turnover before the pandemic was magnified by COVID-19–related surges and stressors.12,13 While temporary and travel nurse staffing agencies have long filled a need for short-term nursing labor demands, the value and demand for nursing skills multiplied during the pandemic.14,15 For institutions that had undervalued long-term nurse employees and nurse retention, the pay gaps between loyal nurse employees and temporary or travel nurses created further backlash from employees, contributed to additional turnover, and saw institutional attrition spiral. The prolonged pandemic disaster context exposed emergency nurses to additional risk factors for burnout, grief injury, fatigue injury, moral injury, and traumatic injury.11,13,21 In the resulting gaps in stable existing workforce supports, we also discuss how quintessentially timely and important regional and specialty-wide resources and infrastructure will be for new nurse transition support.21,22Transition Stages and Transition Shock Models The first year of professional nursing is profoundly transformative.19 Assuming supported and evolutionary developmental knowledge and skill pathways were offered during nursing education, one might expect that new nurses would be able to anticipate a relatively stable postgraduate period rather than the steep, dynamic, and tumultuous learning curve they actually find.