Nurses Bore The Brunt Of The Pandemic. Nearly 9 In 10 Of Them Are Women.

Editor's note: This story is part of a series on women in the healthcare workforce.​​​​

Healthcare employees bore the brunt of the pandemic in the workforce. Women bore the brunt of the pandemic at home. Most nurses are both.

Since the beginning of the coronavirus crisis, nurses served on the frontlines, and many say they've reached a breaking point. They're clamoring for better pay and staffing as they continue to fight for proper resources, including personal protective equipment.

Strikes and other workforce battles are intensifying as a result.

"Nurses were put in untenable situations where they were required to provide care for more and more people with fewer and fewer resources and support. So, it created moral distress and moral injury. How do you compensate for that?" said Deborah Burger, president of the labor union National Nurses United, which represents more than 175,000 nurses nationwide.

Women have an outsized role in caring for the nation's health. They hold 76% of all healthcare jobs, according to the U.S. Census Bureau. Nursing represents a significant share of those jobs: A staggering 87% of nurses are women. A majority work in hospitals.

By the numbers   + 3 million The number of nurses working in the U.S.   61% The percentage of nurses who work in a hospital.   $75,330 The median annual pay for nurses per year.

Meanwhile, the economic fallout spurred by the pandemic has hit women the hardest, particularly those of color. As women felt burdens amplify at home, many had to step away from work to take on the additional load of teaching kids from home, or at least attempt to juggle both.

Perhaps the best illustration of this heightened demand is the number of women who left the workforce at the start of each school year over the past two years. Nearly 670,000 women left the labor force in September 2020, and another 296,000 left the labor force this September, according to figures with Bureau of Labor Statistics.

Amid this turmoil, women's participation in the workforce hit a 33-year low earlier this year, an unsettling milestone.

Women suffered greater job losses than men and recovery is uneven

The total number of nonfarm payroll jobs fell drastically at the start of the pandemic, and a gap between men's and women's jobs persists. (Jobs in thousands.)

"When the history books look back on this, they're going to realize that this was a pivotal moment for women in the U.S. economy because now there was enough of an understanding of all of the issues that women have faced fully participating in the labor force," Elise Gould, a senior economist at the Economic Policy Institute, told Healthcare Dive.

Nurses shoulder the demands at work and at home

Even as the virus has surged and eased intermittently, demands on nurses seemed relentlessness. Vaccines became available, but that didn't staunch the pandemic like many healthcare workers had hoped. Due to the delta variant and low uptake of the vaccine in certain areas, the pandemic surged again in the summer of 2021, exhausting an already burned out workforce.

"I wish they would understand that people are still burned out, it's not like we got a break," a nurse from the Chicago area, who wanted to remain anonymous for fear of retribution by her employer, told Healthcare Dive.

And while the masks are now widely available to the general public after shortages, there are reports that some nurses have continued to face inadequate access to PPE more than a year into the pandemic.

Mawata Kamara, an ER nurse in California who is an NNU member, said that during the pandemic PPE was no longer readily available outside patient rooms — but it was inside administrative offices.

While perhaps well-intentioned to preserve supplies, it sent a message to nurses, Kamara said.

"I felt like it was clear: We don't care enough about your safety. We care more about the money that we spend than we do about your safety," Kamara said.

But while many in the profession say they feel burned out and slighted, they remain in high demand.

Hospitals across the country are having trouble finding enough staff, ratcheting up the workload for those remaining. And the stress may be making that problem worse.

At least 30% are seriously considering leaving the profession, according to a recent Press Ganey survey of 100,000 healthcare employees. Many say they're not getting the mental health services they need. And others report morale among nurses has reached a low point.

The issue of low staffing was only exacerbated by the pandemic, and did not start because of it, some nurses told Healthcare Dive.

Marci Jensen, an ICU nurse and California Nurses Association member, said she's seriously considered leaving the profession.

Jensen is among those citing an incredible disconnect between management and nursing staff. Resoundingly, nurses told Healthcare Dive they don't want any more cookies, T-shirts, candy or pizza sent to their floors from management.

"You're always telling us how short we are on resources and then you're spending money on things like that?" Jensen said of a food truck and T-shirts management has sent. "It feels so incredibly condescending and disrespectful."

The American Hospital Association acknowledges the nation's nurses feel worn out. AHA hospitals and health systems are working on a number of solutions to address burnout, including on-site wellness rooms, mental health and resilience resources and recognition programs, an AHA spokesperson said.

A survey of more than 1,700 nurse leaders identified that their top concern is the emotional health and well-being of their staff, according to the survey conducted by Joslin Marketing on behalf of American Organization for Nursing Leadership, a subsidiary of AHA. Staffing and retention was also identified as one of the main challenges and key concerns.

To address these worries, 76% of respondents said hospitals had increased wages, bonuses or incentives.

"While financial compensation is one way to show recognition, we know healthcare workers want work-life balance," the AHA spokesperson said.

Nurses wages have been stagnant for nearly 20 years, according to figures with the Census Bureau. Physicians, surgeons and pharmacists saw some of the largest increases, while registered nurses experienced "little or no gains in median earnings since 2000," according to a report from Census Bureau.

"Nursing and healthcare in general is a great microcosm of a broader problem which is when we associate work with women, and sort of femininity, we pay less for it, even if it's high-skilled work, even if it's work that has required training and expertise and years of experience," Megan O'Donnell, assistant director of the Center for Global Development's gender program, said.

'This crisis has not been gender neutral'

The pandemic exposed an uncomfortable truth: the insidious ways gender inequities continue to pervade at home and the workplace, leading to dramatic consequences for women's economic progress, experts say.

While the unemployment rate has steadily improved for women since the start of the pandemic, there's a more nuanced story when examining the number of jobs lost and the number of women who have left the labor force altogether.

Women lost jobs or left the workforce at greater rates than men since the arrival of the pandemic. Women lost more than 2.7 million jobs between January 2020 and September of this year, accounting for nearly 58% of all nonfarm payroll job losses during that time, according to BLS data analyzed by Healthcare Dive.

Close to 2 million women have left the labor force altogether over that same period, representing 63% of all those who left the workforce. (The labor force is a measure of both the employed and unemployed, and leaving the labor force means the worker is no longer employed and no longer actively seeking work.)

More women have left the labor force than men

Women represent 63% of those who have decided to leave the labor force, outnumbering men, potentially underscoring the greater demands on women outside work. (Chart in thousands.)

Unlike previous recessions, this one was more acute for industries dominated by women. Put another way, women are "underrepresented in the occupations with the highest ability to telecommute and in critical occupations, implying that women's employment has a stronger exposure to the pandemic recession shock," one study found.

Before the pandemic, women were already providing more child care than men. That trend was only accelerated during the pandemic.

As schools and daycares closed, women were more likely to increase their labor load at home, affecting their ability to work.

Mothers with young children reduced their work hours four times as much as fathers, according to one study. For single mothers, those challenges posed potentially profound outcomes. There are more than 73 million children under the age of 18 in the U.S., and 21% live only with their mothers, which put these children at greater risk of living in poverty as schools and daycares remained closed, another study found. Only 4% of these children live only with their father.

Still, experts believe that intentional policy changes targeted to help women can provide a better bridge back to the workforce and improved workplaces.

"First we've got to recognize that this crisis has not been gender neutral," O'Donnell, with the Center for Global Development, said. The data proves that women and girls have been hit harder, O'Donnell said.

CGD launched an initiative to examine the ways in which the pandemic has affected women in order to pinpoint policy solutions that can promote an equitable recovery.

Drawing on their research findings, the initiative has identified solutions that fit into three buckets: care, cash and data.

CGD found that when it comes to caring for children or elders, women need more support from the men in their households but also from the public sector and the businesses they work for. The Biden administration has also identified this as a priority area.

And, in terms of cash, women need better compensation. If women continue to make less than men, it makes them the obvious ones to step back and deal with the unpaid care responsibilities, O'Donnell said. Finally, experts need to rigorously analyze the data on how final policy solutions are affecting men and women differently.

"A pandemic recession is a setback for women's equality in the workplace. Nevertheless, the long-run results do provide a silver lining. A pandemic recession has the potential to be a watershed moment in terms of the division of labor in the family and in terms of a family-friendly organization of the workplace," a paper from the National Bureau of Economic Research said. "Through these channels, the pandemic can contribute to reducing gender inequality over the long run."

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