Mark Longshore, executive director of the Colorado Nurses Association, began teaching nurses after a career as an emergency department nurse. According to Longshore, students often tell him that they entered the field to care for others, only to become disillusioned upon realizing the modern clinical setting doesn’t allow them proper time with patients.
“Like, wait a minute, this isn't all rose-colored glasses,” Longshore says. “The care that I feel is important isn't the care I'm able to provide.”
Westword spoke with a handful of nurses in the Denver area who wanted to remain unnamed over fear of retaliation at their workplaces. Every nurse agreed that more support from their employers is needed, and that Colorado's nursing shortage, predicted to get worse in the coming years, has led to higher workloads across every hospital department and even in places like outpatient doctors’ offices and long-term care facilities.
Nurses report limited lunch breaks, feeling pressure to work overtime and an increase in physical violence from patients. Their experiences are backed up by a recent analysis conducted by Nursa, which found Colorado is the top state for nurse burnout in the country.
According to the analysis, Colorado has a ratio of 155 patients per nurse and a high cost of living compared to nurse pay, with a satisfaction rating of 3.4 out of ten in a statewide survey.
“Colorado nurses face some of the harshest working conditions in the country,” Nursa found. “Job satisfaction is worryingly low.”
Nursa scored nurse burnout by using measurements for compensation, satisfaction, cost of living, emotional strain, and patient-to-nurse ratio in every state as well as Google search data for terms related to nurse burnout. The Google search data was weighted lowest while compensation and satisfaction metrics were weighted highest.
Nursa found Colorado has the second-highest nurse-to-patient ratio and the second-lowest satisfaction rating in the country, combining for a high chance of burnout.
Factors Contributing to Nurse Burnout in Colorado
Nurses Westword spoke with noted that nurse pay often plateaus, which can make it difficult to stay motivated later into a career for some people. Longshore, whose organization advocates for nurses in Colorado, says the state struggles with experienced nurses feeling like they no longer get paid enough and newer nurses leaving because they see how poor working conditions are compared to other states and industries. “Are those newer nurses leaving because there's not enough experienced nurses to mentor them? That's probably part of it,” Longshore says. “There’s other factors, as well, if you look into generational attributes. …There's a fair amount of negativity toward Gen Z, and, yet, I would argue maybe they're doing what other nurses should have been doing all this time of saying, ‘You know what, I'm not going to put up with this.’”
Tamera Dunseth-Rosenbaum, chief nursing executive for the UCHealth system, says nurses who have been in the profession for zero to two years have the highest rate of turnover. Young people have a willingness to make moves to new places and companies, she says, and it’s harder to sell young people on a career like nursing as remote work options become more popular.
Margaret Bishop, deputy director at the Colorado Nurses Association, worked in surgical and ICU departments straight out of nursing school but has since focused on behavioral health and community healthcare, including in correctional facilities. She says her first year as a nurse was the worst of her life, calling it a terrifying experience in part because of how short-staffed hospitals are.
“Those that were my preceptors were already stressed,” Bishop says. “They didn't have time for me.”
Active nurses must train new nurses while also serving patients, but instead of receiving fewer patients because of the added task of training, nurses with a trainee tagging along are often given extra patients since they have an extra set of hands.
The stress of training and realization of a nurse's many duties can weed out nursing school graduates quickly in Colorado, Bishop says.
“We don't leave nursing school thinking we're going to do a crappy job, but the reality is we're going to be up against a time limit and just do the bare minimum,” Bishop says. “Being asked to do that over and over and over again is not just physically and mentally exhausting, but it's an emotional toll to know that you're not doing the absolute best you can be doing.”
Dunseth-Rosenbaum says UCHealth is working with local nursing schools to make sure the picture of a nursing career is presented accurately to students so they aren’t as shocked when they start practicing.
“I can't think of many professions where a young 22 or 23-year-old is doing CPR on someone to try to save their life, or is dealing with death on, perhaps, a regular basis,” Dunseth-Rosenbaum says. “The nursing profession, in general, is one that is not for the faint of heart.”
In addition to the heavy emotional toll of treating patients, nurses are regularly subject to violence from patients. According to Bishop and the other nurses Westword interviewed, there are ways to report direct assaults, but it isn’t always clear what to do in cases where something inappropriate happened that may not reach the level of a crime.
“There are absolutely outright assaults — sexually, verbally, physically — but it's difficult to quantify everything else,” Bishop says. “I can't tell you how many times I've been spit on or my hands been suggestively rubbed, or someone's had an erection inappropriately. Every single day there was something that was uncomfortable or scary.”
All the nurses Westword spoke to, including Bishop and Longshore, said there aren’t effective systems in place to address direct physical assault, noting that they aren’t typically given time to step away after incidents because of low staffing.
Nurses report they are often asked what they could have done differently to avoid being assaulted, rather than a supportive mindset.
“People think it only happens in the ER, and it happens everywhere. It happens on every unit in the hospital. It happens in long-term care. It happens in doctors' offices,” Longshore says. “That is something that happens to nurses and contributes to burnout, because when they see that their manager, at best, does nothing, at worst says, ‘Could you have done something differently to prevent this?' That's one more tick of: Why am I working here?”
Dunseth-Rosenbaum is part of UCHealth’s system-wide team dedicated to reducing workplace violence and improving safety.
“I had several instances where I had nurses that had debilitating injuries after a workplace violence event and actually had to step out of the profession,” she says. “It sort of became my passion project to try to do anything that I could to prevent a workplace violence incident from happening, and, if it did happen, to make sure that the team felt like they had the support and the resources that they needed to get their mental health taken care of and to be able to come back to work if that was the trajectory that they chose to to pick.”
UCHealth has an assessment tool applied to every patient that can help identify those who might be higher risks for violence. If someone is flagged by the assessment tool, signs are posted on doors warning staff to be careful so they aren't caught unaware and the hospital can implement a buddy system so no one is in the room with those patients alone.
UCHealth has also invested in a training program teaching de-escalation techniques and even details, like where to stand in the room of a potentially violent patient.
“When you're a caregiver, you don't think of those things. All you think about is, how am I going to care for my patient?” Dunseth-Rosenbaum says. “You don't think about, 'How am I going to protect myself should my patient become violent?'”
In 2024, state lawmakers put forward a bill aimed to help with workplace violence in healthcare that would have required hospitals to have dedicated violence prevention committees to document instances of workplace violence and create training programs around violence prevention. UCHealth helped kickstart that bill, Dunseth-Rosenbaum says. The bill would have also required medical facilities to provide post-incident services to employees. However, the measure was killed early in committee.
Steps to Reduce Workload
Nurses told Westword the biggest mitigating factor for burnout is a secure, confidential way to report issues without the fear of retaliation. Longshore says his organization regularly finds that nurses are worried about losing their jobs if they bring up problems with management. “Nursing is highly regulated, so it's not just a matter of, 'Hey, you got fired, but there's always this threat of, ‘We're going to report you to the Board of Nursing,'” Longshore says. “If you get reported to the board, you could potentially lose your license. There goes your career.”
He adds that research shows a supportive environment where nurses are able to take a break, or even a day off, after a traumatic incident can also help prevent burnout.
Along with establishing peer support systems and making counseling available to nurses, UCHealth is using modern technologies to try to help prevent burnout. One example: implementing patient technology techs who are experts in computers, scanners for medication, patient beds and the monitors that patients may be hooked up on.
“We've got a lot of technology at the bedside we haven't historically had,” Dunseth-Rosenbaum says. “We identified that nurses were spending a good bit of their shift troubleshooting technology.”
UCHealth is also investing in virtual health centers to help monitor patients who may be having behavioral issues that require constant supervision by using cameras with two-way speakers. Workers can monitor a few patients at a time constantly with cameras, speak to patients and notify nurses on the ground as soon as a situation begins that might require their attention, decreasing the stress of worrying what might happen to a tough patient while a nurse is tending to others who need care.
Despite the difficulties, many nurses do stay in the profession; Longshore says it’s often a calculation of the good offsetting the bad.
“When a family member comes back to the unit and says, 'Here's a box of chocolates, thank you all for the great care that you did for my mother or child,’ for me, those used to balance out,” he says. “Over the years, it got more and more that they didn't balance out the bad.”
Based on Nursa’s findings, many Colorado nurses might feel the same way
