78% of nurses say hospital care quality has deteriorated over the past two years as understaffing remains nurses' top obstacle

Nurses face increased challenges related to decreased support staff, not enough patient beds, and the inability to discharge patients

Nurses remain highly concerned about the safety of their own units, with nearly 40% saying they would not feel safe admitting a family member

CANTON, Mass., May 5, 2025 /PRNewswire/ -- A newly released 2025 State of Nursing in Massachusetts survey paints a dire picture of the conditions inside the Commonwealth's hospitals. Registered nurses across the state continue to report high levels of patient care quality concerns, unsafe staffing, increasing workplace violence, and a lack of responsiveness from leaders. To escape the physical and emotional toil, more nurses are leaving the bedside.

The survey results are being shared with the Massachusetts Legislature on National Nurses Day to assist them in their deliberations of the growing nursing/patient safety crisis and pending legislation aimed at addressing these challenges.

VOICES FROM THE FRONTLINES: The State of Nursing and Patient Care in Massachusetts

May 6, 11 a.m.

Join the briefing on Zoom: https://us06web.zoom.us/j/85361476926

Meeting ID: 853 6147 6926

This year's survey, conducted by Beacon Research and commissioned by the Massachusetts Nurses Association (MNA), reflects input from more than 500 RNs across the state, including mostly non-union nurses. It is the 13th State of Nursing survey since 2003 and captures a profession and healthcare system in crisis.

> Read the Executive Summary.
> See the State of Nursing PowerPoint.

"Post-pandemic, nurses are experiencing acute problems with the Massachusetts healthcare system – unsafe staffing, workplace violence, and care access – that have grown worse, threatening patient safety and the health of the nursing profession," said Katie Murphy, MNA President and a practicing ICU nurse. "This year's State of Nursing survey paints a stark picture of the environment nurses and patients face today but also highlights solutions nurses have collectively developed. At the bedside, organizing as unions, and within the halls of power, nurses are channeling our frustrations to demand positive change."

Alarming Patient Care Conditions Persist

• 78% of RNs say hospital care quality has gotten worse in the last two years, including 49% who say it has gotten much worse. While slightly improved from the pandemic-era peak of 85% in 2023, this remains 39 points higher than pre-COVID levels.

• 67% report they do not have enough time to provide patients with the care and attention they need— up 22 points since before the pandemic.
• 49% of nurses are concerned on at least a weekly basis that unsafe staffing conditions could put their nursing license at risk.
• 37% of RNs say they would not feel safe admitting a family member to the unit on which they work.

Multiple challenges bedside RNs face have become even more serious since last year, according to the survey:

• Not having time to provide care/attention needed – 68% (up 1% from 2024)
• Reduction in ancillary staff – 65% (up 6% from 2024)
• Not having enough beds for all patients – 62% (up 3% from 2024)
• Inability to discharge patients to outside facilities – 52% (up 4% from 2024)
• Workplace violence or abuse – 47% (up 10% from 2024)
• Inadequate health insurance coverage – 44% (up 14% from 2024)

Unsafe RN Staffing Drives Dire Patient Outcomes

Massachusetts RNs and their patients are experiencing first-hand the consequences of nurses being assigned to too many patients at one time. Unsafe RN staffing is a longstanding problem that has only grown more precarious since the COVID-19 pandemic. Despite exhaustive research on the topic, and the vast majority of nurses standing behind a legislative solution, hospital executives and state leaders have failed to address the issue.

The 2025 State of Nursing results show:

• 83% of RNs are aware of patients not receiving needed comfort or assistance due to nurse understaffing.
• 76% report lack of time to educate patients or provide proper discharge planning.
• 69% said they have seen resulting patient re-admissions.
• 67% report complications or other problems.
• 54% are aware of medical errors.
• 26% of RNs say they've seen patient deaths attributed to unsafe nurse staffing levels.

These figures represent a rise in nearly every negative outcome compared to the 2024 survey.

Nurses' experiences reported in the 2025 survey are backed up by decades of research demonstrating the link between excessive RN patient assignments and reduced quality of care. For example, a study published in the Lancet in 2014 showed that every one patient increase in hospital nurses' patient workloads is associated with a 7% or greater increase in the odds that patients will die. A 2017 study in the Journey of Emergency Nursing found wait times in trauma EDs for diagnostic evaluation double for every three additional patients an emergency nurse cares for in 24 hours.

"There is a very large and rigorous research literature consisting of hundreds of studies and multiple systematic reviews published in the most prestigious scientific journals in health care showing that the more patients nurses in hospitals care for each, the worse the outcomes are including preventable deaths, preventable hospital acquired infections, poor patient satisfaction and worse financial outcomes for hospitals resulting from longer patient stays, Medicare penalties for excess readmissions, and high nurse turnover that costs hospitals many millions of dollars every year," Dr. Linda Aiken, PhD, RN, FAAN, wrote to the Massachusetts State Legislature in 2023 in support of legislation safely limiting RN patient assignments.

Aiken, a University of Pennsylvania Professor of Nursing and Sociology has studied nurse-patient limits around the world and is the preeminent researcher on the topic. Her 2023 testimony foreshadowed the alarming conditions nurses reported in this year's State of Nursing Survey: "Chronic nurse understaffing predates the Covid-19 Pandemic and thus a return to pre-Covid hospital nurse staffing will continue to imperil the public's health."

The "Shortage" Myth and Why Nurses are Leaving the Bedside

The phrase "nursing shortage" is a common refrain in discussions about our healthcare crisis. However, extensive data and the State of Nursing survey results show that we have enough nurses in Massachusetts, but that burnout and unsafe conditions are pushing them away from the bedside.

• 36% of RNs plan to leave the profession earlier than expected— jumping to 50% among nurses with less than five years of experience, according to the State of Nursing.
• 19% say they will leave nursing within the next two years.
• 38% of those leaving say they plan to exit healthcare entirely, up 20 points from last year.
• Among those planning to leave, top reasons include burnout (27%), poor working conditions (26%), and unsafe staffing (16%).
  • Poor working conditions as a reason for leaving increased 19 points from 2024.

As recent data from the Health Policy Commission (HPC) demonstrates, the supply of RNs in Massachusetts is high and continues to grow. In its most recent report on the subject, "Health Care Workforce Trends and Challenges in the Era of COVID-19," published in March 2023, HPC concluded that the workforce challenges facing the healthcare system do not stem from a lack of nurses, but from an increasingly challenging work environment.

• Massachusetts has more nurses per capita than almost any other state, with 12% per capita growth since 2015.
• Unlike many other states, Massachusetts is on track to have a nursing surplus by the end of the decade.
• Massachusetts has increased the number of registered nurses by 24% – nearly 30,000 nurses over the past several years.
• The HPC also pointed out that the nursing education pipeline has remained steady.

The 2025 State of Nursing Survey specifically asked nurses if they had previously worked in a hospital setting, and if so, why they left. Among those nurses, unsafe staffing was the top reason (24%), followed by work hours/overtime/scheduling (18%), and burnout (12%). In addition, nurses expressed a serious concern for their nursing license due to unsafe staffing levels.

• 36% of nurses said they are concerned on "most shifts" that unsafe staffing conditions could jeopardize their nursing license.
  • 48% of nurses working in a direct care community hospital said they worry about losing their license "most shifts."

• 13% said once a week they are concerned and 15% said a couple of times a month.

"When a hospital executive defends poor staffing levels based on a 'nursing shortage' know that the data does not support that argument," said MNA President Murphy. "What the data does support is that nurses are burning out and leaving bedside care and our number one job should be to keep them there."

Workplace Violence: A Crisis Within a Healthcare Crisis

Nurses and other healthcare workers face physical or verbal violence every 36 minutes in Massachusetts hospitals. Healthcare workers experience violence at a rate five times that of other professions. In the years during and following the COVID-19 pandemic, this longstanding crisis has grown even more problematic.

• 69% of nurses in 2025 say workplace violence and abuse is a serious problem – up five points from last year and 27 points from 2021.
• 83% of nurses working in direct care teaching hospitals say it is a serious problem
• 23% say they do not feel safe in their workplace, with that number jumping to a third (34%) among nurses in direct care at teaching hospitals.

• 70% of nurses have personally experienced at least one instance of violence or abuse in the last two years.
• 64% say they received no support from management after such incidents—a 6-point increase over last year.

"It is completely unacceptable that after all of these years, nurses are still being physically and emotionally harmed at an alarming rate," said Karen Coughlin, former longtime Department of Mental Health RN and chair of the MNA Workplace Violence and Abuse Prevention Task Force. "Too many nurses like me have been forced to leave the profession because of unchecked violence. The MNA urges state leadership to take up the collaborative solutions we have developed with hospital administrators and our colleagues at 1199SEIU to prevent healthcare violence and support staff who are assaulted."

Leaders from the MNA, the Massachusetts Health & Hospital Association (MHA), and 1199SEIU Massachusetts delivered testimony on April 9 in united support of An Act Requiring Health Care Employers to Develop and Implement Programs to Prevent Workplace Violence (H.2655/S.1718).

While the groups had supported similar but separate proposals in previous sessions, this marks the first time that a single, consensus piece of workplace violence legislation has been laid before local policymakers. The legislation is designed to reduce violence at hospital facilities by:

• Requiring all Massachusetts hospitals to develop a facility-specific risk assessment and then use that assessment to implement a comprehensive program to reduce the risk of workplace violence.
  
  
• Engaging the workforce in developing the assessment/program that includes worker training and provides a formal written violence prevention plan available upon request to all employees/labor organizations.
  
  
• Establishing strong enforcement through DPH licensing, regular reporting, and job protections for affected workers that include additional paid leave for assaulted workers.

Nurses Demand Stronger Regulation and Support

Nurses across Massachusetts have called on state leaders to enact better standards related to RN staffing, hospital closures, workplace violence, and other pressing issues. The lack of regulation at the state and hospital level is negatively impacting patient care, according to nurses, with 59% indicating more regulations are needed to keep patients safe – an increase of five points from last year.

Simply put, nurses do not feel heard.

• 77% say Beacon Hill lawmakers are not listening to or acting on nurses' concerns about unsafe staffing.
• 63% say hospital administrators are unresponsive to feedback on staffing; 49% report unsafe assignments are rarely or never adjusted by management.
• Nurses who have worked for five years or less (74%) and nurses in direct care at community hospitals (73%) are even more likely to say their hospital administrators are not responsive to feedback.

"This survey makes it painfully clear: Nurses do not trust hospital executives or lawmakers to have their backs or protect their patients from unsafe bedside conditions," said MNA President Murphy. "This is why nurses are demanding enforceable nurse-patient limits and other regulatory action now."

Nurses Support Real Solutions

The 2025 State of Nursing survey shows that nurses want concrete solutions, accountability, and strong investments in their workforce. One of the most urgent solutions is a limit on the number of patients a nurse can be assigned at one time, depending on type of hospital unit. MNA-backed safe patient limits legislation would empower DPH to hold public stakeholder hearings and promulgate regulations that establish specific limits on the number of patients a registered nurse shall be assigned to care for at one time.

• 89% of nurses support the proposed safe patient limits legislation, with 76% strongly supporting the bill.

"There is zero question that safe patient limits are the foundational solution to the nurse staffing crisis," said MNA President Murphy. "Until we ensure that nurses can provide safe patient care without burning out and suffering moral injury, nurses will continue to flee the bedside."

In addition to safe patient limits, nurses are seeking concrete solutions rather than temporary fixes in a number of other ways. In sharp contrast to hospital systems relying on travel nurses and remote nursing strategies, RNs in the State of Nursing survey call for investments in permanent nursing and support staff.

• 53% say higher salaries would keep them in the RN workforce.
• 41% say favorable time off benefits would keep them in the RN workforce (up 12 points from 2024).
• 40% say enough ancillary staff would keep them in the RN workforce.
• 38% say pension benefits would keep them in the RN workforce.
• 30% say full-time health benefits would keep them in the RN workforce (up 10 points from 2024).

A Union Voice and a Call for Change

Interest among nurses in unionizing has greatly increased since the pandemic, as problems that had festered prior to 2020, such as unsafe staffing and patient care quality issues, grew worse and took an even larger toll on nurses. Fundamentally, nurses do not believe their employers will uphold their commitments to improving working conditions. This has been proven time and again when nurses have organized with the MNA, and their employers have engaged in union-busting strategies in failed attempts to keep nurses from securing legal protections.

The State of Nursing survey demonstrates strong support among nurses for unionizing:

• 71% of nurses do not trust their employer to keep promises.
• 64% are dissatisfied with their ability to influence workplace decisions.
• Among non-union nurses, 54% would vote to unionize if given the chance.

"The hospital industry has ignored nurses' concerns for too long, only pay lip service when nurses decide to form a union and take the power they deserve," MNA President Murphy said. "Years of failure by hospital executives and state leadership to properly address unsafe patient care conditions and improve investment in the RN workforce has empowered nurses to organize and form unions across the Commonwealth."

• 24 MGB occupational health nurses voted in March 2025 to join the MNA.
• 28 registered nurses of Dana-Farber Brigham Cancer Center – Foxborough voted join the MNA in December 2024.
• MGB Home Care nurses and healthcare professionals – about 400 in total – voted in July 2024 to join the MNA.
• Approximately 80 MGB Home Hospital nurses voted to join the MNA in May 2024, the same day that a group of Newton-Wellesley Hospital ambulatory care nurses won their vote to join the MNA.
• Martha's Vineyard Hospital ambulatory care nurses are completing a mail-in election with a vote count expected July 2.
• 280 nurses at Framingham Union Hospital voted to join the MNA in January 2024.
• Dana-Farber Cancer Institute – Merrimack Valley nurses ratified their first MNA contract in January 2024.
• 16 nurses at South Shore Endoscopy Center (MGB) ratified their first contract in December 2023.

Federal Cuts Undermine Future Preparedness

Amid growing concern about global disease outbreaks, 42% of nurses say their hospital is unprepared for another infectious disease event—up from last year.

"Federal disinvestment in critical institutions like the CDC and WHO has made nurses more concerned about our readiness for future pandemics," MNA President Murphy said. "Hospitals need a plan—and nurses need support so they can properly respond to the needs of their patients and communities.

In February 2025, the MNA Board of Directors detailed numerous concerns about federal overreach and funding cuts following the inauguration of President Trump. Among those were reductions in NIH funding, proposed cuts to Medicaid, the censorship of live-saving CDC information, and the United States withdrawing from WHO, weakening the international collaboration that can address global health crises.

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Founded in 1903, the Massachusetts Nurses Association is the largest union of registered nurses in the Commonwealth of Massachusetts. Its 25,000 members advance the nursing profession by fostering high standards of nursing practice, promoting the economic and general welfare of nurses in the workplace, projecting a positive and realistic view of nursing, and by lobbying the Legislature and regulatory agencies on health care issues affecting nurses and the public.

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SOURCE Massachusetts Nurses Association