Click here to view the Executive Summary for the “State of Nursing in Massachusetts” Survey.
Mass Nurses Warn of Declining Patient Care Quality, Unsafe Staffing, and an Epidemic of Violence in 2026 State of Nursing in Massachusetts Survey
Majority of nurses say care conditions have worsened as understaffing continues to drive risks for patients and the nursing workforce
CANTON, Mass. – A newly released 2026 State of Nursing in Massachusetts survey from the Massachusetts Nurses Association (MNA) reveals a healthcare system under continued strain, with registered nurses across the Commonwealth reporting worsening patient care conditions, unsafe staffing levels, and growing barriers to delivering the care patients need.
The annual survey, released for National Nurses Week (May 6–12), reflects persistent and in some cases worsening trends identified in prior years, signaling an ongoing crisis for both patients and the nursing profession.
“On behalf of patients and healthcare workers across Massachusetts, nurses are sounding the alarm about our deteriorating healthcare system,” said Katie Murphy, a practicing ICU nurse and President of the MNA. “Nurses are experiencing rampant understaffing, resource constraints, and growing patient complexity, straining our ability to provide safe, high-quality care. These systemic problems demand urgent solutions.”
A new study published in the journal Medical Care supports the State of Nursing in Massachusetts survey results, showing that nurse dissatisfaction has worsened across multiple measures since the COVID-19 pandemic. The study, co-authored by renowned nurse researcher Linda Aiken, concluded: “Job dissatisfaction and intentions to leave employment continue to rise even after the pandemic has receded, and more nurses lack confidence in their management to act in the best interest of patients. New policy approaches seem warranted, including setting minimum safe hospital nurse staffing requirements.”
Quality of Care Declining Amid Staffing Crisis
Nurses overwhelmingly report in the State of Nursing in Massachusetts that patient care conditions have deteriorated:
- 71% of nurses say the quality of care has gotten worse in the last two years. This is up 33 points from pre-COVID levels.
- 69% say they do not have enough time to provide necessary patient care. This jumps to 74% for nurses in direct care teaching hospital positions.
- 72% are concerned that unsafe staffing could jeopardize their nursing license.
Understaffing remains the central driver of these challenges, with 60% of nurses identifying it as the biggest obstacle to delivering quality care, consistent with multi-year trends.
Unsafe Staffing Driving Patient Risks
The survey highlights the direct impact of these conditions on patient care:
- 81% of nurses report patients lacking adequate comfort and assistance due to understaffing.
- 74% report insufficient time for patient education and discharge planning.
- 52% are aware of medical errors tied to excessive patient loads.
- 35% say they would not feel safe admitting a family member to their unit.
“These findings reflect a healthcare system where nurses are being stretched too thin to safely meet patient needs,” said MNA President Murphy. “When nurses don’t have the time or support to provide appropriate care, patients suffer.”
Nurses’ experiences reported in the 2026 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.
Workplace Violence Remains a Serious Concern
While staffing and care quality dominate nurses’ concerns, workplace violence continues to pose a significant threat.
- 69% of nurses experienced at least one incident of workplace violence in the past two years, rising to 79% among newer nurses
- 74% of community hospital nurses say workplace violence is a serious problem.
These findings build on years of survey data showing that workplace violence escalated during the COVID-19 pandemic and remains persistently high. In response, hundreds of nurses and healthcare professionals rallied at the State House on May 5th for a “Safety First” Day of Action.
Support for Solutions and Legislative Action
Nurses across Massachusetts are calling for concrete solutions to address these systemic challenges:
- 93% support legislation to establish safe patient limits for nurses.
The MNA is advocating for An Act Promoting Patient Safety and Equitable Access to Care, (S.1522/H.2448), a bill requiring the Department of Public Health to set limits on the number of patients a nurse can care for at one time based on hospital unit and public stakeholder input.
- 95% support workplace violence prevention legislation.
A workplace violence prevention bill (H.4767/S.1718), supported by the MNA, 1199SEIU, and the Massachusetts Health & Hospital Association, passed the Massachusetts House unanimously. It is pending in the Senate.
Systemic Pressures Continue to Worsen
Nurses report ongoing structural challenges that are compounding unsafe conditions:
- 69% say RN positions are being left vacant or unfilled
- 54% report increased use of contract nurses
- 33% report increased mandatory overtime
- 28% report RNs being replaced by unlicensed personnel or LPNs
At the same time, 66% of nurses say more hospital regulation is needed to keep patients safe, underscoring growing concern that current oversight is insufficient.
Workforce Instability and Burnout Continue to Threaten Care Delivery
The survey also highlights ongoing instability within the nursing workforce, driven by burnout, poor working conditions, and unsafe staffing:
- 16% of nurses say they plan to leave the profession within two years.
- 32% say they expect to leave the profession earlier than originally planned.
- Among those planning to leave, top reasons include:
- Burnout/exhaustion (26%).
- Poor working conditions (15%).
- Being prevented from providing quality care (15%).
In addition, among nurses who have left hospital settings, unsafe staffing remains the top reason (24%), further underscoring the link between working conditions and workforce retention.
These findings mirror trends identified in previous surveys, reinforcing that the issue is not a lack of licensed nurses, but the conditions that push them away from bedside care.
“Massachusetts does not have a shortage of nurses. We lack safe working conditions that allow nurses to stay at the bedside,” MNA President Murphy said. “Until we address the root causes driving burnout and turnover, the system will continue to lose experienced nurses and put patient care at risk.”
As 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.
About the Survey
The 2026 State of Nursing in Massachusetts survey was conducted by Beacon Research and includes responses from 484 registered nurses across the Commonwealth between March 11 and March 24, 2026 . Respondents were randomly selected from the Massachusetts Board of Registration in Nursing. 53% of respondents were not MNA members.
