Studies have found that overworked nurses lead to more errors and lower patient satisfaction. Nurses across the country are stressed, burnt out and thinking of leaving the profession. Surveys, polls and studies of all kinds point to nurses with longer hours, more work and less time to care for patients and unwind from the intense stress of the job.
A University of Phoenix College of Health Professionals 2016 poll found that four out of five nurses are playing a larger role in patient care management than two years ago and 84% of registered nurses believe non-doctors will play an even larger role in patient care management in the next five years. That means more work for nurses.
A recent Kronos Incorporated survey showed that 90% of nurses are thinking about leaving their hospital for another job because of a poor work/life balance. Also, most of the surveyed nurses (83%) said hospitals are losing good nurses because other employers offer a better work/life balance. “Nurse burnout is real, although some like to avoid or downplay it,” Elizabeth Scala, author of Stop Nurse Burnout, told Healthcare Dive. “In fact, there is often a stigma related to nurse burnout.
"Nurses fear that if they speak up, they will not be heard or worse . . . will be retaliated against in some way.
Elizabeth Scala, Author of Stop Nurse Burnout"
In addition to worsening the wellbeing of nurses themselves, burnout can lead to problems with patient safety and hospitals finances. However, there are steps hospitals can take to help ease burnout and some are relatively simple and inexpensive.
What’s causing burnout among nurses
A nurse’s workload, work/life balance and a nursing shortage are all contributing to stressed nurses. An RNnetwork study earlier this year found that 70% of nurses feel burnt out and half of the nurses have considered leaving the profession. Also, nearly half of nurses surveyed said their workload has increased.
Kronos Incorporated’s survey found that many nurses said they skipped breaks and didn’t get enough sleep in between shifts. One-quarter of those surveyed said a change from eight- to 12-hour shifts exasperated burnout.
Half of the nurses in a new CareerBuilder study said they feel “tired all the time.” Staffing isn’t expected to improve anytime soon. CareerBuilder said nursing job vacancies are “increasing at an accelerated rate.”
But hospitals and health systems are struggling to find enough qualified nurses to fill the jobs. CareerBuilder reported that hospitals posted a job listing for registered nurses an average of 10 times on different sites in the first quarter of this year, which points to a “highly competitive hiring environment” for hospitals and health systems.
This employment crunch can lead to larger workloads and longer hours for nurses.
But it’s not just more work and longer hours that is causing stress. Technology can also create a barrier between a nurse and a patient. Scala argued technology like electronic health records (EHRs) systems can make a nurse feel disconnected from patients.
EHRs can help improve care coordination. However, nurses may worry that they are simply inputting information and not making a difference for their patients, Scala said. “While the nurse went into the profession of nursing to provide relationship-based care and impact patients, the computers and charting can make it difficult for the nurse to feel as though they have the time to spend with the patient and family in front of them,” Scala said.
Nurses used pen and paper when Lisa Radesi started in the profession 38 years ago. Now, they have to spend a lot of their time on computers and using other technologies. Radesi, who currently serves as the academic dean at the School of Nursing at the University of Phoenix, told Healthcare Dive that computer and technology literacy are a relatively new skill set in nursing. “They have to be computer savvy and electronically savvy. Fifteen or 20 years ago, you didn’t have to be," she said. "That’s a big role change for them.”
Nurses are also playing a larger role in the overall management of patient care. They are providing more care coordination, post-discharge management and pre-discharge work. Many nurses are taking on more leadership roles in health systems. Nurses have a great influence in patient care and often take on more roles, which can lead to overwork, according to Radesi.
Claudia Douglas, administrative director of the Institute for Evidence-Based Practice and Nursing Research at Hackensack University Medical Center, told Healthcare Dive that workload isn’t necessarily the prime reason for burnout and “less than desired care.” There is a lot more than goes into whether a nurse feels burnt out. One way to help is to create goals and expectations of care, she said.
“Patient acuity, skill mix, staffing plans and staff competence are requisites to provide care.”
Claudia Douglas, Administrative director, Institute for Evidence-Based Practice and Nursing Research at Hackensack University Medical Center"
“High quality of care requires establishing goals and expectations of care, creating action plans to achieve the goals and ongoing monitoring and comparison of the results to the goal,” Douglas said.
How burnout impacts nurses, patient safety and a hospital’s finances
Studies have found that nurse burnout can impact patient infections, patient satisfaction and quality of care.
“Nurse burnout affects patient care negatively," Scala said. "If a nurse shows up to work and is feeling tired, disengaged and unappreciated, then they are not going to provide their best care. They may make a mistake, such as forgetting to check in on a PRN medication or overlook a crucial lab value.”
Patients and families can pick up when a nurse is burned out, which leads to lower satisfaction, Scala added.
Burnt out nurses can also have a financial implication on hospitals. Nurses leaving the job means hospitals have to recruit, hire, train and orient new nurses. That costs a lot of money — not to mention what constant turnover can do to staff morale.
“In today’s healthcare environment, organizations are finding that nurses are leaving clinical roles in less than two years’ time," Scala said. "The constant turnover can be costly to the organization’s bottom line.”
What hospitals can do to help nurses
An increasing number of surveys and studies point to a nurse burnout problem. But what can a hospital or health system do to help nurses who feel stressed out? Lower nurse-to-patient ratios are one way to help. Implementing those types of levels can reduce stress levels while improving patient care, according to Radesi.
"A lower nurse-to-patient ratio “gives nurses the opportunity to take good care of patients from head to toe.
Lisa Radesi, Academic Dean, School of Nursing at the University of Phoenix"
Another idea is to implement hourly or purposeful rounding. A study on hourly rounding looked at how it affected patient satisfaction with nursing care. The report found that hourly rounding in inpatient care can “improve patients’ perceptions of nursing staff responsiveness in units where this may have been a problem, reduces patient falls and call light use, and improves patient satisfaction scores.” The authors of the report recommended that nurse administrators implement an hourly rounding program to test out the idea and find “the most cost-effective approach.”
Seun Ross, director of nursing practice and work environment at the American Nurses Association, told Healthcare Dive that she supports the idea. Frequent unit rounding can maintain awareness of the “pulse of the unit,” she said.
One the two approaches has a cost connected to it, while the other may require making changes to the way nurses perform their work. What does a health system or hospital do if it can’t afford to add more nurses or doesn't have buy-in for hourly rounding? Here are three low-cost tips:
Watch for signs of stress
Spotting burnout isn’t easy, Scala noted. Nurses may come to work trying to hide their stress because they’re afraid of a reprimand. A clear sign of burnout is less enthusiasm for the job. Other examples are a usually social nurse, who starts avoiding colleagues, and a team player who withdraws from team activities, such as projects and committees, according to Scala. Ross argued hospitals monitoring changes in engagement and attendance can get a view on nurses’ stress levels. Nurses who miss shifts, leave early, complain more or disagree more with co-workers might need help.
Douglas' facility conducts anonymous surveys to get feedback from staff and specifically runs a nurse satisfaction survey to get feedback from nurses. “The results are benchmarked against a national database,” Douglas said. “For areas indicating opportunity for improvement, leaders are required to complete an action plan.”
Stephen Young, research scientist of leadership insights and analytics at the Center for Creative Leadership, who co-authored “How Nurse Leaders Can Reduce Burnout: Focus on Mental Energy!” told Healthcare Dive that hospitals need to measure employees’ “mental energy levels and adopt initiatives that will most effectively enhance where energy is low within the organization.”
Staff with low mental energy may need a work shift scheduling change, while low emotional energy may “indicate a harmful interpersonal environment,” Young said.
Annual surveys aren’t enough, Young added. Instead, give employees game-based apps to use daily to examine their energy. That kind of energy assessment tool “can help you to objectively measure your organization's human energy crisis and determine how severe it is,” according to Young’s report.
Teach self-care strategies
Scala, who teaches self-care strategies in her Burnout Proof Live training, argued it’s important for nurses to learn how to separate work from home life. Nurses need to learn how to leave work at home.
“Teaching individual nurses burnout prevention tools is one piece of this complex puzzle,” she said.
Young says engaging workers on their energy levels on a daily basis raises their self-awareness. With that data, a hospital could teach individualized strategies, such as coping and break scheduling.
“Nurses, like any human beings, are a diverse group," Scala said. "Each nurse needs to find the self-care technique that works best for them. A variety of tools must be offered. The best thing an organization can do is to assess what the nurses want/need to cope and prevent burnout. And then to listen to the feedback, implementing a variety of strategies to support their nursing staff."
Make wellness a priority
Surveys have found that nurses often work through their breaks. Nurses not having any time off during a shift can lead to higher stress levels. Hospital leaders need to make sure their nurses are taking enough time off during their shift so they are alert.
One way to show the importance of wellness is to create wellness teams. Radesi believes having wellness teams can keep health front of mind for nurses and staff. Some ideas could be offering nurses massages during a shift, holding departmental group sessions to talk about health and creating a reward program connected to wellness, such as giving a prize to the staff member who walks the most. Another example is setting aside space for wellness. Douglas Hackensack University Medical Center has respite areas with comfortable seating and soothing lighting. The areas promote mental, emotional, spiritual and social opportunities, Douglas said.
Employees often follow their leader — and wellness is no exception. Nurse leaders should model behaviors that can reduce burnout, such as practicing mindfulness, Young said. By putting each employee’s wellness in the forefront, hospitals can improve morale and lower stress levels.
"In today’s healthcare environment, organizations are finding that nurses are leaving clinical roles in less than two years’ time. The constant turnover can be costly to the organization’s bottom line.
Elizabeth Scala, Author of Stop Nurse Burnout"
Understand your nurses
All of these tips go back to the same thing — get to know your nurses. Hospitals should look to improve communication with nurses and involve them in the decision-making process. Also, explain changes when they’re made. Nurses crave professional development, Radesi argued.
“The more they know, the easier it is for them to do their job," Radesi said.
Hackensack University Medical Center’s leadership team holds Town Hall meetings on various shifts to help foster better communication, according to Douglas. “Hospital leadership must be engaged with their team members," Douglas said . "They must be attuned to the challenges team members may face. Collaboration, partnership, active listening, and open and continuous lines of communication are essential."
Author: Les Masterson, Healthcaredrive
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