Understanding & Addressing Nurse Burnout
Most nurses have experienced burnout. Half feel so burnt out they are either actively looking for a less taxing position or considering leaving the profession altogether1. An exhausted nurse workforce does not bode well for high quality patient care, workplace culture, hospital operations, and nurse wellbeing. Nurse burnout is pervasive, and it is a crisis. But it is not all bad news. Healthcare leaders are empowered to foster healthier work environments that engage and inspire nurses rather than deplete them. In this post, we explore what causes nurse burnout, its impact, and what healthcare leaders can do to curb the burnout crisis.
What is nurse burnout?
The 11th Revision of the International Classification of Diseases (ICD-11) defines burnout as “a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed” The syndrome is characterized by three dimensions: emotional exhaustion, depersonalization (for example, increased mental distance from one’s job or feelings of cynicism related to one’s job), and reduced sense of personal accomplishment at work2,3.
Burnout is an occupational phenomenon rather than a medical condition, but it can lead to disturbing psychological and physiologic effects in nurses4. Psychological effects include anger, anxiety, being unprofessional, disillusionment, fear, feeling insufficient at work, feeling overwhelmed, frustration, hopelessness, inability to feel happy, and lack of empathy. Physical effects include fatigue or exhaustion, gastrointestinal problems, headaches, muscle tension, and sleep disorders such as insomnia.
What causes nurse burnout?
Nurse burnout permeates every hospital and specialty (to varying degrees) and is a major driver of the global nurse shortage. Nurse burnout statistics show that 95% of nurses feel burnt out5. The reality is, even in optimal conditions, clinical nurse work is high stress. Nurses handle choices that impact patient lives on a daily—sometimes hourly—basis. They also work long shifts that are mentally, physically, and emotionally draining. However, the root of pervasive nurse burnout runs much deeper than challenging work and long days. The most common causes of burnout boil down to four core themes.
- High Stress Work Environment
Nurses are service-oriented and motivated by providing outstanding patient care. However, there are added burdens beyond the realities of patient care that increase the load nurses carry. Outside of the toll of demanding work and high stakes, many nurses experience physical exhaustion and the emotional challenges of bullying, workplace politics, legal risks, and poor patient outcomes and deaths.
- The COVID-Effect
Before the pandemic, it was common for nurses to experience sleep deprivation due to long night and swing shifts. After the pandemic, this issue worsened. Volume surges and short staffing spurred by COVID-19 required nurses to work even longer hours, often caring for sicker patients. At times, nurses were also asked to come in for the first shift and back again for the third shift. The collective toll of 2 years of asking for more from already burnt-out nurses led to a weary workforce. We recently found that since the pandemic started, 66% of nurses say they have experienced feelings of depression, 66% said their physical health has declined, and 51% experienced feelings of trauma, extreme stress and/or PTSD6. Additionally, the American Nurses Foundation’s Year-Two COVID-19 impact survey found that more than half of nurses report wanting to leave their position because it negatively affects their health/well-being.
- Short Staffing
Most hospitals regularly operate at an 85% or less fill rate. Unfortunately, chronic short staffing places added pressure on remaining nurses and drives burnout. In fact, more than half of nurses say short staffing is the primary reason for wanting to leave their position7. One study showed that nurses with a greater than 1:4 nurse-to-patient ratio have a higher risk of burnout, and that the risk rises 23% with each additional patient. Since burnt out nurses are more likely to leave their jobs8 and nurse turnover places stress on an already stressed work environment, short staffing feeds a vicious cycle of burnout, turnover, and short staffing.
- Rigid Scheduling
Nurses work 12-hour shifts. Or—at least—that’s how hospitals have scheduled nurses for decades. This rigid perspective on nurse scheduling has run its course. Consistently working 12-hour shifts leads to stress, exhaustion, inferior performance, and reduced ability to lead a fulfilling personal life. Nurses who regularly work 10-hour shifts or longer are 2.5% more likely to experience burnout and job dissatisfaction than those who work less9.
What is the impact of nurse burnout?
Nurse burnout undoubtedly impacts nurses, patient care, and hospital bottom lines.
Impact on Nurses: On the individual nurse level, exhausted nurses experience anxiety and frequent illness. Nurses experiencing burnout are more than twice as likely to have thoughts of suicide10 compared with those who are not. This strain on nurse wellbeing has ripple effects on fellow nurse colleagues, patients, and hospitals. Hospitals should look for these signs of nurse burnout:
- Increased frequency of nurse callouts
- Negative input on employee satisfaction surveys
- Greater vacancies and absenteeism
- High overtime metrics
Impact on Hospitals: Nurse burnout is costly to hospitals in part because high nurse burnout rates drive nurse turnover. The average hospital loses $5.2m - $9.0m to nurse turnover annually8. A Study by the American Journal of Infection Control found that hospitals that reduced burnout by 30% had annual cost savings of up to $68 million. Other costly signs of nurse burnout include:
- Recruiting difficulties
- Lower Press Ganey/patient satisfaction scores
- Short staffing
- Lower nurse sensitive indicators
Impact on Patients: Nurse burnout affects nurse bedside manner. Exhaustion does not foster engaged and positive nurse-patient interaction. More concerningly, nurse burnout is associated with increased medical errors, delayed care, injuries, and infection rates12.
How to prevent nurse burnout: What Healthcare Leaders Can Do
Nurses are invaluable—yet overwhelmingly—they do not feel appreciated and empowered. They are often celebrated as heroes, but their needs are rarely addressed through fundamental system changes. It may not be possible to eliminate the stress that comes with the urgency and importance of patient care, but it is plausible to foster a healthier nurse staffing and management culture to reduce nurse burnout. The following best practices can help:
Ensure Engaged Leadership
Invested leaders go a long way to reduce nurse burnout. Leaders who take the time to shadow and mentor employees and get to know their career aspirations are more likely to help them forge a career path that considers their personal and professional preferences. Nurse leaders who are engaged and have an open-door policy that encourages transparency and strong interpersonal relationships typically have lower rates of burnout. The key is to empower leaders to incorporate nursing staff feedback, show empathy for nursing staff, and to foster a healthy workplace culture.
Embrace Flexible Scheduling
As noted earlier in this piece, the 12-hour shift is outdated. With the rise in travel nursing and the gig economy, nurses increasingly seek flexibility in their careers. Nursing staffing structures must be redefined to adapt to the evolving modern workforce. This means including more part- time roles and variable roles and embracing technology to support the shift. New nurse staffing approaches challenge healthcare leaders to move away from a shift-scheduling mindset toward an hours-of-coverage-needed mindset. As the rigidity of a 12-hour shift lessens, nurse empowerment and career satisfaction increases, which reduces burnout. This shift starts by treating nurses as dynamic, individual professionals and taking their career preferences into consideration. For example, a nurse who’s taking classes during the day may prefer the tough-to-fill nights and weekend shifts, while a nurse with small children may benefit from more nights and weekends off. By exploring shift schedules outside of the long accepted 12-hour approach and understanding each nurse's individual situation, you not only expand your pipeline and float pool, but you also build a healthy pipeline of nurses who genuinely want to work with your organization. The more you know about a nurse’s preferences and motivations, the more you can provide them with fulfilling career opportunities.
View your Workforce Holistically
As you consider alternative scheduling models, ensure your technology supports your new approach. The proper technology for your needs will allow you to view your available nursing resources and create a schedule that considers the needs of your nursing staff. By considering the preferences and specialties of nurses you can optimize your staffing resources and empower your nursing staff to take ownership of their schedules. Rethinking your nurse scheduling process may seem daunting. No question, updating your scheduling technology will require an organizational lift. However, the ability to offer nurse friendly, flexible scheduling while viewing your workforce holistically leads not only to less burnout but also more operational efficiency, increased nurse fill rates, and reduced premium spend.
Prioritize Nurse Engagement
Retaining satisfied nurses requires much more than great pay and exciting perks. Pizza lunches and signs that say, “Thank you Heroes” are not enough to retain nurses and reduce burnout. Giving nurses career advancement opportunities, a true voice in their practice, and fundamentally shifting the way nurse schedules are built is a more effective approach.
We suggest building a nurse engagement program that focuses less on nurse tenure and external incentives like compensation and more on nurse involvement at work and internal incentives based on each nurse’s individual career aspirations and personal preferences. The result is a more engaged nursing workforce, less turnover, and improved patient care.
Empowerment and Flexibility: Keys to Nurse Burnout Prevention
Patients, nurses, and hospitals benefit when healthcare organizations prioritize nurse burnout prevention. Nurse leaders who celebrate nurses as dynamic individuals and understand the importance of nurse engagement can make a significant difference in reducing nurse burnout. Beyond that, hospitals that evolve to think more flexibly about their nursing workforce will not only reduce nurse burnout, but also prevent its effects—patient safety issues, costly nurse turnover, poor patient experience, and reduced workforce wellbeing.
Ready to Reduce Nurse Burnout? Trusted Works Can Help
Trusted Works gives you a bird’s eye view of your entire workforce—internal, external per diem, local, and regional float—to understand performance, spend, and trends across source pools. This enables a more flexible labor pool that you can leverage to creatively solve staffing challenges, find the best-fit nurse for any open shift, and automatically apply incentives to shifts that need the most coverage. It also empowers nurses to sign up for shifts that best meet their preferences and needs, giving them the work flexibility and choice that they seek. Learn more about how Trusted Health Works can help your hospital reduce nurse burnout, streamline the source-to-pay process, and optimize labor costs at https://works.trustedhealth.com.