Nurse Burnout: Management and Prevention

The nursing workforce was already feeling added stress to keep pace with the demand for patient care. Then the pandemic happened, exacerbating staffing issues and creating an even more challenging environment in which to provide care.

To address workforce strain and support the ability to continue treating patients, hospitals and health systems turned to travel nurses to augment their nurse workforce. 

Travel nursing grew 35% in 2020, in large part due to increased demand for nurses during and post-pandemic.

As we near 2023, and the looming possibility of a recession, hospital systems are looking for ways to trim margins and reduce costs. To that end, many of the travel nurses hired in the past two years are being laid off. 

But this may not be the expense-saving measure it seems, given many systems now find themselves doubling overtime for staff nurses in order to support patient care. And, given that, this new lack of resources is likely exacerbating the burnout of in-house nurses, leading to costly consequences in their own right. 

To ensure continued delivery of cost-effective, quality care, and to support the well-being of existing staff nurses, healthcare leaders need to recognize the challenges today’s nurses face and work to better manage their environment to prevent nurse burnout.

What is nurse burnout?

Before you can work to better manage and prevent nurse burnout, it’s important to understand what it is and how to recognize its presence in your nursing staff.

Definition

According to The National Library of Medicine, nurse burnout “is a widespread phenomenon characterized by a reduction in nurses’ energy that manifests in emotional exhaustion, lack of motivation, and feelings of frustration and may lead to reductions in work efficacy.”

Causes

Common causes of nurse burnout include:

• Too many patients assigned to one nurse
• An insufficient number of nurses assigned to work a specific shift
• Shifts that are too long with not enough breaks
• Negative patient or coworker behaviors directed towards them
• Insufficient sleep
• Lack of time to eat
• Not feeling supported by the hospital or health system they work for
• Picking up the slack to do jobs outside their role
• Emotional stress

Symptoms

According to the National Academy of Medicine, signs and symptoms of nurse burnout can include “a high degree of emotional exhaustion, cynicism, and a low sense of personal accomplishment at work.” Nurse Journal points out additional symptoms, which could encompass “fatigue, dread going to work, feeling underappreciated, and feeling constantly overworked.”

Statistics: how common is nurse burnout in 2022?

Understanding nurse burnout is important. Understanding how rampant it is within hospitals and health systems, and how understaffed the nursing workforce truly is, is crucial to burnout prevention and management.

Consider this:

• More than 34% of nurses say it’s very likely they will leave their roles by the end of 2022.
• 44% cited burnout and a high-stress environment as the reason for their desire to leave.
• Nearly 32% of nurses plan to leave the field altogether or retire.
• With over half a million RNs anticipated to retire by the end of 2022, the U.S. Bureau of Labor Statistics projects the need for 1.1M new registered nurses across the U.S.
• 92% of nurses feel the pandemic “depleted nurses in their hospital, and that their career would be shorter than they had intended as a result.”
• Nearly half of nurses under age 35 say they have sought professional mental health support since March 2020.
• Of nurses under age 25, 69% say they have been suffering from burnout, which is more than double those older than 25 (30%).
• 60% of nurses under age 25 and 57% of nurses 25-34 do not believe their organization cares about their well-being and generally feel unsupported. 

The effects of nurse burnout on patients and health systems

Nurses operating under prolonged instances of stress or burnout not only face increased risks to their own health and well-being, they also increase the chances that productivity and patient health care will be adversely impacted. In addition, nurses dealing with burnout are more likely to quit or switch roles, exacerbating stress and pressure for the nurses left to fill the void.

The impact on care quality

As Patient Engagement HIT highlights, “A September 2018 Health Affairs study found that provider burnout doubled the odds of an adverse patient safety event, and providers who felt symptoms of depression associated with their burnout saw more pronounced patient safety risks.” In addition, they point out that, “Patients receiving care from a provider suffering from burnout were doubly likely to report low satisfaction with the care encounter.”

A nurse impacted by burnout could be fatigued, depressed, or struggle with concentration. All of which increase the odds that a medication or treatment error could occur. Patient outcomes and the patient experience are a top priority for healthcare organizations—and often impact reimbursement—so doing all you can to improve your nurses’ experience will go a long way toward improving care and positively impacting how patients perceive their care.

The impact on attrition

In one study of burnout, it was found that “the impact of burnout on organizational turnover was significant, with a 12% increase in a nurse leaving for each unit increase on the emotional exhaustion scale.”

This only accounted for emotional exhaustion, yet there are many more reasons a nurse could suffer from burnout and ultimately decide to leave a job. This includes patient load, where a Journal of the American Medical Association study found that, “each additional patient over four per nurse carries a 23% risk of increased “burnout” and a 15% decrease in job satisfaction.”

Burnout contributes to turnover, which contributes to greater burnout for remaining nurses. Not only does this impact care, but it impacts a healthcare organization’s bottom line. It is estimated that it costs 200% of a nurse’s salary to recruiter, hire, and train a replacement. Some studies pinpoint “overall turnover cost per RN at $65,000, while others highlight that the average hospital loses approximately $300K/year for each percentage point increase in annual nurse turnover.”

How to prevent and manage nurse burnout

Invest in your nurses:

• Keep the door open for nurses to address their concern with you. Make them feel welcome in doing so versus as if they will be penalized for their honesty.
• Involve nurses in the decisions that impact their jobs, from scheduling flexibility to the decision to hire travel nurses to fill open roles.
• Provide nurses with workplace support resources to help them care for their mental and physical health, from Employee Assistance Programs to Wellness Programs and exercise facilities.
• Make sure nurses who are suffering from burnout have a direct person they can confidentially confide in and trust.

Empower nurse managers:

• Train nurse managers on how to better recognize the signs and symptoms of burnout, and also in how to help prevent burnout from taking root in the first place. 
• Educate them on best practices for shift assignments, nurse-to-patient ratios, and on who they can reach out to instead of existing nurses on shift if emergency coverage is needed.
• Sit down with nurse managers, ask them what is working and what isn’t, and work with them to develop a realistic improvement plan.

Proactively plan for hiring needs:

• Take the time to forecast your hiring needs for the next 1-5 years. Make a detailed plan based on this forecast that accounts for full-time hires and contingency needs where travel or temp nurses would be ideal. 
• In the short-term, review existing resources to identify gaps and compare existing budgets against the cost of not filling those gaps. You may find it’s time to re-hire temporary nurses as a more cost-effective option over the next 12-24 months.

The nurse profession is one historically prone to overwork, great stress and increased chance of burnout. It’s in the nature of what they do. Any time you work with people in a capacity where they are sick and vulnerable, it can become an emotional and psychological drain. The pandemic amplified this tenfold.

As you look toward 2023 and the state of your nursing workforce, consider both who you have staffed and what they face every day. At Elite365, we’ve seen the impact that a stable, less stressed nursing contingent can have for a hospital or health system. Reach out to us for more advice on how to prevent nurse burnout in your ranks and improve their work environments.