Nurses—especially in the last year during the pandemic—have been experiencing burnout. Often, articles focus on what they can do to make themselves feel better. But what can their workplaces do?
Anne Dabrow Woods, DNP, RN, CRNP, ANP-BC, AGACNP-BC, FAAN, Chief Nurse of Wolters Kluwer, Health Learning, Research & Practice, a Critical Care Nurse Practitioner at Penn Medicine Chester County Hospital, and a Clinical Adjunct Faculty member at Drexel University. She’s also authored and presented on many clinical and professional topics including a recently published eBook, COVID-19: Transforming the Nursing Workforce in the New Paradigm of Care.
She took time to answer our questions about what hospital leadership can do to prevent nurse burnout.
From a hospital leadership standpoint, what are some of the steps they can take to help prevent nurses from burning out?
Health care systems need to recognize that their most valuable commodity is their workforce. For years, health care systems have focused on patient well-being, but now many of those institutions are beginning to see the importance of focusing on workforce well-being too. Hospitals need to provide a safe environment for their workers, recognizing when they’re exhausted, burnt out and/or experiencing moral distress on the job. Safe environments should include the assurance of personal as well as patient safety and having adequate personal protective equipment, clinical decision support resources, and adequate staff to appropriately care for patients.
Staffing needs must be based on clinical acuity and severity of illness, not just on the number of patients. And having an agile workforce that can work in a variety of units as well as be shifted to other units when and where they are needed the most, is also a new essential, thanks to COVID. What we want, and need, are multispecialty nurses who can work across multiple units, not just single-specialty nurses working only with one patient population. Cross-training and upskilling staff to care for patients in a variety of units with a variety of care needs brings flexibility and efficacy to the workforce so managers will not need to overwork staff and can provide necessary time off.
Health care systems need to recognize when a member of their workforce is experiencing burnout and moral distress by having leadership and those trained in recognizing emotional distress available and on the unit to assess for it. Social workers and mental health workers are excellent resources to utilize for this kind of assessment. Taking the time to debrief and discuss what went right and what could have gone better in emergencies is a great opportunity to decompress after stressful situations. Many hospitals have instituted a moment of silence after a death where everyone in the room stops to acknowledge the life that was just lost.
Employee assistance programs (EAP) are good, but only if they can be easily accessed by those who need them. Too often EAP programs are difficult to find on the health care system website, and once they are found, the paperwork and or searching for an available care provider is incredibly challenging. EAP programs need to be made readily accessible and usable.
What should they do first?
The most important first step is to recognize that there is a problem with burnout. If staff are quitting, retiring early, or are becoming less engaged, there is a real problem. Be present! The leaders within the organization must be up on the units to experience what is going on firsthand. You need to find out if staff able to take breaks and leave the unit to have a meal. Are they able to sit down or are they constantly moving and up on their feet? Are they working as a team or as individuals? Health care is a team activity. It takes an interdisciplinary approach to provide the highest quality care and facilitate the best outcomes. If patient outcomes are not where they need to be, the first place to look is at your caregivers to see if they are exhausted, burned out, or experiencing moral distress.
What action steps should leaders recommend that nurses take? How can they get this information to them?
The question should not be what steps leaders should recommend to nurses to combat burnout, but how can health care organizations facilitate workforce well-being and prevent burnout? It is the obligation of leaders to assess the situation, make a plan, implement it, and then evaluate if the plan and interventions are working.
Start meeting with the staff, watch and listen to what they have to say, and start implementing these 10 steps:
- Assess if the staff are burned out or experiencing moral distress.
- Make employee assistance programs easy to access and utilize.
- Adequately staff the patient care units with the right staff for the right patient populations.
- Cross-train the workforce so they are more agile and can go when and where they are needed.
- Provide adequate support systems, unit coordinators, unlicensed assistive personnel, and transporters.
- Make sure the workforce takes their breaks and mealtimes.
- Offer healthy food. Get a cart and take healthy options to the unit if the staff is too busy to get to the cafeteria at mealtime.
- Give the staff time to debrief and collect themselves after a challenging situation.
- Decrease documentation burden and make sure nurses have input on what is added to required documentation in the electronic health record.
- Offer continuing professional development activities and career ladders to meet the staff’s professional needs.
Remember, nurses have family and financial concerns; offer care alternatives and financial counseling if and when it’s needed.
If nurses are already experiencing burnout, what should hospital leaders do? How can they help? And how can they let nurses know that their jobs aren’t in jeopardy if they need to take time off for their mental health because of burnout?
Take the time to see, hear, and experience what nurses are experiencing. You can’t do that from an office, so get up on the patient care units and look around. If the workforce doesn’t feel valued by the organization, they will leave, and there will be fewer caregivers left to care for the patients. Develop a “care without judgement model,” meaning that to whomever is in need of care—a patient, a nurse, or another employee—care will be delivered, without judgment. No one’s job should be at risk if they need to take time to step away and focus on self-care. You cannot be a good clinician unless you care for yourself first. Again, make it easy to access employee assistance and mental and physical health resources.
What should hospital leaders absolutely *not do when trying to prevent their nurses from burning out? What are the biggest mistakes they can make?
The biggest mistake health care leaders make is not recognizing that the health care workers are the most important commodity within their organization. Patient outcomes are optimized only if the staff feels valued, have adequate resources, are properly trained, and feel safe in their work environment—both physically and emotionally. Everyone on the health care team needs time to be able to take a moment to step away and recharge.
During COVID-19, what have been the biggest challenges that nurses are facing in terms of burnout? Is there anything that hospital leadership can do to help?
The biggest challenges have been fear and uncertainty. Fear that we initially didn’t know enough about the COVID-19 virus, and we might bring it home to our families or become infected ourselves, and fear that the death we experienced day after day wouldn’t stop. And uncertainty that we wouldn’t be strong enough to keep delivering care to our patients as we fought this seemingly unending pandemic. Yet we did. We looked fear and uncertainty in the face and said—”we will not be daunted!” That’s who we are—we are nurses, and our passion is to care for those in need.
Health care systems need to invest in workforce well-being, retaining the talent they have and recruiting new nurses to take the place of those who have left the profession. Care begins with those in our family. In health care, the workforce is our extended family.
The vaccine is a game-changer for nurses. The more shots in arms, the lower the number of patients we will see fighting for their lives because of COVID-19. Let’s trust in the science and use the evidence to educate people about COVID-19 and how to prevent it.
And finally, nurses need to invest in their own well-being so they can invest in caring for others.