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Nursing retention

With nurse burnout, prevention is best medicine

BY: Carole Jakucs, MSN, RN, PHN on October 9, 2019

Burnout is a term expressed by people in different lines of work who feel exhausted and underappreciated.

It is a physical and mental stressor that can lead to health problems for those who are affected.

In nursing, burnout can negatively impact patient care, resulting in increased rates of medical errors, decreased levels of patient satisfaction and high nursing turnover rates.

Depending on the group surveyed and study cited, the nurse burnout rate can range from 33% to 70%. Thus, nurse burnout is more common than most people think.

With a shortage of nurses in many areas of the U.S., it behooves nurse recruiters, managers and healthcare administrators to recognize the signs of burnout and find ways to help prevent it from occurring in the first place, said Frederick P. Morgeson, PhD, the Eli Broad professor of management at the Eli Broad College of Business at Michigan State University.

“Prevention is key,” Morgeson said. “But once it strikes, there are many things hospitals can do to understand burnout is present and manage it. Given that nurses work in a life-and-death environment, nurses and all staff will at some point feel stressed and inevitably some will burn out. Being sensitive to this and finding ways to deal with it is important, especially with the trend towards LEAN management and operating with as few staff as possible, which places the biggest burden on nurses.”

Nurse burnout is one of the causes of high nurse turnover rates, according to Morgeson.

“Burnout is the end signal that something else is wrong,” he said. “With websites listing ratings from former employees regarding working conditions at specific organizations, job seekers will know what it’s like to work there. This can negatively impact recruitment efforts if the reviews are poor.”

Strategies to prevent nurse burnout

Morgeson said when burnout sets in, the mind and body find ways to cope. Burnout can happen to anyone and causes real stress and danger.

He said the typical signs of burnout include:

  • Fatigue
  • Disengagement (not being present)
  • Performance-related issues

Morgeson said preventing nurse burnout is essential with current low rates of unemployment, a shortage of nurses, more nurses retiring, an aging population, and nursing being listed in the top 10 professions for growth potential.

A lot can be done in the area of prevention, Morgeson said.

Some ways to address nurse burnout include:

  1. Empowering nurses by giving them autonomy, one of the classic ways to help people cope.
  2. Emphasizing the meaningfulness of their work, otherwise work can feel thankless.
  3. Acknowledging good work by putting mechanisms for recognition in place.
  4. Providing social support, such as encouraging nurses to share feelings from stressful events so staff know they’re not alone and part of a broader community.
  5. Ensuring the presence of high-quality leadership with managers who provide resources and support.
  6. Considering the screening of candidates during interviews for signs of increased levels of resilience for high-stress units such as the ED and ICU.

Proactive steps toward prevention

Once a nurse is burned out, it’s almost too late, said Deena Gilland, DNP, RN, NEA-BC, director at the American Academy of Ambulatory Care Nursing, vice president and CNO at Emory Ambulatory Care and instructor at the Nell Hodgson Woodruff School of Nursing at Emory University in Atlanta.

“It’s better from a management standpoint to be proactive rather than reactive to burnout — it takes more time and energy,” Gilland said. “However, the goal is not to let it progress. If a nurse is in a tough spot, we try as an organization to help the nurse adjust and also consider a different work environment.”

Part of Emory’s proactive approach to address nurse burnout is the creation of nurse retention and engagement teams.

“We focus on nurse engagement system-wide, which helps increase our retention rates and decreases our turnover rates,” Gilland said.

Providing nurses with tools

The goal, according to Gilland, is to support nurses to govern their own practice with a focus on shared governance.

“We give our nurses opportunities to tell us what they need in daily huddles,” she said. “If they find solutions and can resolve the issue, this provides autonomy. If they can’t resolve issues at the unit level, their concerns are rapidly escalated up to the highest levels of management by 10 a.m. the same day. We have responsive leaders who quickly work to resolve any issues.”

A new position was created at Emory to help prevent and overcome nurse burnout called the director of nursing career development and strategy.

“This person oversees our recognition program, serves as a career coach for guidance on professional development and works with nurses seeking a change in their work environment,” Gilland said.

Assessing and responding to staff’s needs

Open lines of communication are important as well.

“With so many demands on nurses, it’s important (that) administration regularly checks in with their nurses, finds ways to increase their resiliency and helps staff connect to finding the joy and identifying the meaning of their work,” said Quanna Batiste-Brown, DNP, HCSM, FABC, RN, NEA-BC, the CNO of ambulatory care at UCLA Health in Los Angeles.

Batiste-Brown conducts daily huddles to meet with her team, understand their needs and see how things are going.

“As nurses, we can’t take care of others if we don’t take care of ourselves,” she said.

Some signs of burnout Batiste-Brown remains vigilant to are if a nurse has repeated tardiness, increased sick calls, absence from meetings, is less vocal in meetings and seems disengaged.

“If I see any of these signs, I’m going to ask and explore why,” she said.

One of several approaches used at UCLA is to include questions that assess for nurse burnout during the health system’s annual employee engagement survey.

“If someone’s score indicates possible burnout, their manager implements an action plan for that person with action items to help find a solution,” Batiste-Brown said.

Nurse wellness at Vanderbilt

Vanderbilt University Medical Center in Nashville, Tenn., has had a nurse wellness program and a nurse wellness committee since 2002.

The medical center was the first in the U.S. to have them, said Margie Gale, MSN, RN,CEAP, a nurse wellness specialist in the Work/Life Connections — Employee Assistance Program  at Vanderbilt.

“Our program is for faculty and staff only and is operated internally by Vanderbilt Health and Wellness,” Gale said. “It costs nothing for our staff to use and see us for individual consults. We see nurses and other staff for personal and family problems or work-related concerns.”

Vanderbilt also has a system in place to provide psychiatric first aid to nurses and staff by responding 24/7 to major events, such as when a patient or staff member dies.

“Either the employee assistance program responds or employee assistance program-trained nurses on the units provide a response in conjunction with the employee assistance program to provide debriefing and support,” Gale said.

Vanderbilt offers other programs in partnership with individual units, unit-based boards and unit-based wellness committees, as well as the Office of Nursing Research, to prevent and address burnout, according to Gale.

“Shared governance, empowerment, building resiliency, nurse engagement, addressing compassion fatigue, discussing ethical dilemmas, providing resources and addressing workplace violence are some of the major themes of these programs, and our way of addressing burnout before it occurs,” she said. “This is very important to us as an organization.”

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Carole Jakucs, MSN, RN, PHN

Carole Jakucs, MSN, RN, PHN, is a full-time freelance writer. Her background in nursing includes tenures in healthcare management and as a care provider. She has worked in med/surg/telemetry, pediatric emergency department and college health. She’s a health and fitness enthusiast, studies dance and enjoys cooking.