Report Draws Attention to Nurse Burnout, Seeks to Restore Joy to Profession

AJN has been asked to share with our readers a new report on nurse burnout: “A Gold Bond to Restore Joy to Nursing: A Collaborative Exchange of Ideas to Address Burnout” (pdf). The report is the result of a November 2016 retreat of leading thinkers in health care and nursing at the Johnson Foundation’s Wingspread campus in Racine, Wisconsin.

Among conference participants well known to AJN were Cynda Rushton, professor at the Johns Hopkins University School of Nursing and Berman Institute of Bioethics, and noted author and nurse Theresa Brown.

The post below detailing the report’s findings is by Cindy Richards of QPatient Insight, the consulting firm that organized the conference. An experienced journalist, she worked closely with conference attendees to prepare the report on the conference’s findings.

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We often hear that America faces a nursing shortage—the United States Bureau of Labor Statistics said in 2015 that we would need 1.2 million more registered nurses by 2024. In addition, surveys of nurses continue to find high levels of job dissatisfaction and high percentages of nurses who express an intention to change jobs or leave the profession in the coming years.

Why? In too many cases, because they are overwhelmed by demands that get in the way of doing the job they signed up to do: caring for their patients.

Challenges Facing Nurses

It’s no secret to nurses that they spend too much valuable time documenting everything they do in overly complicated electronic health record systems. They face physical hazards as well, from high rates of assaults against health care workers to potential injuries from having to lift patients without the proper equipment. Understaffing remains a persistent issue as well: nurses are often assigned to care for so many patients during a 12-hour shift that there is barely time to go to the bathroom or stop to eat a meal.

When the American Nurses Association asked nurses to take a health risk assessment, 82% reported that they were are at a “significant level of risk for workplace stress.” It’s little wonder, then, that a large percentage of America’s 3.6 million nurses report that they feel burned out.

Seeking Answers

Last November, QPatient Insight organized a collaborative retreat of 33 writers, professors, ethicists, technology experts, hospital administrators, and bedside nurses at the Johnson Foundation’s Wingspread campus to discuss nurse burnout. I was privileged to be in the rooms and listen to the impassioned conversation over two days. Then I was charged with taking the wide expanse of experiences, thoughts, ideas, and recommendations and distilling them into a report. My words were posted on a shared online platform and the Wingspread participants worked collaboratively to enhance and refine the results.

Proposing Solutions

The result is a report that includes 35 ideas organized into four sections aimed at combating nurse burnout and restoring joy to the profession. Some ideas are aimed at the policy makers in Washington and statehouses across America. Others are aimed at the health care organizations in your neighborhoods. Still others are aimed at nurses themselves.

Among the recommendations:

Redefine nurse burnout as a workplace injury. This shifts the issue from a personal problem to an organizational one. Seeing burnout as a workplace injury and/or patient safety issues leads to policies aimed at prevention, recognition, and treatment just like any other injury.

Reframe nurse burnout as a patient safety issue. When nurses are emotionally and physically depleted, they can harm their patients by not being able to listen, empathize with their situation and respond to their concerns. Worse, it can lead to physical harm. This puts burnout into a definitive cost category. Those issues that are measured, quantified, and potentially costly are much more likely to be addressed.

Standardize metrics for measuring burnout and tie improvement to financial incentives. There already are metrics for measuring job satisfaction among nurses. But organizations don’t do as much to increase these scores as they do to increase patient experience scores. Why? Because patient experience scores are publicly reported and tied to Medicare and Medicaid reimbursement. With income at stake, health care organizations work hard to improve their patient experience scores. Nursing satisfaction should be valued just as highly.

Train health care professionals together. Physicians are trained in medical school. Nurses are trained in nursing school. But when they leave school and start work, they are thrown together and expected to work in teams. Changing the way health care professionals are trained so they spend time working together in interdisciplinary teams while they are still in school will make the teamwork, camaraderie, and partnership feel like a natural progression when they graduate into their professional lives.

Change the way we talk about the problem of nursing burnout. This is perhaps the most important recommendation of all: Transform the conversation to one about restoring joy to the profession. Talking about burned out nurses is a negative; nurses say they are shamed and blamed for the burnout. That, in turn, makes them less likely to seek help. Instead, they toil alone and unhappy until they simply can’t take it anymore and quit the profession. Or worse, they continue to care for patients physically long after they have checked out emotionally. But wouldn’t everyone want to find ways to feel joy about the work they do every day?

Nurses are the bedrock of our American health care system. Finding ways to support, mentor, and infuse the nation’s 3.6 million nurses with a sense of purpose and joy in their profession is a critical need. Right now, at a time when the entire health care system already is destabilized and its future uncertain, it should be a national imperative.

(Conference sponsors included three nursings schools, the University of Virginia, Johns Hopkins, and University of Texas; two think tanks, the Institute for Healthcare Excellence and the Experience Innovation Network; five health systems, Dignity Health, Intermountain Health (UT), Mission Health (NC), Johns Hopkins (MD), and Aurora Healthcare (WI); and the American Nurses Association.)

 

 

 

2017-05-03T11:40:29+00:00 May 3rd, 2017|Nursing|5 Comments

About the Author:

Senior editor/social media strategy, American Journal of Nursing, and editor of AJN Off the Charts.

5 Comments

  1. Vernon Dutton (@nursingpins) May 7, 2017 at 1:28 am

    First, nursing has got to be seen as a profession by hospitals, as it is, nursing is the only healthcare “profession” that is included in the room and board charge. Unfortunately the state our profession is the result of the history of nursing. From the early days of the beginning of nursing (Training Schools), nurses were little more than indentured servants that were trained to care for patients and also do everything required to run the hospitals while being trained. As the Training schools gave way to the Diploma programs, nurses lived in and ran the hospitals. When nursing left the hospitals for the universities, nurses were left in the hospitals and nurses were never recognized as anything more than paid employees. As Associate and B.S. programs proliferated and universities assumed the “training” or education of nurses, hospitals retained full control of nurses and our fate was sealed. Now we have hospital nurses completely under the control of hospitals with little and mostly no voice in our “profession” and professional nurses that only exist outside of the hospitals. The big crunch for nurses began in the early 80;s as technology boomed as hospitals maximized profits with cost cutting measures. Hospitals continued to see nurses not only as the employees that took care of the patients but also as the ones that ran the hospitals. That means the hospitals continued to see nurses as the ones to answer all the phones, cleaning of equipment, housekeeping, stocking, meal serving and everything else required to run the hospitals. With the explosion of technology and complex treatment, hospitals continued to expect nurses to run the hospitals for them as they have always done. With the advent of EMR, things went from bad to worse, requiring nurses to spend countless hours entering mind numbing repetitious information that is all but useless except for reimbursement. Unfortunately nursing education did not keep up with the rapid changes in the hospitals and nurses were not prepared for the perverted way hospitals utilize nurses and for which their education did not prepare them for. Nurses were taught to be a professional health care provider but when they showed up after graduation they had no idea they had to run the hospital and would only deliver care to a ridiculous number patients in whatever time was left. Instead of spending so much research time identifying and classifying nurse burnout, the time should be spent identifying the cause. The cause of the nurses problem is known and the biggest problem is that hospitals force nurses to care for more patients than can safely be done and added to that is the endless amount of useless documentation required on the computer/pads AND all the historical duties nurses have always done to run the hospital. Nurses are set up to fail before they even start The only fix at this time is fewer patients for the nurse to take care of and support staff to run the hospital. There is no room or need as the hospital sees it for a professional nurse in the hospital.

    Vernon Dutton, R.N. @nursingpins

  2. Sharon smith May 3, 2017 at 8:35 pm

    Nurses should never have to think about staffing. They should be given the tools to do their job by their employer, every shift, every day.

  3. Debra L Stich May 3, 2017 at 5:54 pm

    I retired from hospital nursing after 35 1/2 years. It was not the patient care that made me leave. I found great satisfaction in providing care and comfort to all ages. It was management and administration, and supervisory staff that made the job and working conditions unbearable. There was such an atmosphere of distrust, and I found I had to be “invisible and silent” my last two years of service. Open communication of concerns was discouraged, and a huge focus on “patient satisfaction” left most nurses “dissatisfied”, subject to verbal abuse from patients, families, and coworkers. I watched seasoned nurses come to work, be pulled aside by management…..escorted to their lockers and watched while they cleaned out their belongings, turned in their badge and keys, and then were escorted to their cars and told to leave the campus. I feared that scenario every day I went to my assigned shift. Oppression and intimidation does not build a strong and healthy health care team. I am grateful for the all patients I was able to help and for the ways I made their recovery easier, but I am relieved to be free of an extremely toxic work environment. I did not renew my nursing license once I discovered how much better life is away from the nursing profession. It is a terribly sad state of affairs, and I am afraid for the future of nursing if things don’t change.

  4. Daisy M. Rodriguez May 3, 2017 at 2:13 pm

    I’m glad there is renewed focus on nurses’ job dissatisfaction, job stress and burnout. I studied this subject as part of my research over twenty five years ago and I feel like this is a deja vu. I related burnout and job dissatisfaction to intent to leave the job and their profession. I found a high correlation among these factors.
    Nursing administrators should revisit this persistent problem if we are going to stem the flight of nurses out of the profession and/or jobs as a factor in nursing shortage.
    Daisy Rodriguez- nurse book author

  5. Peter Abraham May 3, 2017 at 11:51 am

    1) Mandated patient to nurse ratios will help tremendously reduce nurse burnout as well as improve patient safety along with increase the time for patient education in an attempt to lower readmissions.
    2) Allow the nurse to be removed from playing the middle person between two or more hospital entities. I.e. if the doctor orders a stat MRI without communicating to the nurse the reasons and the MRI department calls the nurse asking for the reasons… hello, call the doctor directly vs putting the nurse in the middle or at least have the doctor communicate with the nurse and the MRI department as to the reasons et al.
    3) More realistic views of what nurses should be able to accomplish given the current patient to nurse ratios.

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