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.
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.
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.
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.)