By James X. Stobinski, Ph.D. RN CNOR CSSM(E) CNAMB(E), Director of Education
I recently wrote on the salient issue of nursing burnout and the staffing issues resulting from nurses leaving the profession. This month, I would like to turn to some very recent research on the reasons why health care professionals suffer burnout and leave employment. Linda Aiken and her co-authors in a study published in 2023 in the JAMA Health Forum state that, “Disruptions in the hospital clinical workforce threaten quality and safety of care and retention of health professionals.”1
Aiken and her team studied Magnet facilities and found that, “… hospitals characterized as having too few nurses and unfavorable work environments had higher rates of clinician burnout, turnover and unfavorable patient safety ratings.”1 Similar studies for clinicians in six European countries report comparable findings.2 In a study of the top factors for nurses ending health care employment in the years 2018-2021, 41% ended their employment for reasons other than a planned retirement.3 Of those respondents 22% cited burnout or emotional exhaustion and 18% cited insufficient staffing.3 These studies bring the consequences of unfavorable work environments and staffing shortfalls into sharp relief. Most notably, nurses younger than 30 cited emotional exhaustion (43%) and insufficient staffing (40%) as their reasons for leaving health care employment.
As Aiken and colleagues state, it is important to know which interventions the workers believe are effective in decreasing the contributing factors to burnout. A recent debate has centered on whether to build the resiliency of the workforce or devote resources elsewhere. In these three studies doctors and nurses, when selecting from a list of potential interventions to improve the work environment, rated current popular options such as resiliency training, workplace champions and quiet places in the work setting as the least favored choices. These interventions, although popular with health care leadership, have not yet stemmed the tide of burnout and staff exits. We now come to a crucial choice. Do we stick to current methods which have not yet proven effective and are disliked by clinicians or try new approaches identified by the clinicians?
Nurses and doctors in these recent studies offer possible solutions to include better nurse staffing ratios, improved work environments which allow scheduled, uninterrupted breaks, no unscheduled work assignments, more clinician control over work assignments and additional resources devoted to supporting clinicians new to practice.1 This would entail markedly higher labor costs for nursing, but training more providers or placing more emphasis on recruiting will not solve this problem.
It is possible that staffing issues may reach a crisis point where regulatory bodies impose a solution such as mandatory staffing ratios as a condition of participation. Conspicuously, CMS has recently proposed staffing ratios for nursing homes.3 Large scale, systematic changes to the work environment are possible. One example, the changes in physician resident work hours in the early 2000s.
A common theme emerges from these three articles. A sizable portion of the respondents do not trust management to address legitimate safety concerns or create better work environments. In this first study nearly a third of the respondents said their values did not align with that of management.
If we accept that workforce shortages will inevitably cause safety and quality issues and worsen retention issues, we should be attentive to the responses from clinicians.1,2,3 Clinicians increasingly believe that facilities’ leaders have control over issues which negatively impact their work. The fundamental disconnect facility leaders either cannot or will not institute feasible, evidence-based solutions known to clinicians. The evidence, as manifested in prolonged staff shortages, is increasing and pizza parties and more resiliency training may not be enough to reverse the trend.
References
- Aiken, L. H., Lasater, K. B., Sloane, D. M., Pogue, C. A., Fitzpatrick Rosenbaum, K. E., Muir, K. J., McHugh, M. D., & US Clinician Wellbeing Study Consortium (2023). Physician and Nurse Well-Being and Preferred Interventions to Address Burnout in Hospital Practice: Factors Associated With Turnover, Outcomes, and Patient Safety. JAMA Health Forum, 4(7), e231809. https://doi.org/10.1001/jamahealthforum.2023.1809
- Aiken, L. H., Sermeus, W., McKee, M., Lasater, K. B., Sloane, D., Pogue, C. A., Kohnen, D., Dello, S., Maier, C. B. B., Drennan, J., McHugh, M. D., & Magnet4Europe Consortium (2024). Physician and nurse well-being, patient safety and recommendations for interventions: cross-sectional survey in hospitals in six European countries. BMJ open, 14(2), e079931. https://doi.org/10.1136/bmjopen-2023-079931
- Muir, K. J., Porat-Dahlerbruch, J., Nikpour, J., Leep-Lazar, K., & Lasater, K. B. (2024). Top Factors in Nurses Ending Health Care Employment Between 2018 and 2021. JAMA network open, 7(4), e244121. https://doi.org/10.1001/jamanetworkopen.2024.4121
