Addressing the nursing shortage: Alleviating burnout and improving nurse satisfaction
Addressing the nursing shortage: Alleviating burnout and improving nurse satisfaction26 January 2022 | 8min
The World Health Organization (WHO) has highlighted the nursing shortage as a growing concern with an estimated shortage of 6 million nurses in the next 10 years
Contributing factors to the nursing shortage include fatigue, COVID-19, gentrification, and education
Leaders must address the burnout challenge and show appreciation for nurses and hospital staff where possible to build a healthy culture
In The State of the World’s Nursing 2020 report published by the World Health Organization (WHO), the nursing shortage was highlighted as both a priority and a growing concern.1
Many factors have been contributing to this nursing shortage over the last few years, but the recent pandemic has accelerated one factor in particular: nurse burnout. We spoke with LeAnn Thieman, an expert on healthcare recruitment and retention, to gain her insights on the growing problem of nurse burnout and how leaders can help address this issue.
Contributing factors to the growing nursing shortage
HT: According to the WHO report, it is estimated that there will be a shortage of 6 million nurses by 2030. What are the core contributing factors?
LeAnn Thieman: One contributing factor is generational. Many people, including nurses, are baby boomers looking at retirement. The rate of Millenials entering the nursing force is simply not fast enough to replace those retiring. Education is another contributing factor. We have long waiting lists to get into nursing school because we don’t have enough educators and schools to train them.
Another contributing factor is fatigue, especially with the pandemic. Many are burned out, or “drained out” as I like to say. We can refill their wells and develop ideas about how to serve them better so that they can be stronger and stay in the profession longer. Turnover is another factor. We have a shortage of young nurses as they are generally looking for new job opportunities and life experiences at different times. We no longer have generations of nurses who want to stay until retirement.
What the nursing shortage means for healthcare systems
HT: What does that mean for healthcare systems, the delivery of care, and the patient experience?
LeAnn Thieman: Currently, the patient load on nurses is much higher than normal. In intensive care, there can be one nurse per one patient, but because of the shortage, they often have three patients to care for. Even throughout all the hospitals, clinics, and systems, the acuity of the care is much greater today. There are no easy patients in the hospitals anymore. If they’re easy, they would’ve gone home already, so it’s a big burden for the nurses.
Patients used to come into the hospital for surgery and spend a day or two. If they had a hip replacement, they would spend four or five days. Also, now patients are sicker when they get to the hospital because patients are postponing their care out of fear of COVID-19. They haven’t had their annual checkups, or their heart disease may have worsened, or their cancer may be present without knowing it.
Nurses are fatigued which means they are not at their best and their performance suffers. Many insurance companies in the U.S. pay based on patient satisfaction, so if the patient isn’t satisfied, then that affects the bottom line as well.
How COVID-19 has played a role in the nursing shortage
HT: In what other ways has COVID-19 impacted nurses and exacerbated the nursing shortage?
LeAnn Thieman: Nurses are working harder and longer than before, and they can’t work remotely. They often have to help with the homework, with their families, and with children at home. That alone greatly impacted their exhaustion and there are not enough nurses to meet the need. Some nurses got sick with COVID-19 or they got sick otherwise. While we are concerned about COVID, other illnesses are still out there – cases of flu and colds, heart attacks and strokes, and everything else which is requiring a lot more nursing care.
HT: The role of healthcare workers has evolved so much with COVID-19 and technology. Do you think there’s a correlation there of why they’re getting burned out?
LeAnn Thieman: Absolutely. Healthcare workers entered this profession with the heart of caring and that’s how they want to spend their time. Spending a lot of time on administrative work is not nearly as fulfilling as taking care of patients. We don’t have as many independent physicians now as we did before. Many physicians are signed on and a part of a huge healthcare system. They are given numbers that they must meet – the number of patients in a day and the amount of time per patient. It can be frustrating sometimes because you want to take the time you need, and the demand is greater than the time you have.
Nurse satisfaction and the bottom line
HT: What impact do nurses have on the bottom line of hospitals, especially now that patient satisfaction is tied to reimbursements in some health systems such as in the U.S.?
LeAnn Thieman: Every time a nurse walks out the door, it costs the hospital one and a half times that person’s salary to replace them, so it’s a huge impact on the hospital’s bottom line. Retention is one of the key financial strategies a hospital can make. When you have a nurse that is of strong mind, body, and spirit and feels appreciated and loved by his or her c-suite and coworkers and team members and leadership, you have happy staff which translates to the patient and the bedside.
I often say, “A nurse that is completely depleted physically, mentally, and spiritually cannot give from an empty well.” We can’t give what we don’t have inside. That’s why we have to offer them tools to be strong of mind, body, and spirit, and to bring joy to the workplace. There are such little things a nurse can do to increase the patient satisfaction scores when he or she has that little bit of energy and compassion. For example, while hanging an intravenous drip, ask the patients what they need with love and intention.
If you stop, take the patient’s hand in yours, look them in the eye, tell them your name, and say, “We’re going to make this the best day by taking care of you today.” And to do that again, “What else can I do for you? What do you need, especially today?” They might say, “A bath,” or “To call my daughter,” or “To talk to my doctor, because I don’t understand this.” To just take those few seconds for that human touch and that eye contact and the questions of asking them specifically, not assuming what they need at that time.
How can healthcare leaders help address burnout?
HT: What could healthcare executives do to help alleviate burnout risk?
LeAnn Thieman: Burnout is what I term “drained out.” We’ve had some fires here in Colorado, and I’ve seen the damage of being burned out. Healthcare workers are not destroyed, they’re drained out, so we need to strengthen them again. Many healthcare workers tell me, “I really want to take care of myself. I don’t even know where to begin.” That’s why a program is so important for them.
A recent survey showed that 93% of healthcare workers are stressed, 76% reported exhaustion and burnout, and 39% don’t feel they have enough emotional support.2 Even before COVID-19, the physician suicide rate in the U.S., at least, was higher than the national average.3 So many physicians tell me that the heart that drove their desire to enter this profession is no longer there and they’re not always able to muster energy from that place as much.
We are so grateful for electronic medical records, and yet it divides a tremendous amount of the physician’s time. We are especially grateful for healthcare programs, insurance programs, and government healthcare programs, and yet implementing and working in these programs takes tremendous amounts of physicians’ time.
Now they’re looking at higher death rates, not just from COVID-19 patients, but their patients are sicker because they may have postponed their care. As we’re looking at all healthcare, we must look at the nursing staff, the physicians, and c-suites to remind them that they need programs to care for themselves as much as they do everybody else.
You would never deny anybody that you loved or cared for food or drink or sleep. Yet, how often do we in healthcare do exactly that? Having that awareness and offering programs that will help sustain them is important.
HT: What are the main pillars of such nurse programs that should be included?
LeAnn Thieman: The main pillars are as follows:
1. Competitive Pay: Have competitive pay and benefits packages. Focusing this on the needs and wants of the individual, such as increased scheduling flexibility, is a strong advantage.
2. Stress reduction: Where you have a program that cares not just for their body, but also for their mind, giving them stress reduction techniques. In my programs, I teach people to breathe, to laugh, to forgive, to think positively for their mental health and stability.
3. A holistic approach: Offering a spiritual component and taking a holistic care approach as beings that are of mind, body, and spirit. A spiritual connection and belief in some supreme being, or having some connection with the higher power, giving them tools to meditate or to reflect and or even to breathe.
4. Accessibility: Having a more holistic approach with mind, body, and spirit, and offering programs that appeal to different educational styles is also beneficial. So, having programs that are accessible in different formats, for example, books, videos, podcasts, is important to think about.
LeAnn Thieman is a Hall of Fame Speaker and author of the Chicken Soup for the Nurse’s Soul series, was “accidentally” caught up in the Vietnam Orphan Airlift in 1975. Sharing lessons from that daring adventure, she proves that healthcare givers strong of mind, body, and spirit deliver better patient care, resulting in improved outcomes, satisfaction scores, and reimbursements. Her evidence-based SelfCare for HealthCare® program reduces burnout and turnover and boosts retention, recruitment, engagement, and morale
- World Health Organization. Report available at https://www.who.int/publications/i/item/9789240003279. [Accessed January 2022]
- Mental Health America. Report available at https://mhanational.org/mental-health-healthcare-workers-covid-19. [Accessed January 2022]
- American Foundation for Suicide Prevention. Information available at https://www.acgme.org/globalassets/PDFs/ten-facts-about-physician-suicide.pdf. [Accessed January 2022]