Report: 90% of Nurses Considering Leaving the Profession in the Next Year

What follows are parts of an interview conducted by author Bill Siwicki, Managing Editor of Healthcare IT News with Shawn Sefton, CNO. I felt both the questions provided by Bill Siwicki ?and answers provided by Shawn Sefton to be excellent in understanding what is driving nurse burnout.

I have interjected some of my own thoughts in response to Shawn Sefton’s comments to bring a systems-based perspective to the burnout problem. The entire Hospital IQ blog post on the results of its survey, authored by Shawn Sefton, can be read here: https://www.hospiq.com/blog/nurse-burnout-impacting-patient-care/ .

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Healthcare IT News:

Report: 90% of Nurses Considering Leaving the Profession in the Next Year

Does that stat catch your attention? Good. Shawn Sefton, RN, talks about the results of a new survey of RNs, the key problems it identified – and how technology can help lessen burnout.

Shawn Sefton, RN, has experienced first-hand the operational, staffing and scheduling challenges that plague the U.S. nurse workforce, having worked as a nurse and in various nurse leader roles for decades.

She spent her early career as a frontline ED and perianesthesia nurse in various hospitals. Then she served as manager of presurgical services and anesthesia at Boston Medical Center, and as clinical specialist nurse (perioperative projects) and clinical director at Beth Israel Deaconess Hospital-Needham.

Sefton followed those years up as a director at PriceWaterhouseCoopers' health advisory practice, where she led operational and financial improvement engagements at a number of health systems. Today she serves as chief nursing officer and vice president of client services at Hospital IQ, a vendor of predictive hospital operations automation software.

Healthcare IT News sat down with Sefton to get her expert and insider views on the findings of a recent Hospital IQ survey of U.S. hospital nurses.?

She discussed how technology can help solve some of the problems unearthed in the survey, told what she's been hearing from the field when it comes to burnout and turnover – and described some key actions are that hospital and health IT leaders can take now to address some of those challenges and increase nurse satisfaction and retention.

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My Comments: The “90% of Nurses Considering Leaving the Profession in the Next Year” headline grabbed my attention. I’ve seen high percentages of nurses leaving in all sorts of reports, all at alarming levels, but nothing close to 90%. Clearly, if the 90% figure were to be realized in the next year, healthcare in the US would essentially come to a halt. Hopefully that's not going to happen. However, burnout and staff shortages still have healthcare in real trouble.

It appears healthcare, if it doesn’t reduce the fast-rising waves of nurse and physician burnout along with early resignations, will face a potential existential crisis to the larger healthcare system. However, from a systems point of view, this crisis will likely be a slow-motion implosion over a period of years. This theory is supported by the Nobel Prize-winning Law of Dissipative Structures, which describes how systems in nature and man-made systems grow, evolve, and transform.

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Healthcare IT News:

Q. What were the big findings of the November 2021 Hospital IQ survey of U.S. hospital nurses?

A. Hospital IQ surveyed more than 200 registered nurses working in U.S. hospitals to gain better insight into, and a deeper understanding of, the nursing shortage and the impact it's having on frontline nurses, hospitals, care delivery and patients. As one might expect given the breadth of the current healthcare staff crisis in this country, the results were both alarming and illuminating.

Key findings included:

1. Nurses are thinking about leaving, and the pandemic isn't solely to blame. Ninety percent?of respondents are considering leaving the nursing profession in the next year, with 71% of nurses that have more than 15 years of nursing experience thinking about leaving as soon as possible or within the next few months. Seventy-two percent?of respondents said they were experiencing nurse burnout long before the pandemic.

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My Comments:

This is so impactful to healthcare, I’m going to repeat it. I have heard a lot of different numbers around the percentages of nurses planning to leave nursing because of burnout, all of them catastrophic to healthcare. However, if this 90% figure proves to be even remotely accurate, healthcare, as a macro system, likely will not survive in its present form.

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Healthcare IT News:

1. As staff shortages increase, so do the workloads of active nurses. Forty-three percent?confirmed that due to a shortage of technicians in their hospitals, they are now tasked with even more things outside of their respective roles, including cleaning units, procuring supplies and clerical duties as part of their typical workload. Due to these increasing job demands and added burden, Thirty-nine percent of nurse respondents said they were experiencing more serious mental health issues, like anxiety or depression, as a result.

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My Comments:

Notice how burnout threatens to become a positive reinforcing loop whereby burnout causes more burnout. This is a tipping point from which healthcare will have a difficult time recovering and must avoid at all costs. Systems stress, which is the primary root cause of burnout, increases as there are fewer people to keep care delivery systems working at all. Notice, too, that mental health issues are stress induced and increase as stress levels rise.

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Healthcare IT News:

1. High patient-to-nurse staffing ratios and the resulting impacts. Forty-five percent?of respondents said the estimated patient-to-nurse staffing ratios they're seeing and experiencing across shifts are currently 5:1, above the typical standard of 4:1. More specifically, Eighty-four percent?of emergency room nurses and 96% of intensive care or critical care nurses have a 4:1 ratio, which is double the optimal target of 2:1.

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My Comments:

Again, fewer people holding poor care delivery systems together increases stress on both systems and people.

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Healthcare IT News:

1. Access to care is dropping for patients. The understaffing taking place in hospitals, along with the lack of beds, discharge delays and other resulting bottlenecks taking place, are impacting hospitals' ability to provide care to all who need it. Thirty-six percent?of nurses said they've seen patients with acute health conditions walk out of the ER because of the wait times for an inpatient bed. And 37% said that surgeries had to be rescheduled because of bed shortages.

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My Comments:

Every one of these issues is a systems problem. If systems are not improved, the issues not only cannot be resolved, but will worsen as fewer caregivers will be on the job, stressing systems even more.

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Healthcare IT News:

1. Administrative burden and manual tasks are among key drivers of nurse burnout. For many nurses, much of the workflows and processes involved in their day-to-day work are still predominantly manual – in large part, due to a lack of technology solutions, systems and automation. Lack of communication technology, poor processes, along with inefficient operational workflows and administrative burden are key drivers of frustration and burnout among nurses. Forty-five percent?of respondents cited referrals and transfer processes as the most manual tasks they deal with;?42% said updating paperwork was highly burdensome;?and 42% also cited orchestrating patient discharges as a challenge.

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My Comments:

I’m a big believer in automation but not before fixing/de-stressing the current systems. Anything that can be automated in a user friend way should be baked into the new systems. However, automation of bad systems often produces poor outcomes faster, making things worse for caregivers rather than better. Automation should always be user friendly and implemented in a systems-based way with nurses, physicians and other care team members involved in its selection and implementation.

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Healthcare IT News:

6.????To improve the poor work environment that leads to nurse burnout and turnover, nurses suggested the following areas for technological or process-oriented improvements:

• 53% want streamlined processes that ensure visibility into patient needs and communication.
• 45% said better communication and coordination across departments.
• 40% said improved and expanded communication and representation with hospital leadership would improve satisfaction.

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My Comments:

Again, all these are systems issues and taking a systems-based approach to addressing them will create the best opportunities for successful resolution.

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Healthcare IT News:

Q. How can health IT help solve some of the problems unearthed in the survey?

A. The systemic operational, procedural, coordination and technological issues that were raised in the survey are nothing new. While the COVID-19 pandemic served as the final straw for the industry and brought awareness to new heights, these problems plaguing the nurse workforce have been mounting for years.

For leaders across hospitals and health systems, we've reached a point where there is no other choice left but to respond with action, and swiftly, to solve the operational problems contributing to mass burnout and turnover.

Continued …

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My Comments:

It does feel as if we are approaching a tipping point in addressing the burnout problem in a systematic way. The legacy approaches by Admin to addressing staffing problems won’t work this time as it is the systems themselves that are burning out our nurses and physicians.

The Law of Dissipative Structures tells us systems that resist change in a changing environment become ever more stressed. Stress in systems causes dysfunction. Care delivery systems are now so highly stressed, they have become the primary root cause of nurse and physician burnout. How does this happen?

Stress in systems is passed on to those who work in the systems as long term emotional stress. Over time, this stress breaks people down mentally and physically and burns them out or causes them to quit healthcare early.

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Healthcare IT News:

Q. In your position as a chief nursing officer, what have you been hearing from the field when it comes to burnout and turnover?

A. This isn't the first time we've experienced nursing shortages. It's been cyclical in the '70s, '80s and early '90s. The difference is, we were always able to restock the supply with nursing school graduates.

But another trend we've seen over the decades is the nursing staff being a constant target for cost reductions. Almost every efficiency project or consultants' report looks around the hospital for redundancies and possible efficiencies before they eventually land on cutting nurses as an answer.

The problem is, decades of this approach have taken any available slack out of the line. As we've seen over the past couple of years with the just-in-time supply chain we've built for meat or packaged goods, any unplanned disruption of the chain can lead to outsized effects and empty shelves.

Decades of thinking about nurses as commodities – and not people with irreplaceable institutional knowledge –?[have]?led to empty shelves in hospitals and nursing schools.

Not only have licensed RNs been downsized over and over, but acute care settings have also decreased their ratios of professional to non-licensed staff, forcing nurses to practice with fewer resources in diverse healthcare settings.

As inpatient settings find a higher acuity level of patients receiving care from leaner workforces, many experts believe we're just at the start of a new wave of shortages that will be more critical than those of the past. Factor in increased competition for decreasing resources and we'll also see experienced nurses jumping from job to job, taking experience and inside knowledge with them.

Overwhelming workloads, over-scheduling and extended shifts, and the stress of providing care amid a pandemic, [have] pushed nurses to the brink. While many once envisioned a lifelong career in the field, the effects of the pandemic, compounded with years and years of systemic procedural problems, have forced many to leave the profession they once,?or still?love.

Overall, there are a handful of primary messages coming from the field about the current state of mass burnout, turnover, and the diminishing U.S. nurse workforce – all of which are centered on more support, both emotionally and operationally, better processes to make day-to-day workflows easier, and more insight into strategic staffing processes.

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My Comments:

This is sage wisdom, Shawn. With the primary focus of healthcare leadership being maximizing profits, nurses are seen as expenses on the P&L to be minimized whenever possible. Physicians are seen as either expenses or competitors of the hospital for profits. Again, minimize expenses and eliminate competition—a big business mantra.

Although it is easy to make healthcare Admin into greedy despots who know nothing about the woes of nurses nor could care less, most are good people doing what the system requires of them. If they don’t maximize profits, they will be punished by the system in some way. Note that this is the same dynamic at work for everyone in healthcare. Go against the system—expect to be punished. It is this dynamic that creates the culture of silence and never admitting weakness or mistakes.

Fact: Approximately 94% of outcomes in healthcare, good and bad, are a function of the systems in which care is delivered, not the efforts of people. Even the best people cannot overcome bad systems.

Fact: Systems in healthcare are highly stressed.

Fact: Stress in systems causes dysfunction.

Fact: Stress/dysfunction in systems creates poor outcomes.

Fact: Burnout is a systems-based outcome.

Fact: If we don’t fix/de-stress the systems in which nurses and physicians must deliver care, we cannot reduce stress or burnout or the early resignations that might make staff shortages an existential threat to the macro system itself.

Fact: If we can begin to make the systemic nature of problems in healthcare and nursing visible, we can begin resolving them. As long as the systems remain invisible, we will continue to chase the ghosts of symptoms of systems problems instead of root cause.

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Healthcare IT News:

Q. What are some key actions hospital leaders and health IT leaders can take now to eliminate some of the key problem drivers and increase nurse satisfaction and retention?

A. … In addition to technology, fostering an environment in which nurses feel heard, supported and valued is hugely important. Leaders share in the responsibility of recognizing the signs and symptoms of burnout, which requires them to learn them first.

Additionally, nurses and staff must feel safe and comfortable in communicating feelings of burnout to leadership, which means it is up to leaders to foster an open, supportive environment and create opportunities to get this feedback.

For example, setting up educational sessions about burnout and ways to alleviate its impact is one way to spur better awareness and understanding around the topic. And by providing nurses with an avenue where they can share these feelings – whether a digital communication channel or recurring check-in meetings – leaders can ensure nurses feel supported and seen, while actively identifying root causes and opportunities for improvement.

Leaders can't ignore burnout any longer. With nurses halfway out the door, they must listen to nurse's needs, respond with direct action, and implement clear solutions to alleviate the drivers of burnout.

Leaders must make nurses feel supported, but they also have to show them that they actually are supported, and that comes from a combination of improved processes and management soft skills such as listening and empathy.

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My Comments:

I so agree with this. Leadership and management must stop looking at nurses as numbers or things and start seeing them as people—the high value people they are. This is where the people component side of leadership comes in. To lead, leaders must care about those they lead.

Here Shawn artfully addresses the emotional needs of nurses that must be met to reduce burnout. For leaders to reduce turnover, they must be more aware of the power of emotional energy to make or break nurses and all healthcare workers.

If leaders can reconcile the fact that primary root cause of burnout is systems stress being passed on to nurses and physicians as long term emotional stress, the absolute best thing they can do to reduce burnout is to allow and support nurses, physicians and the entire care team in fixing/de-stressing the systems in which care is delivered. This approach also improves quality of care and safety, two areas that have contributed heavily to moral injury.

Leaders would do well to look at the 3D Change Model being implemented at UAB Medicine, which starts with the voices of nurses and all care team members finally being heard: https://lnkd.in/d5ZaGUeD . Notice the renewed energy of the nurses, physicians and the entire care team.

UAB is submitting two peer reviewed papers on implementing 3D to major journals for publication in the next 60-90 days. This may open mainstream healthcare more broadly to 3D as a working model for reducing burnout in nurses, physicians, and support staff.

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Thanks to Shawn Sefton, Bill Siwicki, and Healthcare IT News for your amazing insights into the nurse burnout problem.

Twitter:?@SiwickiHealthIT

Email the writer:?[email protected]

Healthcare IT News is a HIMSS Media publication.

Bill Siwicki is Managing Editor of Healthcare IT News