Six strategies to improve work wellbeing and solve nursing staff shortages
A mental health crisis among America’s nurses is fueling a cycle of burnout, turnover and staffing shortages. The ripple effects reach from individual practitioners and their patients to entire health systems.
“I have never experienced anything like the staffing shortages, stress and burnout as I have during and post COVID,” says Susan Sender, chief clinical officer at BrightSpring Health Services and a 35-year veteran of post-acute health care in both nursing and clinical leadership roles.
Nurses on the front lines during the pandemic experienced high rates of depression, anxiety and PTSD, contributing to increasing rates of burnout and turnover that exacerbated an existing national nursing shortage. While organizations are desperate to recruit and retain nurses, these staffing gaps are causing overwork and added stress.
Approximately 800,000 nurses will leave the profession by 2027 — and 24% are younger nurses not nearing retirement.Study from the National Council of State Boards of Nursing and National Forum of State Nursing Workforce Centers
Approximately 800,000 nurses will leave the profession by 2027 — and 24% are younger nurses not nearing retirement, according to a new study from the National Council of State Boards of Nursing and National Forum of State Nursing Workforce Centers. The report also found that more than half of those surveyed often feel “emotionally drained” and “used up,” while just under half say they feel “fatigued” or “burned out,” with over 29% even saying they feel as though they are “at the end of their rope.”
To break the burnout cycle and retain more nurses, the most successful health care organizations will prioritize work wellbeing.
Work Wellbeing Wins Nursing Talent
The nursing shortage not only has a negative impact on nurses’ mental health and patient outcomes, it also costs organizations big. According to the 2023 NSI National Health Care Retention & RN Staffing Report, the national registered nurse (RN) job vacancy rate is nearly 16%, while the turnover rate is almost 23%. Meanwhile, the average cost of losing a staff RN is more than $50,000, up from $46,100 in 2021. For the average hospital, every 1% rise in turnover costs $380,600 — but it could also save that amount for every percentage it lowers.
Maria Schaefer, vice president of enterprise talent operations at BrightSpring Health, says that even though health care organizations are going to great lengths to attract nurses, many are often unable to hold onto them. “Nurses are leaving their jobs because of a combination of greater work demands with inadequate staff, and competing employers are doing whatever it takes to attract nurses.”
“Whatever it takes” is often competitive compensation, which remains the top draw — not just for nurses, but all job seekers. But research shows employees are motivated by not just pay, but also work wellbeing (defined as greater happiness, satisfaction and purpose with manageable stress). Indeed’s 2022 Work Wellbeing Report found that after pay, stress, dissatisfaction and unhappiness are the leading reasons people look for new opportunities.
Additionally, in a 2022 Indeed survey of 1,400 nurses, 99% said they would consider changing jobs for the right opportunity. The top reasons (after higher compensation) were greater flexibility (43%) and career growth (40%). About 62% of respondents said they would choose a more flexible job over one that paid 10% more. About one-quarter said company culture (25%) and feeling appreciated by colleagues (28%) are more important considerations now than before the pandemic.
These motivations align to the key drivers of work wellbeing, which include:
- Fair pay
- Manager support
- Feeling energized
Dr. Veronica Martin, division senior vice president and chief nurse executive for St. Luke's Health, says focusing on wellbeing has played an integral role in improving resilience and retention.
“It’s about the emotional health and wellbeing of our teams, plus creating practice environments that make our staff feel supported and committed to stay with us,” she says.
But what does it take to support nurses’ wellbeing in a profession that’s inherently high stress? Here are six work wellbeing strategies that will help make more nurses want to work for your organization — and stick around.
1. Promote Your Employee Assistance Program
Since the pandemic, many health care employers have expanded their employee assistance programs (EAPs), which provide a variety of mental health and wellbeing resources, from gym memberships and nutrition information to therapy and counseling services. However, research shows that few workers tend to utilize them, with the Society of Human Resource Management reporting that usage averages less than 10%.
To encourage greater use, increase the visibility of your EAP by promoting it in regular employee communications, such as staff newsletters, emails and team meetings. Provide your people managers and HR leaders with guidance to better communicate these perks to employees and job seekers. Then, if possible, track utilization metrics through your EAP vendor to determine where your efforts are making an impact.
2. Embrace Scheduling Flexibility and Autonomy
Though remote and hybrid work arrangements aren’t an option for most nurses in an in-patient setting, there’s still room to offer greater flexibility and control over their schedules.
This could mean giving nurses flexibility over how many hours or what days per week they work (for example, a 4-10 schedule, or even a 32-hour work week). Offering shorter shifts and variable start times may help to attract untapped talent. For in-home care nurses, it could mean letting them decide when they see which patients each day.
3. Uncover More Time for Patient Care
For many, nursing is more than just a job — it’s a calling.
“I think one of the challenges we have to figure out is how to give nurses the capacity to do what they came into this profession to do, which is to make emotional connections and meaningfully serve their patients,” Schaefer says.
BrightSpring Health has found success using strategies such as telehealth paired with remote patient monitoring, as well as a triage call center for their home health and intellectual and developmental disabilities services. Call-center nurses have access to electronic health records so they can make informed decisions about patient needs and determine whether a nurse actually needs to make an in-person visit.
Sender says the workload relief this centralization has provided — especially for those who no longer have to be on call — has been a “huge satisfier” for her nursing staff. “Nurses can spend more time at the bedside and less time wondering which bedsides to go to,” she adds.
4. Invest in Training and Development
Ensuring your nurses have ongoing opportunities to build their skill sets, grow professionally and operate at the top of their discipline will discourage them from searching elsewhere.
Consider implementing a tuition reimbursement program — or enhancing what you currently offer — for earning degrees, special licenses and continuing education, including online training programs that allow busy nurses to learn at their own pace. Encourage time off to pursue these opportunities and help staff develop a career path so they can visualize exactly how they’ll advance in your organization.
5. Give Nurses a Voice
Don’t just rely on industry trends to guide your decisions — ask your nurses what they really want. Implement monthly or quarterly employee surveys and conduct focus groups to determine their top stressors and how they would like to be motivated or rewarded. Identify the top three to five areas where your organization could improve, then take action to address them.
Dr. Martin says the practice of nursing shared governance, which gives nurses a say in decision-making, has helped drive collaboration and a sense of belonging among staff.
6. Lead With Kindness
While managerial support plays a pivotal role in supporting work wellbeing, many nurses don’t communicate their needs. In a recent Trusted Health survey of nurses, nearly 60% of respondents said they were unlikely to share feelings of acute depression, suicidal thoughts or mental health issues with their direct manager or others in their organization, and only 3% said their managers were keeping them committed to nursing.
By creating an environment in which nurses feel comfortable acknowledging their struggles, managers can help end the stigma surrounding mental health. Here are a few ways to create a culture of kindness:
- Connect on a personal level. Get to know your nurses. What are their goals and daily challenges, and what can you do to address these? Recognize birthdays and other important life events, and support them in putting themselves and their families first and taking time off when necessary.
- Clearly communicate about wellbeing. In meetings and organization-wide communications, acknowledge any tough times your staff may be experiencing and offer extra support to those who need it. Go out of your way to ensure people know you have a vested interest in their wellbeing.
- Show appreciation. Recognize nurses’ accomplishments and achievements and celebrate milestones when possible. Consider throwing a party for National Nurses Week (May 6-12), offering catered lunch-and-learns or hosting employee anniversary celebrations.
Above all, Sender says, it’s important to be proactive in addressing nurses’ work wellbeing needs.
“Whether nurses reach out to us or not, we have to take care of them,” Sender says. “We need to take care of the people who take care of the people we're responsible for.”