Looming Healthcare Worker Shortage Sparks New Consideration for Resilience and Well-Being

After weathering a sprint that has turned into a marathon, nurses faced unprecedented levels of work stress during 18 months of a global pandemic – and that stress isn’t easing anytime soon. Today, we face a potentially disastrous retention crisis among nurses that will be hit hard in the next five years. This crisis isn’t exclusive to nurses – a similar crisis across all sectors of the healthcare workforce is on the horizon if healthcare organizations fail to respond to the stunning burnout levels their employees are reporting.

One measure of burnout, the Maslach Burnout Inventory, identifies several components that influence burnout, including emotional exhaustion and low personal accomplishment. In a review of 2020 studies to assess the risk of burnout associated with the COVID-19 pandemic, 34% of nurses reported high emotional exhaustion, while 15% reported low personal accomplishment. This level of burnout can directly impact nurse health, increase turnover, and lead to compromises in the quality of patient care.

Recognizing the critical levels of burnout, the U.S. Department of Health and Human Services recently announced $103 million in grant funding to reduce burnout and promote resilience, $29 million of which will go toward 10 hospital grants to establish or enhance an evidence-informed resilience program. Is the funding enough? No. But, regardless of grant approval, the onus is on all hospitals and health systems to identify and address nurse burnout before we face a critical shortage.

By 2030, there will be an estimated global shortfall of more than 10 million nurses, with the number of new or younger nurses being outpaced by the number of retiring nurses worldwide, according to the World Health Organization’s State of the World’s Nursing report. It is likely that current levels of pandemic burnout will only exacerbate the staffing gap. One hospital system in Texas reported a 25% staff turnover in the past year – with many staff unlikely to return to the profession.

Building Resilience to the Healthcare Worker Shortage from Data

While it seems like a tall mountain to climb, healthcare organizations can use employee listening programs and data to develop a resilience program.

Perceptyx data – based on responses from 1.3 million healthcare employees across 1,600 facilities in the Perceptyx Benchmark Database – demonstrate that increased workload is the biggest concern for healthcare workers. Nearly half of all employees say there is not enough staff to handle workload. Although job demands are a top concern, data suggest other factors of values, fairness, and rewards also contribute to stress and burnout. Resilience can be built, but not by easing workload alone.

Six Ways to Boost Resilience

Here are six recommendations to boost resilience based on Perceptyx data:

• Think past today to build more optimism — Perceptyx data measuring 125 different aspects of the employee experience reveal that since the pandemic began, “unsustainable workloads” stood out as healthcare workers’ greatest concern. Current caseloads, long shifts, overtime, lack of needed resources (staffing, PPE), and high acuity are leading to exhaustion. To help alleviate rising workloads, healthcare systems have redeployed talent, focusing all human resources on essential operations and pausing non-essential initiatives. Although work demands may seem endless, New York-Presbyterian’s Rick Evans calls for staff to shift from the “get through it” mentality to focus on reconnecting, as a community and with patients, and on future growth opportunities. That kind of reconnection will create hope and help healthcare workers see a brighter future ahead.
• Act on employee feedback to improve feelings of control — The workplace is changing faster than ever. As a result, many workers are feeling a lack of control and less ability to influence decisions. Perceptyx data reveal that one in five healthcare employees believe they have no control over decisions that impact their work. To improve feelings of control, healthcare leaders can actively seek out employee feedback from regular active listening programs. During the pandemic, I saw dozens of healthcare groups rush to do “in-the-moment” feedback programs to find out what changes could be made to get their employees through some very difficult days. The impact of that real-time employee feedback resulted in small but incredibly important workplace support that may have saved lives. Lodging was arranged for those who couldn’t go home between shifts, and cafeterias provided healthy, ready-to-make meals to those who could go home but were too tired to cook. Mental health resources and virtual therapy groups made employees feel like their employers had their backs. Authentic, frequent, and transparent communication from senior leaders can also restore a feeling of control. But, as we learned from many employee listening programs, too much communication can overwhelm staff and increase workload. Both the communication itself and collecting real-time feedback on that communication must be done in parallel.
• Reward accomplishments, even small ones — Many staffing agencies are finding that temporary salary boosts alone are not enough to tempt nurses away from their current positions – there’s more to job satisfaction than money alone. Social recognition is also important, acknowledging the high job demands and sacrifices of healthcare workers. An increase in timely, frequent, specific, and meaningful recognition can help combat burnout, particularly when modeled by managers. But the context of the reward matters – in one organization, a monetary reward, because it was given whenever workload became too hard to bear, was seen as an insincere apology from management, or a “too little, too late” gesture. To avoid this kind of backlash, recognize other positive behaviors not related to workload alone, like helping a teammate or building community, and encourage employees to recognize each other. Giving recognition is just as important as receiving it when it comes to resilience.
• Build community — Although schedule changes, sick days and an increased use of float nurses can increase feelings of isolation, Perceptyx data reveal teamwork and support continue to improve through the pandemic among healthcare workers as teams rally together to serve their patients – nine out of 10 in our database said they felt people in their unit supported each other during the pandemic. Innovative team-support tools like Code Lavender, a quick-response crisis intervention tool for healthcare staff, can help build team cohesiveness even in the most stressful times.
• Create a sense of fairness — Despite furloughs, layoffs and even pay cuts, many organizations offered bonuses or hazard pay, resulting in an overall positive impact on pay fairness, up 17 points in favorability compared to pre-COVID levels. Pay can help nurses feel valued, but communication about the fairness of every financial reward is key. For example, one organization surveyed employees following a COVID bonus and found that opinion was split. Half felt more valued and appreciated after the bonus, while the other half questioned the fairness of who received the award and the amount provided. Leaders reacted by honing future communication to emphasize the policy’s fairness. Fairness principles apply beyond pay and are important when considering any kind of reward or development opportunity.
• Live your values, increase safety — Safety is a cornerstone value in healthcare, with Perceptyx data revealing declining perceptions since the pandemic began. Leaders play an important role in helping to communicate a culture of patient and workplace safety. If leaders make it personal, more employees will listen. For example, some healthcare leaders have been very open about their own mental health challenges to reduce the stigma some have put on mental illness. Other ways to support the feeling of safety at work include recharge rooms, mindfulness checks, coping programs, and floor-level access to mental health professionals. Leader rounding – when senior leaders hit the floor to ask questions and collect feedback – provides in-the-moment insights into barriers preventing safe performance and show leader commitment to patient and employee safety.

Creating a resilience program is not a one-time action, but rather an iterative process of improvements. With an open communication culture, supported by rounding, micro-surveys, and exit surveys, healthcare organizations can make data-driven decisions to reduce nurse burnout and improve nurse retention.

*A version of this article/research was originally published in STAT, September 27, 2021.