Addressing the nursing shortage: Alleviating burnout and improving nurse satisfaction

• 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.

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 Millennials 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.

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.

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.

HT: In your experience working with so many different types of healthcare systems, what have you seen healthcare systems doing to help bridge this nursing shortage gap?

LeAnn Thieman: Many healthcare systems have had to rely a lot on traveler or contract nurses which is extremely expensive and can impact your current staff. Some hospitals raise the salary of their nurses, which is one tactic, others give a stay-on or retention bonus. The bonus can be financial, however, it’s important to ask the individual what they want as a bonus. Sometimes they want extra days off or a better benefits package depending on what currently exists. Most people want schedule flexibility. In the United States, nurses are working 12-hour shifts, so they might work three grueling long shifts and then have four days off.

With their four days off, the first day they spend resting. So having a lot of flexibility with their schedules is most appealing. Some hospitals are forward-thinking, offering wellness or well-being programs, designed to let employees know that you truly care about them and are doing individual things for them, calling them by name, sending cards to their homes for birthdays or anniversaries.

It’s a lot of extra work, but a handwritten note can make a nurse stay on another year. It’s one thing to say to your staff, “go take really good care of yourself.” It’s another thing entirely to provide programs that give them the strategies and tools to care for their minds, bodies, and spirits every day. This is key to retention.

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.

HT: What strategies or conditions have you seen implemented by top-tier hospitals that lead to high nurse recruitment and more resilient nurses?

LeAnn Thieman: Some hospitals recruit their nurses through ads, however, the competition is high. Many hospitals offer a sign-on bonus, which gets very competitive because, generally speaking, there will be another hospital that has a slightly higher bonus. Certainly, compensation is a big deciding factor for which position to take and due to the shortage, nurses can often pick and choose where they want to work.

Hospitals now must show that no one else does what they do, which can be as simple as culture. Offering a culture of caring that is not just a job but is also reflected in their mission statement is a great strategy. Hospitals that do invest in programs that offer tools for self-care and appreciation, and make that a part of their orientation and their onboarding, have a competitive advantage.

They are able to say, “Here’s the app to our program we offer. We’re going to help you download it right now. We sincerely truly care for you.” Potential nurse candidates have to be able to see how they’re going to be treated and be convinced that what this particular hospital does is above what the rest are offering. It’s not always the money, it’s the culture.

Reimbursement for their education is another strategy. Young nurses especially are eager to learn. There are different levels of nursing and different certifications of nursing, so offering to reimburse them for their education and advanced learning will be a strong benefit.

For instance, if nurses are looking at a specific area they wish to specialize in following graduation, such as obstetrics or cardiac, they will consider this and say, “who’s going to help me grow?” They want to develop and will look at what systems are in place to help them do that as well as help their state of well-being and resilience. We must keep the passion for caring alive.

HT: You mentioned that the lack of access to education was a contributing factor to the nursing shortage. Have you seen any healthcare systems getting involved in developing their own training programs?

LeAnn Thieman: Yes, I often recommend hospitals to go out in their community to recruit people. Going into high schools and talking about how great it is to be a nurse. I also recommend that hospitals encourage their nursing assistants to advance their education. There are great stories in hospitals of someone who worked the coffee cart and always wanted to be a nurse or the environmental service person with a heart of gold who was encouraged and became a nurse.

Reimbursing tuition is also a tremendous recruitment and retention strategy and a great way to develop your staff. Some hospitals offer their nurses the opportunity to teach courses in nursing schools or universities, and some hospitals even help to fund the university financially to help them train the nurses. In the United States, some have invested in building nursing school programs which is what we need to meet the nursing shortage.

The good news is that in 2020 there was a 5.6% increase in nursing school enrollment at the baccalaureate level compared to 2019.⁴ Sometimes after national or international tragedies when people see others serving and giving so much, people want to make a difference too, so they sign up.

HT: Particularly for c-suite leaders, what are the top three actionable items you would recommend to them to overcome the nursing shortage, recruitment, and retention challenges?

LeAnn Thieman: My top recommendation for healthcare and c-suite leaders is number one to take care of themselves. I know that wasn’t a part of your question, but that’s what I say to them first. They are benevolent people who often do not care for their bodies, minds, and spirits, and they can’t continue to give from an empty well.

One of the best recruitment tools is that culture of caring. While it is important to have financial benefit packages and wages, examining your culture and demonstrating it through your interview process or marketing, for example, is more important.  For instance, would you like to work for somebody who during their interview has a sober face and talks about all their policies and what they’re looking for? Or, would you like to work for someone with a smile, energy, passion, and compassion who tells you about the programs they have to help take care of you and about the appreciation events that they have?

You must set yourself apart as an organization that cares not only about its patients but also about its staff. One statistic shows that 36% of nurses thought that they were not being respected by their seniors.¹ It’s difficult working with critically ill patients but showing appreciation for them in even the smallest ways will go a long way. You can write an editorial in your local newspaper to praise your staff at little to no cost, for example. Showing that appreciation through your culture or well-being programs is key.

LeAnn Thieman: C-suite leaders need to look at their mission statement and recruitment page. When you go online, every website for a healthcare organization has an About page and a retention page as well as information about how you can apply and get more information. What’s the language on that? You can’t just say you have a culture of caring, you must establish a culture of caring and then be able to speak to it. Leaders need to demonstrate that they are coming from that same place, that passion, that compassion, it can’t be just about the money. 

Make sure that culture is apparent in your statement when you’re trying to hire people. In the interviews, show what sets you apart and why someone should work for you? What is your culture of caring? What have you established? Once this is defined and an integral part of your organization, then you can use it as a recruitment strategy.

To show the joy in healthcare and to bring that to your content and your verbiage on your advertisements and websites and interviews is effective. That “this is a joyful place to work. We are changing lives. We are saving lives” tone. Right now, nurses are just slogging through thinking, “I just have to get through this.” Even the leaders are thinking, “What do you mean joy? I’m just barely hanging on here.” There are so many simple ways that you can add that joy. That must be something that you’ve established through your leadership first.