Medical University of South Carolina

Patti Hart

When we consider the challenges posed at the beginning of the COVID-19 pandemic, the commitment and drive that typically encourage health care workers to join this field were the same traits that helped us weather the first wave.  However, the willingness to give up ourselves to care for others was challenged during the long hours, shortages of supplies to keep caregivers safe and the acuity of our patients. All of these factors contributed to the exhaustion that our nurses faced. Because nurses most often put others first, the lack of self-care, high demands and length of time working in less-than-optimal conditions have caused burnout, and nurses are leaving their organizations and the profession at record rates.

Burnout has always been a concern in health care because of the high demands on our care teams. The demand of this job is not only physical, but also mental and emotional.  Burnout occurs when stress and exhaustion are not managed over a long period of time. While we see different statistics, we are all aware that our frontline care team members have suffered greatly from burnout. The emotional trauma over the past two years is comparable to being in war with little support to assist, causing uncertainties on how to cope with what is being endured. 

We continue to see nurses leaving the workforce in alarming numbers. In 2021, turnover and vacancy rates were the highest recorded compared to the sixteen years of benchmarking as reported by The Advisory Board. (2) This has been highest with our bedside nurses who have continued to endure the largest stressors caused by the physical and emotional demands. While many are leaving organizations as exhibited by the vacancy and turnover, those who are leaving the profession completely will perpetuate our challenges to staff exponentially. Early retirements, second career options and other non-bedside nursing options are luring nurses with significant experience away from the front lines.

The cost of burnout is shocking not only in turnover rates, but also in the impacts this mass exodus is having on outcomes. Employee engagement, patient satisfaction and patient quality outcomes are impacted by the lack of engagement, cynicism and negative attitudes associated with difficulties nurses face in coping with their stress. The 2019 National Healthcare Retention and RN staffing report showed that the average cost to replace one clinical nurse was up to $64,000; however, this number would be much higher today considering the high agency spend required to backfill the loss.  Hospitals are now spending up to $6.9 million each year to manage turnover and recruiting. (1) Burnout has been one of the leading causes of the turnover and vacancy organizations have incurred. It is critical that we understand and address the turmoil causing our frontline nurses to vacate their roles. We must then be creative on our solutions and have nurses practice to the top of their licenses.

"The emotional trauma over the past two years is comparable to being in war with little support to assist, causing uncertainties on how to cope with what is being endured."

When we estimate the loss of just one patient to the health system following an unsatisfied experience, it is $506,755. This is up to a household loss of $1.5 million. (1) This can be magnified when we think about the impact to reputation in our communities and ramifications of negative publicity. Our negative quality outcomes not only affect our patients and their quality of life, but this also increases the costs to provide care and impacts our length of stay significantly. These costs vary by quality indicator, but all negatively impact the organization’s bottom line and are increased nationally related to staffing deficits.

It is our responsibility as leaders to understand the challenges our teams face and create plans to mitigate by being creative and understanding we will not provide the care as we had prior to the pandemic. As leaders, we must be creative in our approach and rely on other ways of providing care with different roles and support systems. Ensuring our teams have the supplies to do their jobs is critical for them to feel safe. Meaningful recognition of our team and showing appreciation is vital to support our front line to make them feel cared for and appreciated. We must support our teams by giving them resilience support to access when they need it.  Identifying burnout early and providing interventions to meet those needs is extremely important. These measures will help support individual care team members, potentially prevent them from leaving your organization, and hopefully keep them from leaving our profession when we need them the most.