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How hospitals can help nurses, and themselves


Health systems are more likely to retain nurses if they listen to their concerns, reduce some tasks, and move to more flexible schedules, nursing advocates say.

As many nurses complain of burnout and hospitals continue to find it difficult to hire and keep nurses, healthcare executives need to be talking to and listening to their nurses.

Nurses have grown weary of inflexible schedules that leave them drained, says Renee Saldana, a spokeswoman for the Service Employees International Union-United Healthcare Workers West (SEIU-UHW).

“I've heard people say, enough with the mandatory overtime, enough with the double shifts,” Saldana tells Chief Healthcare Executive®. “That's why they quit and left, because they were just burned out and had no time for their families or personal life or are in tears because of all the stress.”

More than half of all nurses (56%) said they are experiencing burnout, according to an American Nurses Foundation survey of more than 7,400 nurses last May. A separate survey released this week by IntelyCare found more than three-quarters (77%) said they were considering switching jobs this year.

Some nursing advocates say health systems and hospitals must make changes, and they shared some of their suggestions with Chief Healthcare Executive®.

Rebecca Love, an advocate for nursing reforms and member of the Commission for Nurse Reimbursement, says health systems must recognize that “the status quo of how we continue to do things is not working.”

“I think the best solution is to go to your frontline and recognize that,” Love says. “I think coming in and just admitting, ‘We know that we're not getting something right. So tell us, what do we need to get right? To support you?’”

“I think what you're going to be shocked at is when you ask the nurses, their asks are not complicated,” Love says. “They're simple. And they speak to basically almost every single strategic direction that you have for your organization.” (Nursing leaders share some of their thoughts in this video. The story continues below.)

Many nurses are asking for more help so they aren’t as overworked. Nurses cited better staffing as their top priority, ahead of pay, in the IntelyCare survey.

Vicki Good, chief clinical officer of the American Association of Critical-Care Nurses, says staffing is the top stress point for many nurses.

“What we hear from nurses more frequently is concerns regarding staffing,” Good says. “And, you know, how is staffing determined? And what does that look like?”

Good says nurses are calling more attention to the workload on nurses, and how many responsibilities they are juggling. As Good says, “Are there other tasks being added to the nurse that shouldn’t be?”

Nurses often are saddled with chores that go beyond the realm of nursing, and that has an impact on their ability to do their jobs, Good says.

“Nurses are just crying for the fact that they just want to do what they were trained to do, and they want to be a nurse,” Good says. “They want to be able to spend time with their patients.”

Health systems can also look toward moving away from rigid 12-hour shifts and allow for more flexibility in schedules, nursing advocates say. More flexible schedules would help hospitals keep nurses with younger children, as well as veteran nurses who want to work at the bedside but could be weary after many years of 12-hour shifts.

Some hospitals are turning to more flexible schedules, Good says.

“I think it's starting to spread,” Good says. “But I wouldn't say it's widespread yet. You know, old habits die hard. So, it takes a while for that change to occur. But I will say, as some of these health systems that are doing it, have done it successfully, and are starting to produce or publish their results, I think it's getting the attention of others.”

At the University of Miami Health System, UHealth, nurses who don’t want to work full-time can take per-diem positions. Some nurses are taking, and appreciating, that option, says Alison Mincey, senior vice president and chief human resources officer of The University of Miami and UHealth. It’s also helping to address staffing challenges.

“We have a workforce that is asking for us to think about things differently,” Mincey told Chief Healthcare Executive in a January interview. “And that includes making sure that they're appropriately staffed.”

Hospitals and health systems will get a better sense of addressing problems affecting their nurses by talking directly to nurses, as opposed to consultants, Love says.

“Don't go and spend millions of dollars with another consulting firm, who's going to specifically identify the problems that you think you already know,” Love says. “Go to your frontline and ask them: what are the problems that are causing you to leave us? What are the problems that are forcing you to leave? And how could we do it differently?”

“Save the millions that you're all spending on consultants,” Love says. “And just ask your frontline.”

Hospitals will help themselves by asking nurses what they need and paying attention to their concerns, but at some point, nurses are going to need to see that they’re employers are taking action, Love says.

“The worst thing you can do is ask and do nothing,” Love says.

On the upside, health systems and hospitals can improve their success at retention and recruiting by making the work environment better for nurses. Those efforts pay dividends across the organization, from improving patient safety to bolstering morale across the entire workforce. Two-thirds of hospitals had to reduce capacity due to staffing shortages, according to a recent Kaufman Hall report.

Community hospitals, including small hospitals, can see significant improvement when they address the concerns of nurses, Love says.

If you can drive your largest workforce to be happy, it benefits everyone in that system to be more content with the environment they work in,” Love says.

Read more: Many nurses aren't getting help. That needs to change.

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