These warning signs are tied to nurses leaving hospitals

Health systems continue to struggle to retain nurses, and there are some warning signs that suggest nurses are being worn down, facing burnout, and considering a career change.

The American Organization for Nursing Leadership and Laudio recently published a report looking at some of the key factors that contribute to burnout and foreshadow problems with turnover.

Claire Zangerle, chief executive officer of the American Organization for Nursing Leadership, talked with Chief Healthcare Executive® about some of the warning signs that nursing leaders, and hospital executives, should be monitoring.

"Burnout leads to turnover," she says.

Zangerle, the chief nurse executive of the American Hospital Association, also says health systems must realize, “It’s a system problem.”

“It's not because our nurses don't want to solve the problem,” she says. “It's not an individual accountability problem. It's not a work ethic issue of an individual. It is a system that hasn't come together well … to fix the problem.”

“A lot of times you hear, ‘Oh, they're just not hardy enough. They just can't kick it in.’ That's not the case,” Zangerle says. “That is absolutely the antithesis of what this is. It's, how do we support our nurse leaders to be able to create a system that's going to trickle into supporting the front line to reduce this burnout?”

(See part of our conversation in this video. The story continues below.)

• Read more: Nursing leaders cite problems that aren’t being fixed

Signs to watch

Some indications of growing burnout could appear, at first blush, to be admirable displays of motivation and dedication.

Hospitals and nursing leaders should pay attention to nurses who are regularly arriving before their scheduled shifts and staying later than they should. Zangerle says it’s an indicator that nurses feel they have to work beyond their shifts to get work done, or to help their colleagues.

When nurses are routinely starting early and staying later, health systems pay more in overtime costs, and that makes it harder to invest in areas that could help staff, Zangerle says.

And while some nurses may welcome earning a little extra, it may mean less when nurses are spending their waking hours at work.

Hospitals should be wary of another warning sign: Nurses who are regularly skipping breaks or meals.

“Physiologically, you need to have some sustenance, because if you don't hydrate, and if you don't eat something, you know that has an impact on your brain function, and being able to function,” Zangerle says.

Plus, nurses skipping meals miss the psychological benefit of “being able to just shut some shut down your brain for a minute, and to be able to get off your feet and walk away from the patients, or walk away from the environment to have a breather.”

Zangerle also warns that nurses who aren’t taking vacation days or paid time off (PTO) are at risk of wearing down and becoming vulnerable to burnout.

“Not taking PTO is another contributor,” she says. “Losing PTO is like a cardinal sin. You're basically just walking away from a benefit that you have earned.”

Nurses who are skipping breaks or even vacation days are typically leery of stepping away because they are worried about their patients.

They also don’t want to let down their colleagues, which is admirable, but also raises the risks of burnout and growing dissatisfaction with their job.

“I think they're looking at the staffing and saying, OK, even on a good day, we might not have everybody that we need,” she says. “And on a day when I may have or a block of time where I've maybe asked for the week off, then who's going to cover for me on the time that I'm off?”

Nursing leaders need to make sure their staff members are taking breaks, and health systems should also be tracking to make sure that team members aren’t missing out on vacation days.

As for skipping meals, nursing leaders need to be proactive and handle scheduling so staff aren’t missing breaks.

“Management has culpability in helping manage the schedule,” Zangerle says.

“I can tell you, nurses aren't taking breaks and lunches because they don't want to leave their patient load with a colleague, because that's an overburden … it's really not because they're being martyrs about it.”

Zangerle says the cumulative effect of staying late, skipping breaks and refusing to take vacation days all take a toll on staff, and it’s why health systems can lose good nurses.

• Read more: Hospital nurses need a better workplace, and these nursing leaders have ideas

Talk with nurses

Health systems need to work on improving the work environment for nurses. Zangerle says hospitals that are trying to make their staff more durable aren’t focusing on the problem.

“What we can control is how we manage the work streams, the environment that our nurses are working in,” she says.

Hospital leaders that are looking to create a better environment should be talking to their nurses, Zangerle says.

“I think the most important thing for leaders to address the health and well-being of their staff is to be present,” Zangerle says. “It would behoove them to figure out how to manage their own time as leaders, to be able to have as much face-to-face time with their frontline staff as possible, because that's the only way they're going to be able to take the temperature of the environment.

“And knowing the environment, and knowing what's happening in the environment, what the nurses are facing, how the nurses are managing that is probably the best way to mitigate burnout,” she adds.

Hospital leaders need to build that human connection with nurses. If nurses feel like they have the attention of top leaders, they feel like they’re being respected and can help solve problems.

Health systems should invest in digital tools, including AI solutions, that can reduce stress on their nursing teams, Zangerle says.

If leaders are asking nurses about improving the workplace, nurses are going to expect to see some changes, Zangerle says. Leaders can and should be candid if some proposed solutions aren’t feasible due to budgetary concerns. But health systems should at least try and offer a compromise or other remedy to address the needs of their nurses.

Nurse managers need to prioritize time with their frontline nurses to check in with them and address their needs. Health systems also need to help to make sure nurse managers aren’t being asked to manage teams that are so large that it’s difficult to regularly engage with all of their nurses, Zangerle says.

But nurse managers need the support of top executives, and health systems need to make the well-being of their nurses a top priority.

“This shouldn't all fall on the shoulders of nurse managers to fix,” Zangerle says. “They need leaders to help them figure out how to improve the systems, so that it trickles down to reduce burnout for our nurse leaders and our frontline nurses.”