By Christopher Cheney
Healthcare worker burnout has reached crisis proportions and urgent action is required to turn the tide, a national burnout expert says.
Bernadette Melnyk, PhD, RN, APRN-CNP, is chief wellness officer of The Ohio State University and dean of the university’s College of Nursing. She is a nationally recognized leader on healthcare worker burnout and well-being. Melnyk has published dozens of research articles on healthcare worker burnout and well-being in peer-reviewed journals.
HealthLeaders recently spoke with Melnyk to gauge healthcare worker burnout and well-being in 2021 and the prospects for 2022. The following is a lightly edited transcript of that conversation.
HealthLeaders: Characterize the level of healthcare worker burnout in 2021. How does the level of burnout compare to the pre-pandemic levels?
Bernadette Melnyk: The levels of burnout this year have soared among healthcare professionals. The levels were high prior to the pandemic, but we have several studies that show they definitely have worsened. So, continuing problems with burnout are escalating—compassion fatigue, depression, mental distress are all super high right now.
Prior to the pandemic, you would see burnout rates on average in the range of 30% to 50%. We are seeing levels now that range from 40% to 70%. What is so disturbing about the increase in burnout is not only is it negatively impacting our population of clinicians, but we know when clinicians are burned out, depressed, and suffering from compassion fatigue it negatively impacts healthcare quality and safety.
In the nursing professions specifically, many of the nurses who were planning on working for another five years are retiring now. Younger nurses are leaving the profession—there are turnover rates between 30% and 60% in new graduates. This is creating a healthcare crisis. We do not have enough nurses now—especially in rural areas—to meet the demands. Patient-nurse staffing ratios have gotten worse, which means nurses who are fatigued and burned out are getting higher workloads.
C-suites across the country must fix system issues that we know are causing burnout, or the costs of burnout are going to be horrific.
HL: What are some of the systemic changes that the C-suite should be making?
Melnyk: There are too many tasks. There are staffing ratios that are not appropriate. One nurse taking care of 10 or 12 patients is not an acceptable ratio. Shifts are too long—my research alone in national studies over the past two years has shown that the longer the shift work the poorer the nurse outcomes and the more medical errors that are made. We must stop 12-hour shifts.
We also must do a better job with our electronic health records. It takes up way too much time and it is taking clinicians and nurses away from their patients to the point where it is taking their joy away. Most of us went into the profession to take care of people and to be with people.
These system fixes are critical, in addition to creating wonderful wellness cultures and making available great evidence-based programs to equip clinicians with resiliency skills that they need given the high rates of mental health distress that we are seeing.
HL: In 2021, characterize the impact of the pandemic on healthcare worker well-being and burnout.
Melnyk: We are losing clinicians—that is creating staffing shortages, which is putting more pressure on the ones who are still working. Because of the pandemic, our clinicians have been exposed to a lot of trauma. Many of our clinicians have watched their colleagues die from COVID-19. They have been the sole support for dying patients because of restrictions that were placed on visitation of loved ones. The past 20 months have been traumatic for many of our clinicians.
There is a mental health tsunami that is occurring among healthcare workers. In my latest study with travel nurses, not only did they report high rates of burnout and depression, but the pandemic also impacted their lifestyle behaviors. People have attempted to cope in unhealthy ways. We have seen increases in alcohol use. We have seen increases in unhealthy eating. We have seen declines in physical activity. Downstream, that is going to lead to higher rates of chronic disease, and we must be prepared for that.
HL: What are the prospects for healthcare worker well-being and burnout in 2022?
Melnyk: For the C-suites at health systems throughout the country, if they want to see this improve, they have got to fix their system issues that we know are causing problems. They also must invest in their clinicians’ well-being. It is not an expense—that investment will have a huge return on investment and value for the organization.
The C-suite must recognize that unless their clinicians are mentally and physically well, healthcare safety and quality is going to be negatively impacted as well as costs and patient outcomes.
Unless the C-suite acts, healthcare worker burnout and wellness is going to get worse because the pandemic is going to continue to place strain and burden on our already compromised clinicians. They are already suffering. We must treat this urgently. This is an epidemic inside of the COVID-19 pandemic.
Although there have been efforts to raise the visibility of this issue, we have a way to go. We must treat it with urgency, or the future is going to be even more bleak.
HL: In 2022, what can health systems and hospitals do to address healthcare worker well-being and burnout?
Melnyk: First, they need to invest in appointing a chief wellness officer. Somebody must be ultimately charged with improving clinician well-being. They cannot be a title only. A chief wellness officer must be given resources to be able to improve clinicians’ health and well-being.
Leaders, managers, and supervisors have got to walk the talk. They must build cultures of well-being that make healthy choices easier for their clinicians to make. Health systems need to offer anonymous screenings for their clinicians for depression and suicidal ideation. The suicide rates for physicians and nurses are higher than they are for the general population. There is still a lot of stigma surrounding mental health, including among clinicians. We must emphasize that recognizing that you need help is not a weakness—it is a strength. There is no shame in seeking help.
HL: How can health systems and hospitals create a culture of wellness?
Melnyk: At Ohio State, we take a multicomponent approach to creating a culture of wellness. We target evidence-based interventions to our top leaders, managers, supervisors, and the grassroots of the organization.
Then you must measure your outcomes. Taking an evidence-based, outcomes-management approach is important.
However, changing culture takes time and patience. In many instances, what happens is leaders do not see an immediate outcome, they get frustrated, and they give up. Culture change is not going to happen in a year or two. It takes time and it takes investment. You must get to the point where the culture is one where people feel supported because perception of wellness culture and support impacts what people feel and what they do. Our research has shown this.
HL: What kind of outcomes do you need to measure?
Melnyk: You need to measure burnout, depression, suicidal ideation, stress, anxiety, engagement, intent to leave the profession, and well-being. We measure all these things. For perceived wellness culture, we have a validated scale that we integrate into our annual personal wellness assessment. Perception of wellness culture impacts what people do and how they feel.
Christopher Cheney is the senior clinical care editor at HealthLeaders.