The risks of burnout for patients, and how tech can help
Healthcare professionals around the world are experiencing higher levels of burnout than ever before due to the COVID-19 pandemic. Here Jim Wetekamp, CEO of enterprise risk management provider Riskonnect, tells us how employers can address this.
How has COVID-19 impacted the issue of burnout among healthcare workers?
Burnout among healthcare workers was a chronic condition long before the arrival of COVID-19. This certainly spiked during the pandemic, approaching twice the rate of other industries. At the same time, I believe that employee burnout significantly increased in other industries, bringing greater awareness of – and hopefully attention to – the issue more broadly.
There have been efforts to address employee burnout both in and out of healthcare, but what we’re beginning to see is a more holistic and pre-emptive focus on maintaining and improving employee wellness that has accelerated as a result of the pandemic. COVID-19 served as a clear wake up call to the pervasiveness and impact of burnout. Three in ten healthcare workers are considering leaving the profession due to the emotional drain caused by the pandemic.
What risks does burnout create?
Burnout risk starts with staff members, leaving them susceptible to becoming physically and mentally ill. In turn, physically or mentally ill caregivers put patients at risk. Nurse burnout is associated with increases in patient mortality and hospital-associated infections. Physicians experiencing burnout are twice as likely to self-report a medical error. Burned-out surgeons commit more serious medical errors, and burned-out medical students are more likely to engage in dishonest clinical behaviours and alcohol abuse.
In too many cases, this has created a tragic spiral: Burnout causes safety events, which add additional stress to involved staff as well as the broader care team, ultimately leading to further burnout and additional patient-safety risks.
At the institutional level, this cycle leads to lower job satisfaction and greater employee turnover, which reduces productivity and exacerbates the already growing shortage of physicians and nurses. And staffing shortages are contributing factors for increased risks to patient safety.
How can employers address this?
Beyond the obvious motivator of improving patient safety, organisations will want to address employee burnout because it negatively impacts the patient experience.
Addressing employee burnout can have other benefits as well. Disengaged employees cost organisations roughly 34% of their annual salary. The average cost to replace an employee who quits due to workplace stress is $4,129 per new hire. Employers can mitigate these risks to productivity and retention by creating an environment that proactively identifies burnout and addresses disengagement early.
Low staffing levels are also a top contributor to burnout. Adding staff can actually be cheaper than the cost of low productivity and staff turnover.
As leaders, we have to be open to the fact that employee burnout can exist within our organisations and address it honestly. Just starting the conversation about employee stress and burnout can help employees feel heard. And ensuring that the entire leadership team – not just human resources – is attuned to the issue can help foster a culture where employees feel appreciated, engaged, and that there is adequate recognition of both their contributions and their need to balance work with other life priorities.
What role can technology play here?
Technology can’t create the kind of culture I just described, but it can help facilitate the activities and interactions that operationalise it.
Risk reporting and staying in tune with staff needs are top ways healthcare providers can boost patient safety. An organisational culture where leadership and practitioners openly discuss concerns and solutions around workload, mental health, error rates, and more, enables organisations to get ahead of larger burnout and patient-safety issues.
Coming back to patient safety, employees who report adverse events, near misses, good catches, and unsafe conditions want to know that their efforts matter and are making a difference. You can start by making sure your reporting system is intuitive and accessible. Beyond that, great technology can provide meaningful feedback to event reporters.
The best technology can aggregate data on identified issues, actions taken, and the impact of those interventions on performance improvement -- and make the data available to everyone in the organisation, from the C-suite to frontline clinicians and other employees.
Integrated risk management technology is designed to expand and improve an organisation’s approach to all the risks it faces. Software that integrates the traditionally siloed risk management function into one comprehensive solution gives leadership the ability to easily see the connections between risks – like employee productivity, staff shortages, and patient-safety events. This visibility also helps leaders better understand the causal and contributory factors to risks, as well as interdependencies, to quickly identify effective and sustainable improvements.
COVID-19 "causing mass trauma among world’s nurses"
Healthcare providers are facing ongoing nursing shortages, and hospitals are reporting high rates of staff turnover and burnout as a result of the COVID-19 pandemic. In June a report found that levels of burnout among staff in England had reached "emergency" levels.
Registered nurses Molly Rindt and Erika Haywood are nurse mentors on US recruitment platform Incredible Health. In this joint Q&A they tell Healthcare Global about their own experiences of burnout and what can be done to tackle it.
What does it mean to be suffering from burnout?
Some of the most common reasons for nurse burnout include long work hours, sleep deprivation, a high-stress work environment, lack of support, and emotional strain from patient care.
While every profession has its stressors, the nursing industry has some of the highest burnout rates. The massive influence on patients’ lives, the long hours, and many other factors put nurses at risk of severe burnout. And with the rise of COVID-19, many healthcare professionals feel the strain more than ever.
Burnout in nurses affects everyone — individual nurses suffer, patients are impacted, and employers struggle with enormous turnover. This is why it’s crucial for healthcare systems and management to watch for signs of nurse burnout and take steps to provide a healthier workplace. Employers should be careful to watch for burnout symptoms in their healthcare staff — and not ignore them.
Symptoms include constant tiredness, constant anxiety related to work, emotional detachment and unexplained sickness.
How widespread is this problem?
Unfortunately, burnout affects approximately 38% of nurses per year and even the WHO recently labelled burnout as an official medical diagnosis. To put this statistic into perspective, nearly 4 out of 10 nurses will drive to work dreading their shift. Burnout is a reason nurses leave their positions.
Other top reasons for leaving included a stressful work environment, lack of good management or leadership, inadequate staffing, and finding better pay or benefits elsewhere.
Even before the pandemic, demanding workloads and aspects of the work environment such as poor staffing ratios, lack of communication between physicians and nurses, and lack of organisational leadership were known to be associated with burnout in nurses.
Have either of you experienced burnout?
Rindt: I have experienced burnout as an RN. I was constantly fatigued, never felt like I was off work, and would frequently dream I was still at work taking care of patients. In my particular situation, I needed to take a step back and restructure my work schedule to allow for more time off. After doing this, I was able to reduce burnout by deciding to work two shifts back-to-back and then have 2-3 days off.
Haywood: I definitely experienced constant anxiety related to work - so much so it would impact the days I wasn’t at work. At one point, I was even on medication to help combat the anxiety and stress I was facing on the job.
I had heart palpitations, chest pain, and wouldn’t be able to sleep before working the next day, which slowly started to impact other aspects of my life. I knew I couldn’t continue to live this way, it wasn’t sustainable. Because of this, I began to focus on my needs and prioritising self-care, especially during the beginning of the pandemic. Putting my needs first and not feeling guilty were necessary for me to overcome burnout.
What impact is COVID-19 having on nurses' wellbeing?
Some nurses have suffered devastating health consequences. Many nurses have dealt with excessive on-the-job stress, fears of becoming infected, and grief over seeing patients succumb to COVID-19 while isolated from their families.
New evidence gathered by the International Council of Nurses (ICN) suggests COVID-19 is causing mass trauma among the world’s nurses. The number of confirmed nurse deaths now exceeds 2,200, and with high levels of infections in the nursing workforce continuing, overstretched staff are experiencing increasing psychological distress in the face of ever-increasing workloads, continued abuse and protests by anti-vaccinators.
However, other small silver linings that came from the pandemic include increased professional autonomy, leadership opportunities and career growth potential.
How much of the cause of burnout is due to the hospitals or healthcare providers, and what can they do to address it?
Nurse fatigue poses serious problems for healthcare organisations, and a recent survey from Kronos found 63% of nurses say their job has caused burnout. The survey also found that more than 4 out of 5 nurses think hospitals today are losing good staff because other employers offer a better work/life balance.
Nurse burnout not only contributes to staff turnover, but it can impact the facility’s quality of care, patient satisfaction, and even medical outcomes.
Strategies to address burnout include training improving nurse-to-patient ratios, include nurses in policy discussions, and prioritise fostering a healthy work culture in hospitals.
What does your role mentoring nurses on the Incredible Health platform involve?
Rindt: My role can vary based on the needs of the nurses. The nurses love knowing they have someone in their corner who can give interview preparation advice or provide suggestions on how to improve their resume. Knowing that there is someone who is well-versed in the job process and can help set expectations on what to anticipate, really helps to remove a layer of uncertainty.
Haywood: When screening nurses, it is customised to what their individual RN or nurse practitioner needs, and at a time that is most convenient for them. Nurses are busy and often aren’t thought of first. Being able to provide support from the very beginning of their career advancement journey helps tremendously. We also provide resources such as resume templates and tips that can help nurses be successful and feel supported.