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How Leadership Skills Prevent Burnout in Nursing

A woman with red nails types on a laptop beside a stethoscope.

Clinician burnout is a major problem in the U.S. and a real threat to health care. According to a National Academy of Medicine report, emotional exhaustion, depersonalization, and a loss of sense of professional efficacy — the three dimensions of burnout — are highly detrimental to quality of care. Clinician burnout is also costly for organizations experiencing workforce shortages and difficulty retaining high-quality providers and specialists.

The impact of burnout is considerable in nursing, which is the largest segment of the U.S. health care workforce, representing 30% of hospital employment. Nurses spend more time with patients than all other providers, and the demands placed upon nurses have never been higher. There are significant staffing shortages around the U.S., and an aging population may exacerbate them in the near future. The growth of telehealth may be increasing workloads in nursing at a time when EHR systems are already increasing the mental demand on nurses. During the height of the COVID-19 pandemic, nurses were under tremendous pressure to continue working at or above capacity despite fear, stress, and resource challenges. The factors above and others could leave the country with a nurse workforce at risk of burnout for years to come.

About 43% of nurses in hospitals and 37% of nurses in nursing homes already report symptoms of burnout. Frontline emergency, ICU, and critical care nurses may experience burnout at even higher rates. Given nurses’ importance in care teams, their prevalence in the health care workforce, and the dangerous impact of burnout in medicine, it is imperative that organizations in health care address burnout proactively. One way they can do this is by ensuring nurse managers and other leaders in nursing have the skills and resources they need to facilitate positive change, cultural integration, retention, and direction of staff attitudes — all of which are important when addressing burnout. Advanced education programs such as the University of Michigan’s Online Master of Science in Nursing Leadership, Analytics, and Innovation give nurse leaders the tools to address what is a growing problem.

Why Addressing Burnout in Nursing Is Crucial

Burnout in health care is about more than physical exhaustion driven by overwork. Symptoms include emotional exhaustion, depersonalization, reduced personal accomplishment, lack of motivation, and feelings of frustration. Many studies have documented the negative impact of burnout on nurses in particular. Burnout in nurses can lower nurses’ quality of life, negatively impact performance, decrease engagement levels, and lead to increased nursing staff turnover in health systems.

While studies show consistent negative relationships between rates of provider burnout and perceived quality and safety, the impact of burnout is relatively small and it’s unfair to conclude that nurses suffering from burnout are endangering their patients. What’s more likely is that nurses experience higher levels of burnout in environments where processes and policies don’t align with patient needs. Burnout isn’t a cause of poor patient satisfaction or decreased patient safety, but rather another symptom of the systemic issues affecting health care today.

Many Factors Contribute to Health Care Burnout

Burnout is more common in health care than in many other industries for numerous reasons. When jobs require sustained physical or psychological effort — as is common in health care — workers experience physiological and psychological consequences. This is especially true when workplace processes are inefficient, demands are chronically excessive, resources are in short supply, and suffering and death are everyday realities. Primary causes of burnout among nurses include:

Excessive or unmanageable workloads — Nurses are experiencing higher workloads than ever before, and overwork in health care careers can have dangerous consequences. In one study, an increase in the number of medication-related events correlated with an increase in task demands and nurses’ subjective workload.

Higher nurse-to-patient ratios — A study of more than 10,000 hospital nurses found that nurses are 23% more likely to experience emotional exhaustion for each additional patient they cover after exceeding a 4:1 patient-to-nurse ratio. Another study found that increasing the workload of hospital nurses by just one patient per nurse correlated with significant increases in both urinary tract and surgical site infections.

Inadequate staffing — Job stress and job dissatisfaction (both signs of potential burnout) correlate with short staffing. Meanwhile, when nurses perceive staffing as adequate, rates of burnout are lower.

Time spent on non-care/administrative tasks — Nurses care for patients, but may spend even more of their time on clinical documentation, care coordination, patient flow management, reporting of quality indicators, and the inventory and requisition of supplies. In studies, nurses report spending between 26% and 41% of their time on documentation versus 34% of their time with patients. When administrative tasks leave less time for clinical care, frustration and burnout can be the result.

Long shifts — One large cross-sectional study found that nurses who worked shifts greater than 12 hours were much more likely than those who worked shifts of eight hours or less to experience burnout, be dissatisfied with their jobs, and report an intention to leave their jobs.

Moral distress — Burnout can occur when clinicians’ ethical values or commitments are incongruent with those of patients and families, colleagues, supervisors, or their organizations and/or they feel pressured to act in ways that compromise their values. In nurses, burnout caused by moral distress may also be related to their having insufficient input to clinical decisions or clinical disagreements with physicians.

Frustration caused by technologyGreater use of EHR/EMR systems and other information technology during clinical care leads to more clinician burnout. While technology has the potential to make care better, many organizations don’t use fully functional systems or still have outdated legacy systems in place and/or expect clinicians to do more documentation in the same period with the EHR.

The good news is effective leadership can mitigate these factors and potentially lower rates of nurse burnout, making health care better in the process.

How Leadership Skills Prevent Burnout in Nursing

Good leadership is a key factor in the creation of positive workplace cultures that support staff engagement, increase job satisfaction, and promote success at all levels. Nurse leaders can play a crucial role in reducing the level of nurse burnout in their organizations by promoting worker empowerment and a positive work environment. For example, effective nurse leaders:

Create safety cultures — Studies show that health care leadership can have a positive impact on nurse safety and performance. Nurse leaders can foster an organizational culture in which policy compliance is the norm and nurses (and other practitioners) take safety protocols seriously.

Empower confident decision-making — Nurse leaders familiar with the latest evidence-based studies in nursing care and public health issues make more confident decisions and can share their knowledge with staff, helping them make thoughtful choices about care. Feelings of uncertainty and frustration go down, and nurses believe they can fulfill expectations of high performance.

Ensure staffing needs are met — A greater patient-to-nurse ratio was consistently associated with a higher degree of burnout among nurses (even among nurses who earn higher salaries). Experienced nurse leaders may have the power to reduce shift length and nurse-patient ratios by hiring more nurses. When that’s not possible, they are able to communicate staffing issues with executives in a data-driven way, making a compelling argument for increased hiring.

Encourage autonomy — Transformational leadership is all about getting out of the way. When nurses feel they can make decisions and that managers and other clinicians will respect those decisions, they’re less likely to suffer from burnout. They may also be less likely to experience the kind of moral distress that can spark burnout because they feel confident taking the lead in patient care when appropriate to do so.

Facilitate cross-departmental communication — Nurse leadership can bridge gaps between policy and practice and different departments. This is important because communication gaps in health care environments can lead to understaffing, clinical disagreements, and unreasonable expectations.

Give work meaning — Health care leaders make work meaningful by giving staff members opportunities to challenge themselves and grow in clinical nursing roles or in other roles. In clinical settings, this can lead to less burnout and higher rates of patient satisfaction.

Promote team-based care — Studies show coordination of care and value-based care (VBC) can reduce clinician burnout and that high-quality teamwork promotes clinician well-being and resilience.

Support professional developmentGallup surveys show that managers “get the best performance from their team members when they identify what their people do best, praise them for it, and guide them into tasks and partnerships that maximize their natural talents.” Employees who have the opportunity to do what they do best are 57% less likely to experience burnout.

How to Prevent Burnout in Nursing

Studies show that qualified nurse leaders are instrumental in creating the kinds of positive and effective work environments that reduce burnout. That’s important when you consider that patients cared for by nurses who aren’t burnt out are twice as likely as other patients to report high satisfaction with their care. Engaged nurses are also less likely to quit the profession (turnover costs health care systems between $22,000 and $64,000 per new hire), and a growing number of studies have linked nurse engagement with patient outcomes.

The University of Michigan’s Online MSN in Leadership, Analytics, and Innovation program trains and educates adaptive and flexible nurse leaders who can be innovative in the face of the many challenges they’ll see in their careers. It’s a degree that opens doors leading to a wide range of opportunities in nursing leadership. U-M Master of Science in Nursing - Leadership, Analytics, and Innovation graduates go on to lead cross-functional care teams, improve nursing processes, educate and empower nurses, and shape health policies. They have titles like nurse manager, director of case management, and Chief Nursing Officer. They’re also nurse practitioners, nurse mentors, and nurse administrators.

If you’re a registered nurse with a BSN and you’re ready to take the next step in your nursing career, an online Master of Science in Nursing in Leadership, Analytics and Innovation from U-M School of Nursing can give you the skills, knowledge, and qualifications to change the field of nursing for the better. After earning your master’s in nursing leadership, you’ll have the tools to identify where burnout is coming from and develop strategies for overcoming it, as well as the confidence necessary to push for positive change in your organization.

You can learn more about the Master of Science in Nursing in Leadership, Analytics and Innovation, analytics, and innovation program admissions criteria, graduate financial aid, or the student experience by reaching out or registering for an upcoming online event. When you’re ready, apply online.