Strategies for Preventing Burnout and Turnover in Healthcare Professionals

Healthcare is one of our most vital industries, and yet it’s notorious for being a high-stress, high-turnover environment. According to a study by NSI Nursing Solutions, the average national turnover rate among all hospital healthcare workers is 16.5%. And the costs are heavy:

• Each additional percentage point increase in turnover costs the average hospital another $359,650
• It takes hospitals between 36 to 97 days to hire a replacement for an experienced RN
• The average cost of turnover for a bedside RN ranges between $44,380 and $63,400

While there are many factors contributing to the employee retention problems of the healthcare industry, one of the most notorious is burnout. According to CareerBuilder, over 60% of healthcare workers report being burned out at their jobs.

It’s not surprising. Understaffing, heavy workloads, and insurance red tape can all take their toll. So how do you fight all that and improve employee engagement and well-being for healthcare professionals?

Advice for Individuals

Paula Davis-Laack, Founder and CEO of the Davis Laack Stress & Resilience Institute, speaks and trains on burnout prevention and stress residence in the healthcare industry. She offers three strategies to prevent burnout, focused specifically on nurses but valuable for all healthcare professionals:

1. Become more of an “otherish” giver

Every nurse I know has a strong tendency to put others first [...] In his book Give and Take, Adam Grant [...] found different subsets of givers, two of which are “selfless” givers and “otherish” givers. Selfless givers give their time and energy without regard to their own needs (“hey — it’s 3pm and I haven’t eaten yet today!”).

Otherish givers find a way to balance giving with their own self-interest and self-care. This might be difficult at first, and you may need to identify core beliefs standing in your way; such as, “Good nurses must always put the patient first,” or “I have to be a people pleaser.”

2. Incorporate resilience training

Psychological resilience has been associated with a lower prevalence of burnout in intensive care unit nurses, and resilience has been shown to be both feasible and acceptable to ICU nurses. One of the biggest adopters of resilience training in the U.S. has been the United States Army, through its Comprehensive Soldier and Family Fitness program.

3. Let go of emotional labor

Pain, illness, and the emotions that go along with those things don’t always bring out the best in people, and unfortunately, nurses are on the receiving end of some pretty awful behavior. Despite this, they need to make quick decisions, dispense treatment in an accurate way, and provide good “customer service.” Doing this often requires emotional labor, which involves suppressing your real emotions (frustration, anxiety, anger) in order to show interest, concern, and sympathy toward your patients and their families. Emotional labor has been linked to job stress and burnout, yet in those units where nurses were able to express their emotions with their colleagues in an authentic way (i.e., they could appropriately “let it go” without any backlash or repercussion), burnout was buffered.

Trainer, speaker, and consultant Steve Albrecht teaches stress management and coaches to prevent burnout for healthcare professionals. “I talk to those employees about the need to put themselves first, over their facility and their patients. You can't take care of others if you're not well yourself. I tell them to say no to so much overtime, to hang around more with friends who they don't work with, and to get more exercise. Burnout happens when people feel trapped and overwhelmed, and not in control of their career or their destiny.”

To help healthcare workers achieve personal wellness, he teaches the BREADS technique:

• Breathing exercises
• Relaxation moments at least twice per day
• Exercise
• Attitude (staying relentlessly positive)
• Diet
• Getting more Sleep

“They can't control their employer or their patients,” says Albrecht. “They can only control themselves.”

Advice for Organizations

Burnout drove Dr. Paul Coleman to quit the state-run psychiatric clinic he’d been working at for five years. He has since found a much more sustainable career path running a private psychology practice. As Coleman explains:

“Much burnout is viewed — wrongly — by many as something wrong within the practitioner exclusively. Maybe they cannot handle heavy workloads. Maybe there are other stresses in their lives. Maybe they have a hard time dealing with organizational rules.”

While individual factors can contribute, Coleman states that, “The core of the problem is the organization itself.”

Coleman identified some of the signs of a dysfunctional organization:

1. Secrets

The higher-ups know things that others do not — things that the employees feel the effects of but cannot clearly identify. So a sense of mistrust develops followed by a sense of unfairness. Those in on the secret always have more power and flexibility than those out.

2. Crazy rules

One's performance evaluation is based on the curve. That means that some people must get a lower performance rating regardless of their actual performance. And some will get a higher rating (if they have been part of the system long enough) simply because it is their turn.

3. The white wall of silence

It is not often that one professional will confront another professional who has done something seriously wrong or unethical. So less capable or less ethical employees are allowed to function and not be corrected.

4. A high degree of responsibility but a lower degree of power

Nurses, for example, are on the front lines more than doctors. They have a great deal of responsibility but often lack the final power. It isn't that they should have the power, but they are sandwiched in between the MDs and the patients. They get the bulk of the complaints from each side. They need more support rather than being told, “You knew what you were getting into when you became a nurse.”

5. Innovation is not rewarded

Publications and professional accomplishments are not rewarded in many settings as they might be in other settings. It might be expected and thus not seen as an extra effort, or more often it is viewed as not that relevant to the system as a whole.

6. Jealousy

That can happen anywhere. But in a healthy system, the productive staff, those who get things done and are often valued more by patients, are seen as role models for others to emulate. In an unhealthy system, jealousy is allowed to flourish because administrators are either jealous themselves, or it allows them to manipulate the situation to whatever purpose it might serve.

7. Bureaucratic paperwork

Sometimes, addressing a problem requires more paperwork and meetings than an administrator wants to deal with. It’s easier to deny a problem exists or pretend it is not that big a deal and therefore not worth fixing.

Fixing a dysfunctional system requires buy-in from senior leadership. “It really does begin at the top,” Coleman says. Here are the strategies he suggests:

• Reward consistently high performance.
• Take employees’ thoughts and feelings seriously. Don't make quick judgments if you haven't really heard from the employee.
• Penalize bad-mouthing, gossip, and obvious signs of jealousy. Reward cooperation, reward those who praise their colleagues for a job well done.
• Make sure the organization's stated values are actually lived up to — and they they dovetail with the employees’ values.

Burnout among healthcare professionals isn’t easily solved. But the strategies listed here, for both individuals and organizations, are a start toward improving sustainability and employee engagement for this industry that impacts all of us.

Editor's Note: This post was originally published in June 2015 and has been updated for freshness, accuracy, and comprehensiveness.

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