Burnout is a national risk facing healthcare workers and especially nurses practicing in complex care.
A cardiothoracic intensive care unit (ICU) at a large teaching hospital in Southwest Michigan implements a dual-role nurse pilot project whose intent it is to tackle the health system’s high turnover rate to offset costs for orientation and advanced training of every new nurse. The multi-year initiative sheds light on burnout, a national factor facing healthcare workers ─ and especially nurses whose patients require a high complexity of care.
Contributing factors leading to nurse burnout
For nurses, there are multiple contributing factors that lead to burnout, many of which were heightened by the COVID-19 pandemic. Included among these are high physical and psychological demands handling patients and families; increased patient acuity and the complexity of care provided; added pressure and workload; and difficult-to-retain areas of support such as environmental services, nutrition services, and nurse technicians.
In our post-pandemic world, authoritative sources reveal national data showing a disturbing effect related to the nursing shortage crisis. The statistics bring increased attention to a long-standing workforce problem and include:
- 2022 NSI National Health Care Retention & RN Staffing Report states turnover increased by 8.5% with a national average of 27.1%; additionally, hospitals experienced a 95.7% RN turnover rate over the past five years.
- U.S. Registered Nurse Workforce Report Card and Shortage Forecast projected in 2020 a shortage of clinical nurses totaling 154,018 and an additional shortage of 510,394 by 2030.
- U.S. Bureau of Labor Statistics estimates the job outlook for nursing will average 194,500 openings per year over the next decade, as team members are leaving the workforce for other occupations or retirement.
- The average turnover cost for an RN is estimated at $46,100 (with a range from $33,900 to $58,300), and the average hospital could lose up to $7.1 million per year in turnover costs.
The national data are telling, and illustrate what Spectrum Health’s Cardiothoracic Cardiac Care Unit (CCU) in Southwest Michigan was confronting: an all-time high level of burnout. The large teaching hospital and not-for-profit system’s Cardiothoracic ICU is a 22-bed CCU that provides care for critically ill medical and surgical cardiology and thoracic patients.
Testing a dual-role initiative to increase engagement and satisfaction
In an article in Nursing Management®️, Spectrum Health’s Cardiothoracic ICU averaged 25.7% nursing turnover. In 2018, the average cost of orientation for this unit was $800,000. This cost incurred by the unit was spent on educating and orienting new hires. The expense was one of many factors, including the high complexity of care, which propelled the leadership team to develop a dual-role initiative.
According to the article, the pilot project’s hypothesis was that full-time employees would benefit from a change in clinical setting, leading to increased engagement and job satisfaction. A dual-role is an employee who will work a portion of their FTE (full-time equivalent) in two different clinical units; in this instance, various departments, including the emergency department, labor and delivery (L&D), outpatient surgical services, and more, collaborated to create a dual role with Cardiothoracic ICU. The method allowed the employee to practice in ICU shifts to maintain their nursing competencies.
Prior to the 2019 launch, leaders developed guidelines outlining their expectations for the employee, as well as the nurse’s expectations from the team. To support the nurse’s successful transition to the dual role, throughout the project leaders met with the employee and team members for feedback and shared learnings.
