Tackling Burnout: Investing in Nurse Managers to Secure the Future of Nursing, Enhance Manager Effectiveness, and Support High Quality Patient Care

Background: Burnout is a widespread, pervasive issue the healthcare industry. Many efforts related to burnout reduction have been focused on front line caregivers but there is continued opportunity to address burnout in leadership. The global aim of this quality improvement project was to reduce burnout among the nursing leadership team at a large, academic medical center in the greater Boston area. Problem Description: A preliminary survey was completed to assess for the presence of burnout within the leadership team. Results revealed that more than half of the nurse leaders surveyed were experiencing burnout at least 50% of the time. This quality improvement project was designed with these results in mind. Methods: A review of the literature was completed to determine available knowledge relative to burnout in leadership. One study conducted by Prochnow et al. (2021), was similar in nature and was used to frame the survey for this initiative. The survey developed by Prochnow et al. (2021) was utilized to measure burnout drivers, components, outcomes, as well as thriving factors and mentorship. The Plan Do Study Act method was utilized as a framework for improvement. The Plan phase included collecting preliminary burnout data to establish and define the local problem. The Do phase included a pre-intervention survey to establish a baseline, followed by delivery of burnout education and a burnout reduction toolkit. This phase was completed with a post-intervention survey. Additional survey questions were added by the project team to assess demographic characteristics of participants, as well as evaluate the perceived effectiveness of the education and toolkit. In the Study phase, data was reviewed and statistical analysis completed. The Act phase included dissemination of findings and integration into the nursing strategic plan for 2023. Intervention: The nursing leadership team was provided with an educational session addressing burnout during the annual nursing strategic retreat. This education provided an overview of the literature, review of available resources within the organization, and a summary of evidence-based interventions to reduce burnout. Nurse leaders were also given a burnout reduction toolkit with a summary of each intervention, available references if applicable, and a link to locally based options to employ that intervention. Examples included outdoor walking routes close to the hospital campus, local massage therapist, and employee assistance program information. Results: A total of 29 nurse leaders participated in the pre-intervention survey and intervention, with 24 nurse leaders completing the post-intervention survey. The survey collected data in three areas; demographics, burnout assessment, and a qualitative section to elicit further, individualized feedback. Demographic data revealed that the majority of participants (37.9%) had been in their role less than one year. In addition, when asked about total years in nursing leadership and not just current role, the majority (51.7%) also reported having less than 5 years of experience. The burnout assessment revealed that nurse leaders were generally satisfied with their job and engaged in their work, but felt a great deal of stress associated with their work. Participants also reported experiencing burnout symptoms at least weekly. When evaluating knowledge of burnout, there was a notable increase after the intervention with more than 75% of leaders reporting significant knowledge of burnout post education. In addition, many open-ended question comments revealed nurse leaders felt better prepared to address their burnout in the future. There were no statistically significant changes in any burnout metrics post intervention as analyzed with a paired t-test as well as a Wilcoxon Signed Rank test. However, there were two areas of interest regarding job satisfaction and work appreciation. These two areas demonstrated a medium effect per the Cohen’s d statistic. Conclusion: The specific aim of this quality improvement project was to reduce nurse leaders reporting burnout 50% of the time by 10% and those reporting burnout 75% of the time, by 3%. The specific aim was not met, however, there was a notable increase in knowledge of burnout. If more time was allotted between the intervention and the post survey, and a larger group of participants were included, it is possible the results may have been significant. Several nurse leaders commented that time was a limiting factor for them in trialing burnout reduction interventions. It will be important to continue to survey nurse leaders as time continues, to measure the long-term effectiveness of the interventions