Nursing Leaders Tackle Ways to Fix ‘Accelerated Burnout’ in New Nurses

Nursing leaders shared strategies for addressing “accelerated burnout” among nurses new to the profession during a panel discussion hosted by the National Council of State Boards of Nursing (NCSBN) on Thursday.

Approximately 100,000 RNs left the workforce during the COVID-19 pandemic and another 800,000 anticipate leaving in the next 5 years, said Maryann Alexander, PhD, RN, chief officer of nursing regulation for the NCSBN and the discussion’s moderator, citing a survey in the Journal of Nursing Regulation from April.

Notably, 41% of the RNs who left the workforce were younger on average (mean 36 years) and had less than 10 years’ experience.

“One of the main reasons younger nurses [said they] are stressed is because they feel ill-prepared to enter the workforce,” Alexander said.

According to panelist Karen Lyon, PhD, MBA, APRN-CNS, CEO of the Louisiana State Board of Nursing, a 2021 survey conducted by her state board found that a lot of newly licensed nurses — those who entered practice in the last 2 years — were already burned out.

Some have dubbed this trend of nurses feeling overwhelmed and wanting to leave in this early phase of their career “accelerated burnout,” she noted, and there are multiple drivers.

“They were discouraged. They were ready to leave the profession,” Lyon told MedPage Today in a phone call.

“It’s not just that we had COVID — we have a shortage of nurses, we have a shortage of nursing faculty, and then we had students that were going through their clinical programs at that time and … many of them were forced into different kinds of education models than we’d ever seen before,” she said, referring to simulation models.

Such models are good for learning tasks, she added, but cannot replace the experience of treating “real patients in real situations that have real health problems.”

As for solutions, Alexander said, “Every single institution in this country has got to have a transition to practice program for their new nurses.”

These formal programs would assess new nurses’ skill levels, “fill in the gaps,” and provide mentoring and support through their first year, she explained. Not all small or rural hospitals have such programs, “but they need to,” she added during a call with MedPage Today following the panel discussion.

Another strategy to support newly licensed nurses is to leverage virtual nurses.

Lavonia Thomas, DNP, RN, nursing informatics officer at the University of Texas MD Anderson Cancer Center in Houston, said that in addition to managing discharges and admissions, experienced remote nurses have been hired by MD Anderson to onboard new nurses.

The new nurses appreciate having a more senior, remote nurse to turn to with questions, and they don’t have to worry that they are taking that nurse away from another patient, Thomas noted, adding that it’s these kinds of interventions that have helped MD Anderson to stabilize nurse turnover.

Asked whether nurse staffing ratios could help address workforce challenges, particularly burnout, most panelists supported the idea, with an important caveat: nurses should decide the ratios.

“The last people on earth I want doing staffing ratios for nurses is legislators,” Lyon said. “You could have five patients all with the same diagnoses and maybe the same comorbidities and they’re all different and you’ve got to be able to do that staffing and develop [ratios] … based on the needs of your patient population in your hospital in your setting. And I want nursing in control of that.”

Thomas pointed out that it’s not only the patients who are different — nurses also have different skill levels. During certain shifts when more new nurses are on a unit, that ratio may need to look different, she said.

The American Nurses Association announced its support for a federal staffing ratios bill on November 1. NCSBN does not have a formal position on staffing ratios, Alexander said.

Finally, one more way to support the latest generation of nurses is to focus on the health of the existing workforce, said Eileen Fry-Bowers, PhD, JD, RN, dean of the University of San Francisco School of Nursing and Health Professions.

“When students move into the practice setting … they’re going to be working with colleagues and preceptors and if those individuals are not at their best health, mentally and physically, they are not going to have the ability to support the newer nurse,” said Fry-Bowers.

“It takes a village to raise a nurse,” she added.

As more experienced nurses, Lyon told MedPage Today, “we have to be able to look at ourselves critically, and when we’re making mistakes and not providing a welcoming, supportive environment, we need to change that.”