How office-based procedures can impact nursing burnout

a nurse with an infant in the hospital for nursing burnout

The healthcare sector is well within a crisis in terms of staffing. While much ink has been spilled in regards to shortages of physicians, the problem cuts across nearly all front-line healthcare professions, especially nurses. Exacerbated by the stresses and demands brought about by the COVID-19 pandemic, nurses are suffering the effects of burnout and the resultant mental, physical, and emotional exhaustion that come along with it. According to the USC Keck School of Medicine, a survey by staffing firm Incredible Health revealed that 34% of nurses polled planned to leave the profession by the end of 2022. That is coupled with a boom in our aging population, which will require more healthcare servicing, as well as a lack of nursing faculty at our nation’s schools. The Bureau of Labor Statistics projects that between 2021 and 2031, the profession as a whole will only grow by 6%, or 195,400 nurses. Compare that to the number of nursing jobs they project to be added: 203,200 each year of the decade.

What’s more is the staffing shortage among healthcare workers is a type of feedback loop. Healthcare Dive highlighted a recent poll by Connect RN, a nursing staffing firm, who found that half of the nurses they spoke with considered leaving the profession. The top reason given was ongoing staffing issues that left remaining nurses with overburdened workloads. They voiced concerns about the lack of control they had over their careers as well as what they saw as ineffective leadership in the face of the crisis.

The shortage in nurses does not bode well for patients. When healthcare professionals of all stripes find themselves overworked, stress levels tend to rise opening the door for missteps in care. A 2002 paper published in the Journal of the American Academy of Medicine found that increases in the nurse-to-patient ratio in hospitals significantly raise the likelihood of mortality upon admission and instances of failure-to-rescue. The same increases were found to dramatically impact feelings of burnout and job dissatisfaction.

Nursing Burnout Reduction

United Health Foundation and the American Nurses Foundation are piloting a program that will address issues of nursing burnout. The initiative aims to “transform organizational culture, remove the stigma associated with seeking mental health support and offer nurses a new burnout prevention model to help them use mental health resources earlier and more effectively,” says United Health Group’s press release. Using a military-derived model, the program will bring into focus the problems being voiced overwhelmingly by younger nurse and those of color for whom the shortage has been especially taxing and who often lack access to needed resources.

For hospitals and health systems, reducing feelings of burnout can add up. A study by the Journal of Public Safety finds that programs combatting burnout and its related problems can drive down recruitment costs a full 36% while improving retentions rates by 20%.



Reshaping Caseloads

While no one denies that programs aimed at reducing nurse burnout rates are needed, there are other areas where moves can be made to alleviate the pressure nurses are facing. As the shortage is mainly affecting bedside nurses in hospitals, a general down-shift in hospital caseloads could free beds, decelerate the pace of work, and allow nurses to concentrate their care on the patients that need it most.

Moving certain procedures that need not be performed in hospitals into other settings is a tested, safe, reliable method of decreasing health care costs and providing care tailored to the specific circumstance. These spaces currently include ASCs, offices, and clinics where surgeons and physicians perform a wide-range of procedures, both corrective and preventative, such as knee arthroscopy and colonoscopy.

The development of office-based procedures has been facilitated by several factors. As McKinsey points out in a recent report, the field of anesthesiology has seen innovations in pain management and new drugs used, such as ketamine and propofol, have allowed for a much more manageable recovery for staff and patients. Further, costs associated with outpatient procedures – McKinsey uses total knee replacement as an example – are markedly lower than their inpatient counterparts. This, obviously, is an added bonus that makes office-based procedures attractive to both payers and patients who see their out-of-pocket expenditures decrease significantly.

Environmental Change

Opportunities to create more manageable work environments with an intentional focus on stress-reduction is not some pie-in-the-sky idea, but rather rooted in sound science. A study published in the International Journal of Environmental Research and Public Health found that incidences of nursing burnout in hospitals had a direct relation to patient mortality and length of stay. A highlight of the research was the way in which “the work environment could be leveraged to minimize” the effects of nurse burnout.

Changes to the work environment can be manifold, but as we face a nursing burnout crisis – not looming, but here – it is critical that we entertain all ideas which can help abate or turn the tide. Office-based procedures stand to play a role in making sure that hospital resources and staff are focused on delivering topline care to those who require acute services and advanced monitoring. Assigning sites of service that are appropriate for the procedure and patient can help unburden nurses, especially in times of public health crises, and give them back the time they need to care for their patients and themselves.

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