The topic of how to reduce nurse burnout has continued to be a compelling issue for healthcare providers. A recent popular article on this topic suggests burnout can be reduced by applying the following strategies to foster nurse resilience:
- Seeking out support groups,
- Having a buddy system or
- Learning coping skills
Feedback from healthcare professionals who recently completed coaching training shared the belief that several of these methods can be tailored to meet the needs of healthcare workers.
This article provides one method where these techniques, when combined with a coach-like leadership style and when used in a team setting, can be an effective tactic in helping reduce nurse burnout.
Definition of Nurse Burnout
A recent definition of nurse burnout shares the belief that “…this type of burnout is a disorder that is directly related to workplace conditions due to the occupational stress in which health and education workers are constantly under, mainly associated with interaction with other people… Regarding their usual risks, health professionals are exhausted during work hours, and therefore will not be able to perform an effective care practice and may cause harm to both patients and health service in general.
Examples of symptoms of nurse burnout include:
- Always feeling tired or fatigued
- Dreading going to work
- Emotional and physical exhaustion
- Feeling apathetic about helping others
- Constant dread or panic about work
- Loss of appetite
- Loss of sleep
- Increased anxiety and depression
Nurse Burnout and Patient Safety
A number of recent academic articles and related dissertations suggest the reduction of nurse burnout has shown to have an increase in patient satisfaction and quality of care. According to a recent study from the U.S. National Institute of Health (NIH) “A positive safety culture toward the patient was associated with the absence of burnout and a high capacity to deal with stressful situations. Open communication, management support, professional suitability, mutual learning, and teamwork are considered dimensions of safety culture; it is likely that the professional inserted in this scenario feels productive and satisfied, and therefore exposed to a lower chance to develop burnout.” The article further shared the bottom-line belief that “There is a relationship between high levels of burnout and worsening patient safety.”
In light of the above insight from the NIH, and in collaboration with healthcare leaders who had completed coaching skills training I focused on what they believed nurses felt were the “top three” needs when it came to reducing their risk of burnout. Their feedback suggested that (in order):
- Being a member of an inclusive, compassionate team
- Having a strong sense of purpose, reinforced by a supportive infrastructure (e.g., good pay, access to equipment and resources) and
- Leadership that engaged them “where they were at” were the most important attributes that helped nurses feel safer, less stressed and better equipped to manage the emotional exhaustion linked to burnout.
The role of the first-line leader in reducing nurses burnout has been further shown to be an effective resource. A recent article from the University of Michigan’s School of Nursing suggests “Good leadership coaching is a key factor in the creation of positive workplace cultures that support staff engagement, increase job satisfaction, and promote success at all levels. Nurse leaders can play a crucial role in reducing the level of nurse burnout in their organizations by promoting worker empowerment and a positive work environment”.
Subsequent feedback from recent interviews with nurses and nursing leadership at the first-line supervisor level felt that the following technique helped their team members feel part of a team and that their co-workers were part of their “support squad”.
Try this burn-out reduction technique experts call: “Upcoaching the huddle”
In hospitals that practiced shift change “huddles”, nursing leaders who completed coach skill training added a component to the huddle that included reinforcing team engagement. A huddle is a short, stand-up meeting (10 minutes or less) that is typically used once at the start of each workday in a clinical setting. In inpatient units, the huddle takes place at the start of each major shift. Note that current practice endorses the belief that most huddle templates support a patient-centered approach, and focus on the unit/department’s operating environment. This is a practical and well-respected method, especially within high cadence healthcare operating environments.
Coach-like healthcare leaders decided to add a component to the huddle that focused on the patient caregivers, and to addressing the caregiver’s needs for inclusion, psychological safety and team support for their current emotional state of mind (i.e., for meeting co-workers “where they were at”) prior to the start of each shift.
Sample approach The following script is a blend of best practices:
Step 1 – Prior to the huddle – understanding the process and building trust
Team members have agreed through prior meetings (usually facilitated by the first line leader or peer who has completed team coaching training) to create a safe space in the huddle to share “where they are at” when it comes to their emotional readiness to supporting the needs of the patients in their care. Team members develop various, simple to understand methods for ranking their readiness. For example, in one case team members share a 1 to 10 scale of engagement, with 10 being fully ready and 1 being not ready at all. Those who are less than a 10 share what support they may need to contribute more fully to the team’s success, and as a team they work through how to provide this support.
Note-as a best practice, team members who know they are 5 or less are strongly encouraged to meet with their shift lead prior to the huddle in order to work through their concerns.
Team members also agree that no one leaves the huddle until everyone is ready to commit to supporting each other’s emotional readiness.
Step 2 – during the huddle – establishing a “safe space”
Team members talk through their individual readiness and proactively work through mitigation tactics (sometimes called ‘agreements’). For example, if one team member has to check-in on a day care issue, everyone knows who is covering their station. Or if a team member is experiencing waves of grief following a loss, team members share their availability to support the grieving, and options for accessing additional resources.
During the huddle the shift lead provides coach-like support (e.g., asking open ended questions, staying in the moment, actively listening), allowing the team to work through their own solutions to supporting the emotional readiness of their peers. As an option, an informal list of agreements is validated by the team prior to start of shift.
Step 3 – After the huddle- sustaining trust with the team
Often, teams will do a mid-shift huddle to check-in on their agreements. This allows for adapting in the moment to issues and ensures team members are supported throughout the shift.
At the end of the shift, team members do a brief calibration experience to review their actions and set expectations for the next shift.
Feedback on this approach
- “As a nurse in a patient-centered public health facility I have found that doing the emotional check in with my co-workers has made me feel less disengaged…I feel I am no longer alone with my feelings and see that others are often going through the same issues.”
- “I used to feel as a shift leader during the huddle that all I was doing was putting out fires, now the team takes ownership for their own solutions…I can focus more on bringing my positive emotional energy to the team.”
- “I feel that my voice is being heard and that my co-workers have my back.”
Taking the first step
This technique and others relating to being a more coach-like leader can be learned through participation in a coaching skill-building program. If you would like to learn more about an initial coaching certification program or coaching in healthcare, please take a look at ACT’s Leader as Coach and Leader as Coach for Healthcare offerings. ACT Leadership and Performance Coaching, LLC has a great deal of experience partnering with the healthcare community to develop and deliver coach training and coach training certification programs.
In addition, if you are curious about how other organizations have benefited from organization-wide coaching programs, ACT has the expertise to guide you through a review of best-in-class case studies and the option to speak to Erin Hutchins or Mike Hutchins (ACT’s co-founders) regarding your specific needs.