Combating nursing burnout, one workplace at a time

As the pandemic dragged on, professional caregivers dropped out or became worn out as stressful days melted into weeks and months. At the facility in Wolfeboro where Pike worked for eight years, “We were just trying to stay above water.” Taking more shifts meant mounting fatigue and more responsibility, and constantly donning and doffing full protective gear made caring for fragile patients much more challenging.

“It was scary. I was considering leaving nursing last August,” said Pike. “There was an everyday fear that just by doing your job, you could lose your nursing license.”

But last August, Pike’s solutions became clearer — and so did her work environment and ways to reboot.

Weather permitting, the Moultonborough resident now goes kayaking after work, finding peace and quiet on rivers and lakes. During the winter she stokes her woodstove or lights a log in the fireplace and sets a timer to immerse herself in reading that is pleasant and engrossing. She checks in, including through social media, with colleagues going through similar trials and striving to preserve their stamina, resolve and wellbeing. 

It's a soul-saving routine. The pandemic’s danger has abated slightly, and COVID’s outbreaks appear to be shorter and less severe, according to New Hampshire’s health experts. But there are still plenty of unknowns. Is this new normal forever?

Today, Pike’s prized coping mechanism is something she doesn’t — something that sets the tone for her work and life: a positive workplace culture that reinforces community and bolsters morale, and jumpstarts her personal sense of mission and awareness that she makes a big difference for others.

In August, when Pike started work at St. Francis Rehabilitation and Nursing Center in Laconia, she found an invigorating role in an intimate, family-like, all-hands-on-deck setting, where care staff communicate early and often and cover for co-workers, and employees — regardless of their job or department — feel valued for how they contribute to residents’ quality of life.

“It’s the little things they do to appreciate you. They will cover the floor and help you out. It’s just a very positive environment. All the little things together make a big thing. I look forward to coming to work every day,” Pike said. “The patient is really driving the care. We treat the patients like this is their home.”

It sounds like practical wisdom and common sense — especially for nursing homes. But the challenges of COVID and trying to limit outbreaks and prevent patient deaths ushered in days laced with worry and constantly changing protocols — and a survival mode of vigilance and apprehension. Rotating periods of isolation made caring for the whole person more difficult, and turned up the pressure to spend time with each patient individually.

“When we have a shutdown, moods drop. Residents can’t come out and do things so they become sad and our staff is sad for them,” said Nicole Snider, human resources director at St. Francis.

In January and February 2021, when COVID went through the 50-bed nursing home, “We lost so many people we truly cared about and loved,” said Brenda Buttrick, administrator at St. Francis. “We try very hard to run this building like a home.”

Especially after that time, morale building became a priority — something to serve patients and staff daily, like life-saving medication.

Now, positive workplace changes are helping health care workers move forward and feel renewed, including at nursing homes run by Catholic Charities New Hampshire.

Visiting family members are still questioned about COVID symptoms and required to wear masks and protective face shields, but they’re allowed to visit regularly and spontaneously without appointments. St. Francis administrators visit rooms and serve trays during daily meal times, taking the heat off direct care staff during the busiest times of the day. Entry level unit aides make beds, and answer phones and buzzers from patient rooms. Employees in housekeeping, maintenance, nursing, recreation and administration are updated throughout the day about emerging needs, evolving situations, and happy events for residents and staff. Staff receive uplifting messages, encouragement and thanks by text from Circle of Caring, an offsite communications provider. When inspirational quotes trickle into employees’ cell phones, “You wait for it. It does boost mood,” Snider said.

Regular employee appreciation events, with photos and nominations from administrators and comments from peers, go a long way to boosting spirits and sustaining morale. “Letting direct care workers know how much we appreciate them does seem to help the culture a lot,” Snider said.

Nursing and direct care recruits, many who enter through work-study programs subsidized by Catholic Charities, are taught the tenets of CHOICES, which stands for collaboration, honor, optimism, integrity, compassion, excellence and service — a conduct code throughout the charity’s agencies.

“Having these values helps set the bar for how we treat one another,” said Buttrick. “The environment needs to remain positive. Even if we’re having difficult days, we pull together as a team.”

The stats on burnout — and tips for what to do

For Pike and others in nursing home jobs, this shift comes not a moment too soon: According to a May 23 advisory from the U.S. Surgeon General’s office, health care worker burnout is exacerbating the already-critical staffing shortage, which can jeopardize care. In the next five years, there’s a projected shortage of over three million low-wage health care workers and nearly 140,000 physicians nationwide. There needs to be more focus on the mental health and well-being of frontline workers, with overall change and more support, according to the federal report.

Burnout was a problem before the pandemic hit. In 2019, the National Academies of Medicine found that up to 54% of nurses and physicians and up to 60% of medical students and residents were suffering from burnout, which included worrisome and chronic symptoms of stress and fatigue.

Especially in the wake of COVID, nursing homes are trying to keep an eye on work-life balance.

“Facilities are trying to keep staff morale up because they’re trying not to lose anybody,” said Brendan Williams, president of the New Hampshire Health Care Association, which represents roughly 100 nursing homes and assisted living facilities throughout the state. “It’s been such a trying experience the last couple of years.” Even those who work in hospitals, where pay is higher, “are considering leaving because of the extraordinary burden of caring. Everyone is trying everything they can at this point to make their employees as happy as possible,” Williams said.

At skilled nursing facilities, including Belknap County Nursing Home, Employee Assistance Programs offer mental health counseling by phone. “Burnout still exists,” said administrator Shelley Richardson. “We try to look for staff incentives and watch for morale issues” and encourage staff self-care.

Important, too, is a workplace culture shift. The Surgeon General’s office urges health care facilities to transform work environments to be responsive to workers’ voices and needs. Changes include eliminating punitive policies for seeking mental health or substance use disorder treatment, and reducing administrative burdens to help professional caregivers spend more productive time with patients and colleagues.

The guidelines prioritize social connection and community as core values of any thriving health care system. Investing in public health initiatives and the public health workforce is also a goal.  

Making health care facilities feel like family and community for staff and patients alike

At St. Francis, Pike believes there’s a palpable difference from places she’s worked in the past. “It doesn’t feel like a corporation,” she said. “It feels like a community and a family.”

During spells of COVID contagion risk, patient room doors remain open, but are covered with transparent plastic so residents can wave and talk, and see their neighbors while they do chair exercises in doorways.

After COVID, social activities and opportunities to laugh and have fun are reigning — including during a recent celebration of Nursing Home Week.

“Today is tie-dye day, we’re all dressed in tie-dye,” Pike said. “Yesterday was '80s day” with staff dressed in Jane Fonda workout suits or glittery Michael Jackson garb. “Patients can dunk some of us in a dunk tank. Every day they’re looking forward to something else and asking, ‘What are we going to do today?’ You build connections with peers and patients when we do these things together.”

In ongoing practice, the post-pandemic recipe for survival — even when there are fewer workers on deck — seems to be mission, mindset, morale, praise and support.

“I got a birthday card in the mail” signed by the administrators, said Pike. “It’s little things. People have to want to come to work.”

During the workday, administrators and supervisors check in to see how staff are faring and if anything needs to be fixed or addressed.

Burnout can still occur, Pike said, but it lessens if you know when and how to take care of yourself.

As nurses, “We want to step up and help out, but you have to know your limit and when you need time off.” When Pike feels stress mounting, “I will meditate, go get a massage or take quiet time to sit at the beach. Whatever helps your soul.” Sometimes she attends painting classes or crafting groups after work.

Setting a timer to read for a certain amount of time provides just enough of a mental break to reboot. “It takes me out of whatever I’m feeling when I’m having a rough day,” she said.

Before taking a job at St. Francis, “I used to dread waking up and coming to work,” said Pike. “Now I come here and there’s a purpose for me. I’m coming to see my family and check in. It doesn’t really feel like work anymore.”

“Your mental health is equally important as how much you’re getting paid,” said Pike. “Listen to yourself. Sometimes we feel guilty making the changes that are necessary because we as health care workers put ourselves last. The hardest thing for a nurse to do is say no.”