The State of Nurse Burnout and What We Can Do About It

Burnout, the feeling and the term, is now ubiquitous in many workplaces, but data shows it’s still most prevalent in healthcare settings, particularly among nurses. The nurse turnover rate in hospitals is more than 18% annually, and in Emergency Departments (EDs) it surpasses 22%. There is also an exodus of nurses from the profession, with burnout a significant culprit. 

Acute care settings, like EDs, are especially stressful environments, but burnout happens in many hospital units. Most importantly, leadership can take action to improve working conditions and combat burnout. In honor of Nurses Week, we examined nurse burnout, its effects on nurses, hospitals, and patients, and underexplored solutions. 

Burnout Causes and Its Effects on Nurses

Research has distilled the critical causes of burnout to work-related stressors like inefficient workplace processes, poor leadership and management, long work hours, a heavy workload, and a lack of control in their careers, among other workforce stressors (including structural inequities, implicit bias, discrimination, and sexual harassment). 

In addition to harming nursing staff, burnout results in decreased patient care and unsafe environments for staff and patients. Burnout is a key ingredient in compassion fatigue, described as a state of exhaustion and a biological, psychological, and social dysfunction. Compassion fatigue is prevalent in many careers, including among public defenders, clinical psychiatrists, and social workers. However, front-line healthcare workers like nurses are particularly susceptible to developing compassion fatigue, which can lead to depression, anxiety, and posttraumatic stress disorder (PTSD).

“Nurses are exceptionally empathetic, and they want to care for people. That’s why they get into it. It’s not an easy journey [to become a nurse], says Scott McConnell, the Nurse Educator in the Emergency Department at Jefferson Einstein Montgomery Hospital in Pennsylvania. He holds an RN, BSN, and MBA and has more than 30 years of experience as a paramedic. McConnell also owns and operates an EMS educational company called DistanceCME. 

The State of Burnout in Nursing

A 2023 American Nurses Association survey revealed that 47% of nurses are considering leaving their jobs in the next year, and 43% are considering leaving nursing altogether. This is particularly concerning because 22% of respondents left a position in the previous six months (so it’s too soon to move again), and others were close to and waiting for retirement. The top two reasons they gave were burnout and understaffing. COVID exacerbated the issue, with the average national turnover rate for bedside nurses increasing from 16.8% in 2019 to 18.7% in 2021. However, 72% of nurses who took the survey said they were already experiencing burnout before the pandemic.

The burnout epidemic among nurses and the subsequent high turnover rates have contributed to the national staffing crisis hitting hospitals, which has been described as a systemic issue. When nurses leave a job or career altogether, it creates more work for the remaining nurses, leading to burnout and an insidious snowball effect. 

This is happening across hospital units, but more so in EDs. “A big part of my decision to leave [my bedside nursing position in the ED] is burnout. I found myself not wanting to come into work some days,” says Anna Becks, the SANE Coordinator at MetroHealth Systems, a Level 1 Trauma Center in Ohio. She holds an RN and BSN and has a decade of experience as an ED nurse. 

Nurse Burnout by the Numbers 

A recent study estimates that Emergency Department staff turns over, on average, every five years, which contributes to a lack of experienced nurses and is linked to decreased quality of care. When experienced nurses leave, the hospital depends more on younger nurses, who miss out on the teaching and support that would come from the more established nurses. Nearly 25% of these young nurses leave within the first year. 

The Emergency Nurses Association (ENA) Executive Synopsis on Emergency Nurse Retention points out that continually educating new emergency nurses requires a higher proportion of the organization's recruitment and retention budget, which can diminish the hospital’s financial viability.

The ENA reports that the average cost of replacing a nurse is estimated to be $56,000 per nurse. This figure doesn’t include specialized education for critical competencies, specialty certifications, or advanced training for high-acuity patients, which may increase costs. Hospitals nationwide lose an average of $3.6 million to $6.1 million yearly due to turnover. Some studies say that each 1% increase in nurse turnover can cost a hospital an additional $306,000 per year.

Administrative Tasks and Nurse Burnout

Research has shown that nurse burnout arises in part from an “assertiveness-goal achievement response” and occurs when nurses feel they cannot achieve their goals. This results in frustration, a sense of loss of control, and low morale. For nurses, their goals are connected to caring for patients, not paperwork.

What we’re talking about here is the burden of administrative and documentation tasks that fall on nurses. “If it wasn’t documented, it wasn’t done” is a truism in nursing.  

Documentation burden contributes to burnout partly because nurses feel they cannot achieve personal accomplishments, which translates to job satisfaction. The Office of the National Coordinator considers documentation burden a high-priority problem. In a study published in 2022, nurses reported that their overall workload had increased by 15% in the last year, with 43% saying they were taking on more tasks outside of patient care, like cleaning units, procuring supplies, and administrative tasks. 

Nurses make up the largest portion of electronic healthcare record (EHR) end-users, documenting an average of 600 to 800 data points per 12-hour shift, or one data point every 1.1 minutes. Studies indicate that “the correlation between documentation burden, emotional support, and depersonalization suggests that nurses are affected by documentation burden.” These studies also indicate that software usability issues contribute to documentation burden and, by extent, to burnout syndrome.

Hospital-wide chronic understaffing means nurses must step up to fill the gaps. Nurses report that even in large hospital systems, the Emergency Department is regularly understaffed, lacking nurses, techs, registrars, and other crucial support staff. 

For example, when Emergency Medical Services (EMS) brings in a patient, ED nurses often have to perform intake, registration, and documentation due to understaffing. EMS paperwork can then get misplaced, and more time is wasted tracking it down hours or days later. 

McConnell is also the Nurse EMS Liaison at his hospital. In addition to caring for patients and training younger nurses, he coordinates with EMS for closed-loop learning. He receives calls from EMS managers about patients they brought in, and McConnell searches through the patients’ charts. He then obscures HIPAA-protected information and types up a report or calls the EMS to discuss the patient. This manual process gets particularly backed up when an influx of patients enters the ED or after taking a few days off work.

In addition to bedside nurses, those working in administration feel the brunt. Becks, for example, prepares specialized trauma reports for the state of Ohio. The IT team prints out a report from their EHR system and delivers it to her. She then manually inputs the data into a spreadsheet to create a new report for the trauma manager and the state. But there is a better way.

Improved Workflows to Combat Nurse Burnout

Many solutions to nurse burnout have been proposed, including wage increases, improvements to health and retirement benefits, and adequate staffing. Some hospitals have started offering services to support resilience, like providing meditation rooms or hiring a masseuse. However, as McConnell and Becks pointed out, these resilience programs are useless when nurses can’t step away from their duties to enjoy them. 

Technology can be a valuable tool to help fight nurse burnout related to administrative tasks and documentation burden, particularly for Emergency Department and Trauma Department nurses. In addition to expediting these tasks, helping ED and trauma nurses reclaim feelings of personal accomplishment can reduce burnout and the intent to leave. 

Electronic records and other technologies have historically helped streamline the documentation process and significantly reduce the time nurses spend on paperwork so they can spend more time with patients. However, not all technological solutions are created equal. 

ImageTrend’s Patient Registry platform is completely interoperable with any EHR system and eliminates the need to hunt down misplaced paperwork or for double data entry, including EMS data and closed-loop learning. These automatic processes save time and reduce additional documentation burdens, like those that fall on a Nurse EMS Liaison, for example, freeing the nurses to care for patients. 

There is an opportunity to improve ED processes and leverage technology to streamline administrative tasks and optimize nurse workflows. Any interventions should be chosen and implemented with input from nurses who use these technologies every day.