The past 18 months have clearly depleted healthcare staff and leaders in ways never truly imagined. Mental well-being, resilience and recovery have been challenged to critical levels worldwide with alarming numbers of healthcare staff leaving the field. However, something largely unknown to the general public and avoided by many healthcare leaders is the fact that enormous stress and burnout have been impacting healthcare clinicians and staff since well before the COVID-19 pandemic hit (National Academies of Sciences, Engineering & Medicine, 2019).

Cumulative burdens have compromised staff health and well-being such as: staffing shortages in nursing, increased patient acuity, rapid patient turnover, growing chronicity and co-morbidities, infectious disease outbreaks, ignored burdens from exponential digital and electronic advancements, regulatory and accrediting demands, and the toll of shiftwork.

The fallout of these accumulating burdens in healthcare, if not mitigated, will impact most individuals’ coping capacity and effect physical, mental, and emotional health and well-being. Thoughts will become primarily negative and the mind will build stories that mount into negative emotions and then behaviors to escape the suffering. For example:

“I have to work late and help out my peers as it is my job.”

“My boss doesn’t care how stressed I am.”

“My family has to be second always and this is killing me.”  

“I just can’t do this anymore. I don’t know how to meet all these patient needs and family demands in this chaotic environment. Is this job really worth my health and well-being?”

Leaders must alleviate these burdens and negative effects and stop the bleed. They can impact retention and the well-being of nurses. Below, I outline four strategies that leaders in healthcare can implement.

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Strategy #1: Educate Nurses about Mindfulness or Cognitive Behavioral Strategies

The first important strategy is to understand how to interrupt the stress-accelerated negative thought cycle – it begins with self-awareness. Self-awareness is essential to mental, emotional, and spiritual health and well-being. Without self-awareness we easily become captive to the stories of our minds – our thoughts cascading into stories that are often embellished with limited evidence of truth. These stories lead to negative emotions and, in turn, behaviors to escape our suffering. These behaviors often slip into unhealthy ones, such as overeating, poor dietary quality, substance abuse, poor sleep hygiene, inadequate physical activity, negative social interactions, overall poor self-care, and/or quitting one’s job.

Leadership can be key to interrupting such a cycle by modeling and supporting healthy thought patterns, validating stress and distress among their nurses, and ensuring programs are available that promote nurse well-being and self-care.

In two recent 2020 systematic reviews on effective interventions for nurses (and also physicians in one of the reviews), interventions that targeted stress were highly effective for nurses (Melnyk et al., 2020; Stanulewicz et al., 2020). Moreover, mindfulness and cognitive behavioral therapy (CBT) were deemed highly effective in one of the reviews (Melnyk et al., 2020). In a third recent review, mindfulness programs were also deemed effective for nurses for reducing stress, anxiety, depression, and burnout, and having better job satisfaction (Ghawadra et al., 2019).

Multiple systematic reviews in general have demonstrated effects of mindfulness interventions on a range of mental health outcomes (de Vibe et al., 2017) and for a range of long-term physical conditions (Long et al., 2017). In both CBT and mindfulness interventions, key steps are:

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o  Becoming aware of your thoughts,

o  Accepting and not judging the thoughts,

o  Accepting accompanying emotions,

o  Focusing on the present moment, and

o  Reframing the thoughts toward a more positive and hopeful lens.  

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Strategy #2: Promote a Culture of Health & Well-Being for Nurses

Healthcare leaders can and should prioritize nurse well-being and embed it into the culture from the time of onboarding all the way until retirement.

In a 2015 Harris Poll Nielsen Study of employee and employer opinion of workplace health promotion (wellness) programs, fewer than half of participants felt that their work environment allowed them to maintain good health and only 45% felt they had access to the available programs (McCleary et al., 2017).

Learn from nurses what programs they value, how they want to access them, and what will encourage a culture that promotes their health and well-being. In two published reviews examining return on investment of worksite wellness programs, it was determined that poorly conceived and coordinated programs, which lack comprehensiveness and are without clear, measurable goals or supportive cultures, are likely to fail (McLellan, 2017). Creating cultures that care about nurses and all clinicians through multiple programs and resources is essential in today’s stressful healthcare environments.

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Strategy #3: Evaluate Nurse Staffing and Scheduling Practices  

There is evidence that the well-being of a nurse is directly tied to the scheduling practices and staffing policies of the organizations where they work. Health organizations should consider evaluating their practices and policies and find ways to reimagine and innovate workflow, human resources, and workplace wellness (Shah et al., 2021).

One of the most critical factors impacting nurse burnout is high nurse-to-patient ratios. A recent study concluded that the nurse-patient ratio is a direct determinate of the effects of psychological, mental, emotional health and nurse productivity in the workplace, which also determines the patients’ overall health (Gutsan et al., 2018). Health systems should focus on implementing known strategies to alleviate burnout, including adequate nurse staffing and limiting the number of hours worked per shift (Shah et al., 2021).

Health organizations should also consider using scheduling rules to promote nurse health. Rules can offer structured guidance that ensure the healthiest possible schedule is developed (Jeffrey et al. 2017). The organization cited in the paper has adopted certain rules, including the practice of avoiding excessive consecutive hours, overtime, and working more than three consecutive 12-hour shifts. Additionally, the group advocated to engage employees in scheduling as it “promotes structural empowerment and is an indicator of a healthy practice environment.”

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Strategy #4: Establish a Plan

It is imperative that leaders establish a strategic plan that solely addresses nurse well-being. Key points in the plan can include:

• Engage key senior leaders in recognizing the business case for investing in nurse well-being interventions and programs.
• Dedicate resources to evidence-based programs that promote mental well-being especially focused on self-awareness, self-compassion, mindfulness, and cognitive reframing.
• Validate the stress of nurses, including leaders, and work towards a shared commitment to supporting stress management of all staff.
• Engage in creative and innovative strategies to manage the complexities and burdens of healthcare in acute care settings.
• Provide opportunities for front-line nurses to lead well-being initiatives and cultivate resilience and mental wellness.
• Implement journal clubs to dialogue and support strategies and tools to facilitate self-awareness, mindfulness, and positivity.
• Engage in gratitude interventions, which can promote positivity, inspiration, and peaceful thoughts among nurses.
• Implement team strategies to create well-being of teams that promote compassion for one another.
• Celebrate nurse achievements and accomplishments as part of promoting well-being.

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