Stressful work environments and neglecting self-care can swiftly lead to nurse burnout and other mental health concerns, such as anxiety, depression, and compassion fatigue. The ongoing COVID-19 pandemic, fueled by the Delta variant and vaccine hesitancy, has exacerbated nurse burnout rates and put nurses at higher risk for acute stress disorder, PTSD, and other mental health issues. It’s important now more than ever that nurses have the support they need from their healthcare facilities during this unprecedented time of stress. There are numerous offerings a hospital can provide their staff to help improve mental health. If you’re a nurse, here are a few things to look for in a healthcare facility.
Low Nurse Turnover Ratios
Healthcare facilities with lower nurse turnover ratios typically have higher job satisfaction among their nurses. While a good work environment plays an important role in workplace satisfaction, so do benefits a facility offers to help support its staff.
While the turnover rate for staff RNs in 2020 was 18.7% nationwide and 24.9% in the southeastern United States, WakeMed Health and Hospitals prominently displays its low nurse turnover rate of 9.6% to 11.9% and high nurse engagement in the 74th percentile. WakeMed, a private, not-for-profit healthcare system based in Raleigh, North Carolina, employed nearly 3,100 RNs in 2020.
WakeMed believes its employees are its greatest asset and accomplishes these better-than-average numbers through competitive salaries, a comprehensive benefits package, and a wealth of programs and services to help its employees professionally and personally. Some of its most popular offerings include health benefits, retirement savings plan with employer matching, short-term and long-term disability coverage, paid vacation and sick leave, reasonable PTO accrual rates, bereavement leave, tuition and specialty certification reimbursements, college savings plans, on-site fitness centers, a confidential employee assistance program, employee health clinic and pharmacy services, and discounted childcare rates, among others.
Mental Health & Well-Being Services
Nurses who could benefit from mental health services may not seek it due to the existing stigma or fear of losing their job. The Joint Commission encourages the removal of barriers that keep healthcare staff from seeking mental health services, including removing policies that reinforce stigma and fear over professional consequences. Many hospitals recognize the need to provide support systems for mental health and well-being services. These systems may be offered through their Employee Assistance Program and can include free, confidential assessments, referrals, and short-term counseling.
Boston Medical Center (BMC), a private, not-for-profit academic hospital, holds itself to a high standard of care to its employees and offers a wealth of benefits for the health and well-being of its team of 1,700+ nurses. Besides comprehensive and affordable health plans for employees who work 20 hours or more per week, its well-being offerings include a comprehensive Employee Assistance Program and its [email protected] Program provides emergency childcare and eldercare. It also has an on-site Working Well Coach and on-site Resiliency Clinician. BMC understands the value of rest and relaxation for mental health and well-being, so it offers a generous PTO program that starts at 33 days per year for full-time employees, which increases to 43 days over time.
NewYork-Presbyterian Hospital is dedicated to supporting its employees and helping them improve and maintain their health and personal growth. NYP’s unique wellness initiative, called NYPBeHealthy, helps employees achieve their well-being goals by providing weekly Restore and Relax classes, complementary well-being coaching, and employee fitness centers. NYP also recognizes that nursing can be physically and emotionally challenging and provides on-site health coaches, programs to help keep a healthy mind, and free yoga classes. It also ensures employees are taken care of with 100% paid retirement plans, tuition reimbursement, generous parental leave, childcare, and eldercare, among other benefits.
St. Luke’s University Health Network, headquartered in Bethlehem, Pennsylvania, offers an Employee Assistance Program and many other health and wellness initiatives. It also found a way to overcome the many barriers to its employees’ ability to access mental healthcare, which included stigma, cost, scheduling delays, and mismatches in provider supply/demand. St. Luke’s introduced Internet-delivered cognitive behavioral therapy via an evidence-based solution named SilverCloud to provide online behavioral health programs to employees and their spouses. Programs address anxiety, depression, and stress, and enable participants to manage work and life pressures.
Wellness and Work-Life Balance
Programs that promote wellness and work-life balance naturally go together with mental health and well-being services. Kaiser Permanente employs more than 63,000 nurses in over 600 locations and is committed to caring for all its employees holistically. It values health, wellness, and happiness and understands that for employees to be their best at work, it begins with being their best outside work. Therefore, Kaiser provides an array of resources that enhance employees’ wellness and work-life balance.
Some of the many benefits and services Kaiser Permanente provides include one-on-one wellness coaching, wellness and employee Assistance Programs, healthy workplace practices, flexible scheduling options, and generous holiday, vacation, and sick leave. It also provides mental health and wellness tools that support stress reduction, emotional well-being, and meditation practices, among others.
The National Business Group on Health Honors named Kaiser Permanente as one of the top 50 businesses given “Best Employers: Excellence in Health & Well-Being Awards” in 2019. These awards recognize employers with an extraordinary commitment to improving their employees’ quality of life and overall well-being, including contributions to mental and physical health.
Nurse-to-patient ratios recognize the need to set a limit on the number of patients each nurse cares for simultaneously to ensure safe patient care. Besides a range of negative outcomes for patients, low staffing also impacts nurses, often leading to fatigue, burnout, and job dissatisfaction. Currently, there aren’t any federal mandates regulating this number, but there are proposed RN-to-patient safe staffing ratios.
On a state level, 14 states currently address nurse staffing in hospitals with official regulations and seven require staffing committees to be responsible for nurse-driven ratios and staffing policy. However, only California stipulates a required minimum nurse-to-patient ratio by law. Ratios must always be maintained and include a ratio of 1:2 or fewer in the ICU and 1:4 or fewer in the emergency department, among others.
Massachusetts did pass a law with specific ICU nurse ratios that require a ratio of 1:1 or 1:2, depending on patient stability. Boston Medical Center strives to meet or exceed the standard set by the state and attempts to keep its nurse-to-patient ratios as close to 1:1 in stressful ICU environments. It’s transparent in its staffing models and regularly posts its ICU nurse staffing ratios by unit. For example, from April to June 2021, its average nurse-to-patient ratio in the SICU was 1:1.18852, NICU was 1:1.68493, and PICU was 1:0.87504. BMC understands that appropriate nurse/patient staffing enhances patient satisfaction, reduces medical errors and accidents, prevents nurse fatigue, and improves the quality of life for patients and staff alike.
Usable & Easy to Accumulate PTO
Paid time off is a great incentive and promotes a good work-life balance that can help prevent nursing burnout. Many hospitals have some type of PTO program, but these programs aren’t created equally. Some programs allow nurses to quickly accrue and use PTO, while others put limitations on both. In 2021, there were 6,090 hospitals to choose from nationwide, so do some comparisons.
Northside Hospital in Georgia offers vacation and PTO, plus sick days, paid holidays, maternity and paternity programs, bereavement leave, sabbaticals, and volunteer time off. Employees automatically accrue PTO, which they can use for vacations, sick time, and holidays. What’s unique about its PTO benefits is employees can cash out unused hours at year-end or transfer hours to another employee
Current and former RNs commend Presbyterian Healthcare Services’ PTO policy. Located in New Mexico, PHS puts 16 hours of PTO into the PTO banks of all eligible full-time employees during their first week of employment and pro-rates this amount for part-time employees. PTO begins accruing on the first day of employment and employees can use their PTO as soon as it accrues. PHS bases PTO on years of service, which includes 200 hours annually for employees with zero to five years of service, 240 hours for up to 10 years of service, and 280 hours for 10-plus years of service. PTO banks carry over and are capped at 320 hours.
Mental Health and Well-Being Resources for Frontline Workers
Nurses have always had difficult jobs, but the COVID-19 pandemic drew attention to how hard their jobs truly are. The pandemic placed unprecedented stress on nurses and put them at an even higher risk for all types of mental health issues. In a recent study by Vivian Health, 43% of respondents didn’t feel their employer was doing enough to support their mental health and well-being. After working in the healthcare field during the pandemic, 83% of respondents felt their mental health had been impacted and 36% felt it had been significantly impacted.
As nurses on the frontlines during the pandemic, it’s more critical than ever to have an employer who supports your mental health and overall well-being. There are also numerous free mental health resources for frontline workers, including:
- The American Nurses Association offers a comprehensive list of mental health help for nurses
- Operation Happy Nurse is a go-to resource for nurses coping with the pressures of being a real-life superhero
- The ANA’s Well-Being Initiative offers free tools and apps to support nurses’ mental health and resilience
- The American Psychiatric Nurses Association’s Well-Being Initiative provides a nurse’s guide to mental health support services
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