The health care industry has seen high staff turnover amid a "Great Resignation" among American workers, and this trend is likely to continue. However, according to a new study, hospitals can mitigate these high turnover rates by implementing specific programs to address burnout.

Health care's 'Great Resignation' is likely to continue

According to a new study led by the American Medical Association, the health care industry is likely to see more staff turnover as workers experience burnout and resign.

For the study, researchers surveyed 20,665 health care workers at 124 hospitals and health systems between July 1, 2020, and Dec. 31, 2020, to examine the relationship between Covid-19-related stress and work intentions. Among the respondents, 44.84% were physicians, 11.14% were nurses, 10.17% were advanced practice providers (APPs), 11.83% were workers in other clinical roles, and 3.57% were administrators. The remainder, 18.45%, were in other roles such as clerical and housekeeping.

In the survey, respondents were asked questions about their overall stress, feelings of burnout, fear of infection, perceived anxiety/depression, work overload, and whether they felt valued by their organizations. They were also asked about the likelihood of reducing their work hours over the next 12 months and the likelihood of leaving their practice within the next two years.

Overall, the study found that higher levels of burnout, stress, workload, fear of infection, and anxiety/depression were associated with a greater intention to reduce hours or leave the health care practice.

Specifically, 31.4% of physicians, 33.7% of nurses, and 28.9% of APPs said they were moderately likely or higher to reduce their work hours in the next 12 months. In addition, 23.8% of physicians, 40% of nurses, and 33% of APPs said the likelihood of leaving their practice within the next two years were moderate, likely, or definite.

"Because multiple studies have demonstrated that intent to leave among physicians correlates with actual departures, these findings are of concern," the study's authors wrote. "Costs of replacing healthcare workers are also substantial." For example, replacing a nurse may cost up to 1.3 times their annual salary, and replacing a physician could cost between $250,000 and over $1 million. Overall, the aggregate cost of physicians leaving to burnout is estimated to cost the United States $4.6 billion every year.

According to the authors, a potential mitigator of burnout was feeling valued by an individual's organization, which was strongly associated with a lower intention to reduce work hours or leave the practice. "[R]educing burnout and improving a sense of feeling valued may allow healthcare organizations to better maintain their workforces post-pandemic," the authors wrote.

How burnout-reduction programs can reduce turnover

One way health systems could prevent burnout and reduce high turnover rates, particularly among nurses, may be through burnout-reduction programs.

In an analysis published in the Journal of Patient Safety, researchers from the University of Virginia Health System analyzed more than 20 separate studies to examine the cost of burnout-related turnover among nurses. Data from these studies was compiled into a Markov model, which is a probability forecasting model that was used to create hypothetical hospital scenarios.

Overall, the researchers found that hospitals without burnout-reduction programs spend an estimated $16,736 per nurse per year employed for burnout-related turnover. In comparison, hospitals with burnout-reduction programs—including wage increases, professional mobility, and learning and leadership opportunities—spent an estimated $11,592 per nurse per year employed, or around 30% less.

In addition, the researchers also found that nurses working at hospitals with burnout-reduction programs stayed at their jobs around 20% longer than nurses working at hospitals without such programs.

Jane Muir, an ED nurse and doctoral student at UVA's School of Nursing who led the study, pointed to the hard data. "There is an economic argument to be made for properly compensating and supporting nurses."

To address the issue of high turnover rates, the study authors recommended hospitals be proactive in supporting programs to reduce burnout among nurses.

According to Muir, organizations could improve the way they address burnout by assessing and tracking nurse burnout during exit interviews. "[H]ospitals that don't track this data do so at their economic peril, given the expense of hiring travel or contract nurses to fill staffing gaps," she said.

Muir added that health care organizations that routinely assess burnout will be able to adjust salaries, bonuses, well-being programs, and professional development practices to anticipate and prevent high nursing turnover.

"An important way to get hospitals to invest in making the environment more sustainable for nurses is to quantify how cost-effective it is to retain them," Muir said. "If you're not shedding light on the economics of this issue, you're being complacent to the value of what nurses bring and if they're being compensated.”(Gooch, Becker's Hospital Review, 12/16; Sinsky et al., Mayo Clinic Proceedings, 12/15; Gooch, Becker's Hospital Review, 12/15; Muir et al., Journal of Patient Safety, 10/13; Kueter, UVAToday, 12/14)