Healthcare workers have left their roles or profession altogether in droves amid the challenges of the COVID-19 pandemic.
In many cases, workers cite burnout as a contributing factor. A Medscape poll of 10,788 nurses conducted over the summer of 2021 found that at least 1 in 5 respondents in each nursing position category reported being very burned out or burned out.
Employers are turning to innovative solutions as a result. For example, "stay interviews" that focus on what motivates employees to continue working and what could improve about their experiences on the job have become more popular.
Becker's reached out to executives from health systems across the country to gain more insight about which changes are needed within the healthcare work environment to improve retention. Below are responses from 22 executives.
Editor's note: Responses were lightly edited for clarity and length.
Meredith Foxx, MSN, MBA, APRN. Executive CNO at Cleveland Clinic: "It's really important that we continue making fundamental changes in our care delivery models. The COVID-19 pandemic served as a catalyst for challenging many hospitals across the country to change the way they delivered care. We must provide care that is centered on the patient, with the team collaborating and sharing responsibility. We need to be flexible and ensure we have resources in place to support our caregivers’ success both at work and outside of work."
Theresa Brodrick, PhD, RN. Network Chief Nurse Executive at Hackensack Meridian Health (Edison, N.J.): A healthy practice environment must support shared decision-making and allow the voice of the nurse and other patient care providers to influence policy and practice. Organizations must create a structure that empowers nurses at all levels to have a voice in decision-making, encouraging diverse and creative input to advance their professional practice. Such collaboration contributes to the achievement of outstanding organizational outcomes, which includes the attraction and retention of outstanding nurses and other healthcare professionals.
Lewis Marshall, MD. CMO at NYC Health+Hospitals (New York City): Work in the healthcare industry has become a job. It used to be a calling; people got personal satisfaction from helping others. This includes all healthcare workers — pre-hospital care, building services, support staff, nursing and providers. We need to bring back joy and satisfaction in healthcare to recruit and retain people. It’s about people. It’s about respecting and acknowledging them for the dedication and commitment to the patients in some of the most dire circumstances. Instead of recognizing them for the sacrifice, we ask them to do more without more resources. Healthcare is spread way too thin.
We use the term "ancillary" to describe staff that are not direct caregivers. This term is not respectful. We should be calling all staff "essential" staff. Just try to get a blood test result without the lab technician. Respect and recognition will go a long way to helping us feel like we are valued. Recognize individuals for that good catch, or clinical units for reaching zero catheter associated urinary tract infections. Our facility began issuing "zero certificates" to units for achieving zero harm. The certificate is presented to the unit by the chief medical officer and the chief nursing officer. Make work more enticing to the staff, be flexible with scheduling, and share positions between people to allow for work-life balance. Maybe the term should be work-life synergy, finding that sweet spot.
While increasing salaries is always a welcome thing, it doesn’t address the overstretching of our staff, the burnout or the stress. We found that during the pandemic, paying enhanced sessional rates to entice staff to do additional shifts only added to the feeling of burnout. After doing the additional shift for the enhanced rate, staff would then have to call out the next shift due to exhaustion. Joy and satisfaction are what will bring and keep people in healthcare. This change must be brought about by our healthcare leaders. Leaders must set the example.
Joe Gage. Chief Human Resources Officer at Bon Secours Mercy Health (Cincinnati): Healthcare isn't just a job, it’s a calling, a purpose. It is imperative that we also provide resources to help associates thrive — flexible schedules, psychological well-being, career growth and meaningful work.
At Bon Secours Mercy Health, our vision is to be a ministry where people want to work and clinicians want to practice. We cultivate a strong alignment between the ministry’s mission and our personal calling. As we grow, we want to empower each associate to do meaningful work at the top of their license at an organization that provides forward-thinking, digitally enabled, agile, mission-driven work. And we are expanding resources to help associates thrive — flexible schedules, resources for psychological well-being and free education paths for career growth to enable a sustainable career in our ministry.
Jeffrey Katz, MD. CMO at Memorial Hermann Health System (Houston): In order to meet the needs of the new world in healthcare, old, rigid, out-of-date criteria used by human resource experts needs to be abandoned in favor of new, more relevant and actionable approaches. The educational qualifications are less important than the actual experience of the candidates. And the actual experiences of the candidates are, in turn, less important than the will or enthusiasm of the candidate. I see many candidates put aside because their CV does not meet standards established for good reason once, but now way out-of-date and not conducive to current worker availability. Let's hire people who want to do the work and are willing, available and able to learn some skill outside of their education but with evidence of decency, honesty, a good work ethic and the judgment and intelligence to pick it up.
Cheryl Nester Wolfe, RN. CEO at Salem (Ore.) Health Hospitals & Clinics: The first thing that came to my mind was an inclusive culture. And inclusive on a lot of different levels — not just from a diversity perspective, but also inclusive in decision-making and the feeling that you can come to work every day and do your very best for patients.
We need to make changes at all levels of the organization, and that's the work we've been doing. We're a Magnet organization. We have been since 2010. We've been redesignated three times now. And the whole basis of that is staff empowerment and staff control of decision-making when it comes to their ability to be able to improve care and take care of their patients. The journey continues to achieve that work environment, whether you're a nurse or you're in a different discipline in the organization.
Our current journey has more of the diversity influence, and we're making sure that all members of our team feel valued in the culture. It's been a journey that we've been on for quite a while. I think the basis of it is people who want to come to work and stay at work, as well as feel able to be gratified by the work that they do and to make the needed changes to take care of people in the most effective way.
Tony Reed, MD, PhD. CMO at Temple University Health System (Philadelphia): We need improved teamwork within and across all disciplines in all professions. As an industry, we are getting much better at working in collaborative, interprofessional teams. Clusters of infighting and isolationism still exist, however. And we must commit to the elimination of silos, feudalism and random acts of microaggressions against our peers and colleagues.
Michael Sloan. Vice President of Human Resources at CommonSpirit Health (Chicago): A current priority around hiring and retaining staff is expanding our wellness programs that incorporate specific services that address burnout, acknowledges staff's hard work, creates a healthy work environment and moves toward the mental toll the pandemic has brought on our healthcare workers.
In addition, we need to offer flexibility and think about how the work that is currently being done can be done another way. This could include: reducing nonclinical tasks, fostering a better sense of teamwork between front-line caregivers and ancillary service lines, and offering opportunities to staff who want to grow in their current roles or in other roles.
Karan Singh, MD. CMO at San Gorgonio Memorial Hospital (Banning, Calif.): We need to engage our clinical staff and provide a platform where they can not only share their experience of being on the front lines, but also provide us with their insight into solving the problems. Sometimes as leaders, we can discuss issues affecting our organization in an insulated vacuum and be disconnected from the challenges faced by our clinical staff every single day. As I continue to have conversations with my clinical colleagues all across the country, it is clear that a lack of autonomy and clinician empowerment is the shared theme resulting in burnout and eventual resignations. As healthcare leaders, we must empathize with our clinical colleagues and allow them to drive important decisions surrounding the practice of medicine at their respective organizations.
Vincent Barba. MD. CMO at Matheny Medical and Educational Center (Peapack, N.J.): I think we, as leaders, need to build an open, just culture in our hospitals in which all our colleagues feel safe and confident in speaking up about patient and staff safety issues and events at all times. This will go a long way to restoring joy and meaning to our work in the healing arts.
Aaron George, DO. CMO at Meritus Health (Hagerstown, Md.): Certainly, every healthcare organization is working on those traditional workforce practices that we see as impactful to recruitment, retention and culture — money, benefits, bonuses, scheduling flexibility and well-being. The reality is that we must do them all, because they demonstrate a level of commitment. But the truth is that these necessary investments really only get you a seat at the table. The key to the future is continually connecting back to the "why." Workers show up for money, and are just as quick to leave for more money. Team members stay because they feel a calling. Each healthcare system uses different words to articulate their mission, but among them all our goals are incredibly similar: to ingrain a purpose for patient care and to elevate above all the primary goal of improving health and life.
At Meritus Health, our mission is to improve the health status of our region by providing comprehensive health services to patients and families. Thus, the fundamental workplace culture is found in ensuring that people show up to work because they believe in that mission. That somehow, they tie the sum of all of their actions, encounters and work back to the core of improving lives. Not just any lives, the lives of their neighbors. Every person we care for we must feel a connection with. Then, we need to relate that connection to our larger reason for existence in our community.
This has become challenging, even in the front lines of healthcare among our overcrowded emergency departments and overwhelmed critical care units. It is even harder to inspire such culture in a way that our environmental services teams, finance departments and other integral areas feel that their work truly changes lives. And it does, even if the ripples of their efforts are not so easily felt from behind office doors, through keystrokes on a computer or clearing a sidewalk on a snowy day. But we must make and integrate those connections, reinforcing that we are all in the business of caring for people, caring for each other. At the organizational level, instilling this culture comes from recognition of our workforce and from celebration of patient and community health outcomes.
Juli Johnson, MSN, RN. Chief Nursing Executive at Parkview Health (Fort Wayne, Ind.): I think a workplace culture of ownership is key. Several years ago, we established a shared governance model that put nurses at the table on discussions from bedside to boardroom. While the past two years have presented challenges, our belief in our front-line team has only grown stronger. It’s more important than ever to listen to them, hear what's meaningful to them and make the necessary changes to continue providing high-quality care for our patients no matter what the circumstances. Being valued for their contributions to, and ownership in, our care environment can be a powerful satisfaction for nurses who have had to dig deep during the pandemic.
Paula Pritzl. Director of Employee Relations at Marshfield (Wis.) Clinic Health System: I believe the key to recruit workers to join and/or stay in healthcare is their "why" — their onboarding experience and engagement. People gravitate toward healthcare for a variety of reasons, but primarily to care for others, to make a difference in their healthcare throughout their cycle of life, and to make a difference in the delivery room, the surgical suite, a hospital stay, traumatic events and end-of-life care. As leaders in the organization, it is imperative that we develop and implement tools to incorporate and sustain engagement, feed their why, and onboard to foster a sense of belonging and collaboration. This is a journey, not a race.
Engagement needs to be incorporated into our everyday workflow and not viewed as just another added task. Engagement tools do not have to cost a significant amount of money, but rather begin with core elements of gratitude, belonging and kindness. Beyond the execution of tasks and projects, we need to ensure leaders have time to dedicate to fostering relationships, addressing staffing challenges, actually listening and responding to the needs of their teams. We encourage managers to look at quick wins.
By listening to staff, we can identify some pet peeves or roadblocks that can be removed in order for a more seamless delivery of care or determine something that can be provided as a token of appreciation for the staff. A Keurig and K-cups can put a smile on just about any employee’s face.
Providing managers and leaders with tools through focused education and training is imperative to a successful engagement culture. Empower managers to make decisions in their respective areas with the intention of contributing to an increase in overall engagement for the entire system.
Accountability is also a critical factor through the engagement process. Rounding on staff is one of the most impactful minutes a manager or leader can make in a day. A lack of focus on people will lead to employees feeling as though they are on their own, without support or recognition, followed by a sense of not belonging. This can be contagious among teams and lead to decreased productivity and increased turnover.
Layton Anderson. Chief Human Resources Officer at Jefferson Regional Medical Center (Pine Bluff, Ark.): Working in healthcare has always been about purpose and feeling like you are making an impact on people’s lives, no matter what part of the organization you are in. That hasn’t disappeared, but it has become harder over the past couple of years. The pandemic has made it difficult for many in healthcare to feel like they are making an impact, as the sheer impact on the health of the country has been dramatic, and healthcare workers have seen it firsthand. Public sentiment toward healthcare workers has also had its ups and downs during this pandemic, which also has caused many to question if it is worth it.
The pressure in today's healthcare is to continue to do more with less. We are looked at like we are a manufacturing company and not like we are dealing with people’s lives at their most vulnerable. We need to create a culture where healthcare workers are able to have a quality of life and still purposeful work. We need to find a way in our culture to allow our workers to recharge so they can find their purpose and encourage, recruit and train the next generation of healthcare workers.
Ask most bedside nurses and other patient caregivers when was the last time they didn’t get called to come in to work an extra shift, asked to stay later or to have to make a choice between family or a prior commitment and work. I bet they can’t remember or can only remember one time. A better quality of work/life balance would keep people and attract them.
Scott Dimmick. Chief Human Resources Officer at Lakeland (Fla.) Regional Health: The healthcare industry can tend to have a culture that is considered to be formal, traditional, mechanistic, bureaucratic and maybe even a little stodgy a technical term for boring). This can be illustrated by how the leaders dress, the preferred communication styles, the pace of change, the structures, policies, committees and control mechanisms, to name a few.
Now enter the millennial generation into the workforce — but they are not only entering the workforce, they now represent the largest generation in the workforce, and they will make up the majority of the workforce within this decade. Not surprisingly, the millenials prefer workplace cultures that are almost the exact opposite of the current or historic healthcare industry culture. Thus, the main change we need to make is to ensure the millennial generation feels welcome, comfortable and actually attracted to a culture they can relate with.
Millennials value diversity and equality, empowerment, involvement (a respected voice in what is going on), flexibility (real flexibility, not just bid shifts), formal professional development with planned (guaranteed) career advancement, all things technology and mobile, and organic cultures with much less structure. The baby boomers have dominated the workplace for decades, but that is no longer the case. The workplace demographics have changed, and we need to complete our cultural transformations and embrace the values of our modern workforce.
John Tynes, MD. CMO at St. Joseph Hospital (Denver): I think that our biggest challenge is going to be to restore in our workers the sense that healthcare is a worthy calling. The past couple of years have demonstrated for all the world to see just how stressful it can be to be a healthcare worker, and many of our colleagues have unfortunately come to the conclusion that they are undervalued and underappreciated, or that they are just not making enough of a meaningful contribution to justify the risks and frustrations that they encounter every day. Additionally, these realizations have often played out in a very public way — on televisions, magazines, internet news feeds, blogs, etc., which has likely also scared away many who might have pursued one of the many roles that they could have filled in the industry.
It will require impassioned, articulate and active leadership to counter this trend. We need to find ways to guide our providers and staff back to the reasons that they got into healthcare in the first place, and to help them rediscover the fact that there is in fact no higher calling, and ultimately no better place to find a sense of purpose and value than in serving to restore and improve the health of our fellow men and women.
Sarah Horn, RN. Senior Vice President and Chief Nursing and Operations Officer at Salem (Ore.) Health Hospitals & Clinics: One word that comes to mind is self-value. I think the pandemic has highlighted the need for an increased investment in our workforce. Nursing itself is a very giving profession, and the central product that nurses deliver in the care they offer is themselves. But what they don't do is take care of themselves very well.
I think when it comes to nursing or any healthcare profession, we need to do a better job teaching them how to take care of themselves just as they do their patients. We bring empathy to what we do, but we don't bring empathy to ourselves, and the moral distress certain healthcare workers have faced has been pretty harsh, so I think it's important for us to learn how to encourage others to take care of themselves. There needs to be a heightened focus on that going forward.
James Heise, MD. CMO at Door County Medical Center (Sturgeon Bay, Wis.): We must create strong clinical-administrative dyad leadership structures so decisions made make sense from both the financial/operations perspective and from a clinical perspective. Tone-deaf decisions made by nonclinical leaders that directly affect bedside care teams (clinicians, nurses, techs) have a tendency to suck the life out of people working to directly care for patients. We’re very fortunate to have that here, and it lends itself to a vibrant culture committed to taking great care of our patients.
Alex MacLennan. Chief Human Resources Officer at Tahoe Forest Health System (Truckee, Calif.): We have to focus on pride. We must enhance the pride people feel for the great work they do. I meet with new employees in training, and the stories are countless of people who started their careers in healthcare because of a personal experience they had, such as a nurse who provided care to someone with a traumatic injury or a doctor that took the time to be compassionate and was moved by it. Many decided to push their careers because of those experiences.
The last two years have been a roller coaster of emotion and pride and have had high points, such as the public shouting thank you to the "healthcare heroes." Now those same people are frustrated, and some take it out on those same heroes. Culture demands that we focus on pride and trust with the public and allow joy to come back into the workplace after two exhausting years. There are many ways to enhance pride; one of the easiest is to express gratitude for what the employees are doing. Recognition is an important step and should be tailored to each employee. When employees are proud to come to work, getting through those challenging days is much easier.
Stephern Allison. Chief Human Resources Officer at Maimonides Medical Center (New York City): Healthcare workforce members are focused on taking care of others and often neglect themselves in the process. Self-care is a foreign concept, especially for those on the front lines. The pandemic highlighted the problem of burnout among the healthcare workforce that existed for quite some time but did not receive much attention until now.
Acknowledging burnout as a public health crisis is the first step in mitigating the loss of team members. This acknowledgment is a stepwise approach; it requires a cultural change that begins with policymakers and transcends to organization leaders.
Developing and implementing programs aimed at educating the workforce and providing resources for self-care, in addition to providing real-time access to support, are critical elements in reducing burnout. This would lead to a reduction in burnout and subsequently improve morale and retention within the industry. Additionally, having these programs in place will not only promote retention but lend to overall recruitment efforts.
Jim Keller, MD. CMO at Advocate Lutheran General Hospital (Park Ridge, Ill.): The change needs to be made both at the healthcare system and society level. We need to help our healthcare workers rediscover the meaning of their work while feeling appreciated in a safe environment.
Darcie Robran-Marquez, MD. Vice President of Population Health and CMO at Presbyterian Health Plan (Albuquerque, N.M.): Prioritizing and promoting a culture that focuses on self-care, resources and support for the healthcare workforce is critical. We know that healthcare workers are less likely to access the care they need despite feeling the constant effects of burnout and high stress levels. As healthcare leaders, we need to put programs in place that acknowledge the pressure and stress that our teams experience every day while providing practical support to help the workforce thrive.