Burnout in nursing home staff has been a hot-button topic for years, but despite the spotlight, providers still need better tactics to diagnose and systematically address the issue in their buildings.
That message — published this week in an in-depth report by the American Association of Post-Acute Care Nursing — came with a three-part plan for addressing the negative impacts of burnout, compassion fatigue and moral injury in nursing homes.
With worker recruitment and retention taking center stage across the country, the advisory couldn’t come at a better time, experts note.
Providers first need to be able to properly diagnose and distinguish between those three key harms, according to Patricia McGaffigan, RN, senior advisor for safety at the Institute for Healthcare Improvement.
She said that there is an “inextricable link” between the well-being of nursing home staff and the care they provide for residents.
“Nonphysical harms to the workforce are frequent, and while it doesn’t take a highly complex approach to protect the workforce from nonphysical harm, we need leaders, managers, and staff who are able to discern and accurately diagnose these harms to ensure that our interventions are appropriate,” McGaffigan wrote. “If we don’t get the diagnosis right, we’ll continue to have these same conversations one year or five years from now.”
The three problems stem from different causes and require different solutions, she explained.
For example, “burnout” is often used as an umbrella term, but should refer specifically to the mental harm caused by sustained workplace stress. That stands in contrast to moral injury — distress from being forced to act in ways staff are uncomfortable with due to time constraints, regulations, policies, etc. — and compassion fatigue (stress arising from complicated relationships and difficult care situations).
Compassion fatigue is particularly common in skilled nursing settings, McGaffigan said, since care workers are often working and forming relationships with high-acuity patients over a long span of time.
Diagnosis and systemic changes
Once these distinctions are understood, the first step to successfully treating worker fatigue is to properly diagnose what harms staff may be experiencing.
That process should involve a high level of direct connection between nursing home leadership and staff, McGaffigan emphasized. Leaders should survey staff, ask what makes a fulfilling day of work and, critically, invite staff to contribute to the process of finding solutions.
It’s vital to be proactive, to not shy away from directly connecting with frontline staff and to prioritize acting quickly.
“This approach can be amplified in leadership rounds and even in basic techniques, such as stay interviews,” McGaffigan wrote, “to help understand what keeps people attached to their jobs and illuminate some opportunities to act a little bit sooner.”
That staff involvement can help drive a successful part two: implementing systemic changes to address burnout and other harms.
While McGaffigan spoke positively of providing self-care tools and supports, she stressed repeatedly that broader change is necessary as well — and should be targeted at each of the three types of harm discussed.
Burnout, for example, is best addressed by cutting out unnecessary tasks, by ensuring that duties are spread fairly among staff and by employing similar interventions that directly impact daily workflow. Compassion fatigue, meanwhile, may also be eased by spreading difficult care tasks equitably around staff, but it likely also requires more peer-to-peer support.
Moral injury might require the provision of mental health resources for staff, interviews to determine what policies and practices might be able to be changed to resolve moral conflicts and, in general, empathetic top managers who are willing to connect directly with workers.
“These dilemmas often result when the policies and procedures don’t necessarily match the realities of the care being provided in the facility,” McGaffigan explained.
Finally, she also urged providers to include these workforce wellness goals in their Quality Assurance and Performance Improvement programs.
“Workforce wellness should be the ongoing work of the organization,” she said. “This requires ongoing measurement, monitoring and evaluation to identify gaps and opportunities for improvement.”
