How Hospitals and Medical Practices Are Helping To Reduce Physician and Healthcare Worker Burnout
An Interview With Jake Frankel
As published by Authority Magazine
One is organizing daily operations and building schedules that optimize efficiency. They can also create support groups and work buddy systems that can serve as an outlet for staff frustrations and a forum to discuss conflicts and challenges. It is also important to encourage nurses to take breaks and time for themselves. So, for example, hospitals could introduce a mandatory vacation day policy with a quarterly check to make sure their staff is taking the time they need to recover from work.
The pandemic was hard on all of us. But statistics have shown that the pressures of the pandemic may have hit physicians and healthcare workers the hardest. While employment is starting to return to pre-pandemic levels generally, the healthcare sector is lagging behind with a significant percentage of healthcare workers not returning to work. This is one of the factors that is causing a shortage of doctors. Some experts say that the US may soon be short almost 124,000 physicians. (See here for example)
What are hospitals and medical practices doing to help ease the extreme mental strain of doctors and healthcare workers? What are hospitals and medical practices doing to help solve the scourge of physician and healthcare worker burnout?
To address these questions, we are talking to hospital administrators, medical clinic executives, medical school experts, and experienced physicians who can share stories and insights from their experience about “How Hospitals and Medical Practices Are Helping To Reduce Physician and Healthcare Worker Burnout”. As a part of this series, I had the pleasure of interviewing Dr. Sarah Cartwright.
Dr. Sarah M. I. Cartwright is the Executive Director for the School of Nursing at the University of St. Augustine for Health Sciences, encompassing the Master of Science in Nursing, Doctor of Nursing Practice (DNP) and Post-Graduate Nursing Certificate programs. She is a highly dedicated nursing professional with a passion for advanced education, professional development, data analytics, and quality and outcome assessment, with a clinical focus in PeriAnesthesia nursing.
Thank you so much for joining us in this interview series! I know that you are a very busy person. Before we dive into the main focus of our interview, our readers would love to “get to know you” a bit better. Can you tell us a bit about your childhood backstory?
I was fortunate to grow up in a large family. My father is a retired United States Army veteran with a career focus as a physician assistant, and my mother is an educator. I am the oldest of five sisters. We were all inspired by our parents to be avid readers and learners, and to take advantage of wherever we were stationed across the globe. As a teenager, I was diagnosed with cancer and at 14 became a survivor. Going through treatment, I saw firsthand how interprofessional collaborative practice, especially in an academic setting, makes a difference in health and wellness. This experience is a core memory that influenced my career path. As a young child I wanted to be a teacher, but after being a medical patient for so long, I knew my calling was to pursue nursing, so I could be a part of another’s healing journey.
What or who inspired you to pursue your career? We’d love to hear the story.
I began working to become an RN at 17 years old. I was a little overwhelmed during those first days, but they sparked my love of lifelong learning. One of the benefits of nursing, as with any other healthcare-focused profession, is that you are always learning! After many years of bedside and administrative roles in a large academic health system — where I was able to focus on validating and improving the patient experience through collaboration with interprofessional colleagues — I felt called to more formally share my experience with the next generation of healthcare leaders. Educating medical residents, graduate nursing students, and graduate health science students in leadership, informatics, quality and patient safety, and evidence-based scholarly practice was a natural fit. To this day, I find these teaching experiences give back as much to me as I give to students’ skills and practice. So, the opportunity to evolve as a leader in the academic space coupled nicely with the skills I honed in clinical practice.
What are some of the most interesting or exciting projects you are working on now? How do you think that might help people?
As a program, we have successfully taken advanced practice nurses from students to practitioners specializing in family practice and psychiatric mental health. These practitioners help close the access gap found in primary care among various populations. They promote public health across the lifespan by serving communities across the country, from the urban to the rural, from the affluent to the vulnerable, and everywhere in between. Our student body is diverse, and they enter practice in their communities — serving patient needs in their hometowns.
Our Doctor of Nursing Practice students focus on reducing health disparities driven by social factors. They have successfully led projects to improve access and outcomes in emergency rooms, urgent care centers, primary care centers, and care coordination between acute and long term care. Impactful projects with our partners in Veteran Affairs hospitals and clinics have led to new national protocols for improving access to colorectal screening for spinal cord injury patients, and for improving the oral health of veterans. National policy review projects have led to policy briefs on autonomous practice for nurse practitioners, and we are in international discussions to develop toolkits for implementing best practices in underserved areas. Our ultimate goal is to improve the health and wellness of our nation through the advancement of nursing practice, and we are doing so one student at a time across the U.S.
You are a successful leader. Which three character traits do you think were most instrumental to your success? Can you please share a story or example for each?
Three character traits that have been most instrumental to my success are lifelong learning, effective communication, and willingness to change. Healthcare is always evolving through new technologies, guidelines, therapies, and policies. As we move forward, we must understand the new paradigms, and that is where being a lifelong learner is key. What you understood yesterday carries forward to inform and influence tomorrow, but tomorrow’s landscape will be different. This requires the need to learn and understand new perspectives, exchange information in a manner that has forward momentum, and be willing to adapt to the new environment. We must understand where we have been to plan for where we want to go; that journey requires us to listen, understand, plan, and execute the new pathways. It can feel overwhelming and stressful, especially when there is a lack of clarity. I have found the best way to capitalize on the character traits I’ve mentioned is to be an active part of a team, so you have people to learn from, listen to, and work alongside when you have to make changes or overcome difficulties. Healthcare is a team function. No one can do it alone! Without diverse perspectives, shared experiences, and interprofessional collaboration we all are less.
Ok, thank you for all of that. Let’s now shift to the main focus of our interview about minimizing medical burnout. Let’s begin with a basic definition of terms so that all of us are on the same page. How do you define “Physician and Healthcare Worker Burnout”? Does it just mean poor job satisfaction? Can you explain?
At The University of St. Augustine for Health Sciences (USAHS), we describe physician and healthcare worker burnout, specifically nurse burnout, as “the state of mental, physical, and emotional exhaustion caused by sustained work-related stressors such as long hours, the pressure of quick decision-making, and the strain of caring for patients who may have poor outcomes.” At the end of the day, no job is stress-free. But nurses work in an environment that is exceptionally high-stress by nature, which can lead to the exhaustion we know as “burnout”.
How would you define or describe the opposite of burnout?
For consistency with the definition of burnout I’ve given above, I would define its opposite by saying those who do not face burnout are comfortable and satisfied in their work environment. They have found a pleasant balance between their work life and mental health. When nursing professionals find this balance, they are able to take time to think, which ultimately leads to better care for patients and themselves.
From your experience, perspective, or research, what are the main causes of Physician and Healthcare Worker Burnout?
Nurses face several headwinds, factors that cause burnout, that prevent them from getting the opportunity for growth in the profession. One is the increase in labor. According to The U.S. Bureau of Labor Statistics, employment of registered nurses is projected to grow six percent from 2022 to 2032, faster than the average for all occupations. While this is good news for aspiring nurses, the pace of this increase could lead to understaffed hospitals, overworked nurses, and nurse burnout.
Second, lack of sleep. One of the largest burnout risks for professionals in any industry is chronic lack of sleep, and this is particularly common for nurses who work long hours and consecutive shifts.
Third, being in a high-stress environment. Every nursing specialty brings its own challenges, but some specialties are naturally more stressful than others.
Fourth, lack of support. If your workplace lacks a culture of good teamwork and collaborative practices, burnout is likely more prevalent there.
Lastly, emotional strain from patient care. Patient care is one of the most rewarding aspects of nursing, as you make connections with patients and feel the satisfaction of helping them get better. But if you work in critical or end-of-life care, the emotional toll of dealing with lower recovery and higher mortality rates can lead to increased rates of burnout.
Have you seen burnout impact your own organization? Can you give a first hand description of how burnout can impact the operations of an organization?
Burnout can impact organizations in many ways. However, I have noticed that when nursing professionals have the capacity to work to the highest level of their practice, as informed by advanced education, they are better-equipped to succeed in the workforce and can therefore help remedy the ongoing labor shortage within the nursing profession. This is evidenced at the bedside — where leaders are moving beyond task management to interprofessional practice — and in the community, where advanced practice nurses fill the access and care gaps, especially in underserved and vulnerable populations.
Does your practice currently offer any mental health resources for providers or clinical staff? We’d love to hear about it.
Having access to mental health services for medical professionals is extremely helpful as they navigate both their personal and professional lives. One way to achieve this is for medical professionals to connect with psychiatric-mental health nurse practitioners who are specially trained to provide cognitive care through assessment, diagnosis, education, and treatment. Psychiatric-mental health nurse practitioners fulfill a vital role, but this role requires extensive academic and professional experience. USAHS is helping to increase access to these specialists within the industry by offering a robust selection of nursing programs.
In my work I have found that streamlining operational efficiency with digital transformation and automated processes helps to ease the workload of providers and clinical staff. Has that been your experience as well? Do you think that streamlining operational efficiency can be one of the tools to minimize medical burnout? We’d love to hear your perspective.
Having strong operational skills, and instituting efficient processes, will allow you to oversee daily operations and staff schedules without putting your fellow nurses at risk of burnout from overwork or emotional strain. Acquiring this level of operational expertise requires both experience and education. As I mentioned earlier, attaining a higher level of training will allow nursing leaders and professionals to succeed in the healthcare environment and fight burnout.
Can you share five things that hospitals and medical practices can do to reduce physician and healthcare worker burnout?
There are many steps medical practices and hospitals can take to reduce burnout in the nursing industry. One is organizing daily operations and building schedules that optimize efficiency. They can also create support groups and work buddy systems that can serve as an outlet for staff frustrations and a forum to discuss conflicts and challenges. It is also important to encourage nurses to take breaks and time for themselves. So, for example, hospitals could introduce a mandatory vacation day policy with a quarterly check to make sure their staff is taking the time they need to recover from work. They should also educate nurses on coping skills to use when they are stressed. Methods such as breathing techniques, restorative exercise, journaling, and a post-work relaxation routine can make a big difference in your physical and mental health and well-being. Lastly, if a staff member finds their current specialty too stressful, the hospital or practice should encourage them to make a change. For example, they could become a family nurse practitioner, which would give them more autonomy in their practice. Earning your graduate nursing degree, such as a Master of Science in Nursing or Doctor of Nursing Practice, can enable you to switch to a specialty that’s a better fit.
What can concerned friends, colleagues, and life partners do to help someone they care about reverse burnout?
Concerned friends, colleagues, and life partners of a nurse experiencing burnout can help a lot just by being there. Give them a support system to lean on and allow them to be heard. Also, check in with them regularly. Reaching out and letting them know that you are thinking about them provides the comfort and reassurance they might be looking for.
What are a few of the most common mistakes you have seen people make when they try to reverse burnout in themselves or others? What can they do to avoid those mistakes?
Nurses can experience extreme stress in their field, so they may try to move to a different specialty to reverse burnout. However, this can often be a challenging process and even a cause of further stress. It is important to note how much easier earning a graduate nursing degree can make it to switch to a specialty that’s a better fit for your ultimate career goals.
It has been said that our mistakes are our greatest teachers. Can you share the funniest or most interesting mistake that occurred to you in the course of your career? What lesson or take away did you learn from that?
Looking back over three decades, I have to admit there have been times that I have made mistakes, as we all have. Here’s a funny one. A few years ago I was finishing a draft of a report for quality metrics, and while preparing to send the report, I took a phone call from my daughter, who asked for a recipe file for cupcakes for a school fundraiser. I was multitasking, and the result was that I sent that cupcake recipe to the quality committee instead of the report. I immediately noticed what I did — just as I hit “Send.” Needless to say, I was embarrassed! I apologized, and in the end no harm was done, but I did learn a valuable lesson about being present in the moment, whether you’re completing a task, writing an email, or having a conversation with someone. There are so many calls for our attention that to be present requires us to spend energy, but it is well worth it. You’ll find that having moments where you block out the noise can help with stress management, too, and they allow you to balance the calls for your time in a more meaningful way.
Can you share your favorite “Life Lesson Quote”? Why does that resonate with you so much?
To paraphrase a quote I first heard almost two decades ago that was shared by Marla Cilley, you’re not behind, don’t try to catch up! Just start where you are and continue to move towards your goals! This really spoke to me then and still does, because some days a growing to-do list can start to feel oppressive. Agility is a skill, you can practice it daily, and when you start to jump into your daily endeavors enthusiastically, wherever you are, it can truly change your perspective for the better.
Ok, we are nearly done. Because of your role, you are a person of significant influence. If you could inspire a movement that would bring the most amount of good for the greatest number of people, what would that be? You never know what your idea can trigger.
If I could inspire a movement as a leader, it would be to challenge each professional — in nursing and all health care disciplines — to find their voice to advocate for their patients and their practice. The best way to inspire is to speak up: share perspectives of what is happening in your community, in your practice, and in your family. We all have the experience of being humans who need health care, but our individual experiences are not the same. Being heard, and making a small change that leads to a bigger change, are the things that prevent burnout and rejuvenate the passion that led you to practice to begin with.
How can our readers further follow your work online?
You can reach me on LinkedIn, and check out other exciting work happening at The University of St. Augustine for Health Sciences (USAHS)!
This was truly meaningful! Thank you so much for your time and for sharing your expertise!
