I recently read this article, “These warning signs are tied to nurses leaving hospitals” from Chief Healthcare Executive. Before I read it, I will be honest and thought I knew what I would read.

I thought I would see more emphasis on finding resilience, hardiness, and/or self-care as recommendations for how to address nurses leaving the bedside. Such recommendations do have a place at the individual level. However, I am one of those nurses that left the hospital after 3.5 years at the bedside.

I never went into nursing expecting to not work at a hospital. I only knew of that path at the time I entered nursing school and the profession. (Keep in mind, I was in school before the internet connected everyone to show what else one can do in the nursing profession).

I remember feeling as though it was just becoming too hard to manage all of the inefficiencies as an individual day after day while keeping the lives front of mind of the young children I cared for across the United States. “Why is this so hard?” I remember asking myself day after day. None of my other coworkers seemed to be as affected by the system challenges I found unnecessary each day at such a young age and point in my career.

I could not articulate it then but I can see now why I found it so hard. I was one person working within a system. We place so much pressure on the individual nurse to “do it all” and “find a way”. Take one more patient, one more admission, or one more discharge and do it within the timeframe of the 12 hour shift. Time is finite. To add more is to speed up or eliminate some aspects that would otherwise be done.

Then I found my way into the IT department as a clinical analyst. The entire structure was different at that time. Each person worked as part of a team with a set number of projects. Our capacity (amount that we could do each week) was measured by our managers. Projects were only taken on when there was capacity to develop and build the project. This opened my eyes that there are other ways to manage responsibilities and workload. I did not need to feel as though I had the world on my shoulders each day.

In this article, Claire Zangerle, CEO of the American Organization for Nursing Leadership (AONL) offers some insights I agree with and have expressed for years…

“It’s not because our nurses don’t want to solve the problem. It’s not an individual accountability problem. It’s not a work ethic issue of an individual. It is a system that hasn’t come together well… to fix the problem.”

The article continues on to share some potential warning signs for leaders to look for in nurses who may be at risk of leaving. These include: staying late, skipping breaks and refusing vacation days.

However, beyond these factors, Zangerle shares that the work environment needs to be invested in further: “What we can control is how we manage the work streams, the environment that our nurses are working in.”

So much time is lost in the process of preparing for something one needs to do in direct care. Just a few examples of this include:

• Finding bed linens when the linen cart is empty
• Preparing medications only to find one is missing and the nurse needs to call pharmacy
• Finding an IV Pump or Pole to hang a fluid bag
• Finding a syringe pump to hang an infusion medication
• Finding a wheelchair to transport a patient to radiology
• Returning the missed call (or calls) because you were in another patient’s room
• Trying to deliver medications for multiple patients all due at 8 am

These are just a few that quickly came to mind. There are so many others. However, just from this list, you can see how these ‘time sink’ activities are largely outside of the control of the individual nurse. Each one of these could be evaluated for system level improvements and new operational workflows.

Beyond identifying the operational workflows for improvement, is a need to revisit how we look at the environment and lead in a proactive way.

In a place where there is pressure to add more technology, it is critical that we as a profession understand where and how technology can support us, add value and give us back some time to deliver the human care that the patients depend upon. Otherwise, we will continue to cycle through burnout and see more ways that nurses workaround the operational inefficiencies outside of their individual control.

~ Dr. Kelley

Tiffany Kelley PhD MBA RN NI-BC FNAP FAAN