Several years into the pandemic and the ongoing staffing crisis, nurse burnout concerns still plague hospice and home health agencies. Their nursing staff continue to feel the pinch of heavy workloads and understaffing. Hospice and home health agencies must find a way to support fewer nurses with fewer resources. To help reduce burnout, agencies can outsource after-hours calls.
Survey says
An American Nurses Foundation survey in its second year measures the pandemic’s impact on nurses. Part Two’s findings were released in 2022 and included questions on mental health and well-being, major contributors to nurse burnout concerns. The study found that “among respondents who say that their organization is experiencing a staffing shortage (89%), more than half (53%) say that it is a serious problem. In addition, younger nurses are increasingly leaving their current positions and roles. According to the survey findings, nurses ages 25-34 and 35-44 were more likely to change positions than nurses over age 55. Similarly, 60% of nurses under 25 and 57% ages 25-34 do not believe their organization cares about their well-being and generally feel unsupported.”
Hospice nursing is often meaningful work, and caring for patients and their families can be emotionally rewarding. However, studies are consistently showing that hospice nurses experience significant professional burnout. For example, a 2022 report from BerryDunn found that nurse turnover rates increased 28% from 2016 to 2020 (14.6% to 18.7%). The report also found one out of five hospice agencies experienced a nurse turnover rate exceeding 30%.
Researchers expect the current clinical shortage to grow in hospice through 2040. Expect the shortage to produce more demanding work for nurses in the field. Concurrently, researchers also found that workload and administrative demands contributed more to hospice worker burnout than witnessing dying and death. Workload and staffing ratios are among the top ten reasons nurses leave organizations.
The cycle of burnout
Unfortunately, burnout can be cyclical: burnout leads to staff shortages, and staff shortages lead to burnout. As a result, hospice and home health organizations often experience high turnover rates. This is one of the significant reasons you need to help reduce nurse burnout in your agency. Remember, the side effects of burnout can be costly, as nurse burnout can also lead to poor job performance and medical mistakes.
After-hours calls can also be a significant stressor for on-call nurses. Imagine that one of your nurses is with a patient and family during a home visit when another patient’s caregiver calls. If the nurse doesn’t take the call, they risk not helping someone in need. If the nurse does take the call, it can make the family at the home visit feel like they don’t have the nurse’s complete attention, affecting the experience of both the caller and the family at the home visit. It can also leave the nurse feeling like they didn’t serve either patient or family well –> more burnout.
Being on-call also has physiological consequences that lead to increased burnout and decreased engagement. For example, one study found that being on-call was associated with reduced energy levels, mood, and calmness. In addition, frequently being on-call can make it harder for nurses to recover from work.
Components of nurse burnout
Nurse burnout has three common components: emotional exhaustion, depersonalization and dissatisfaction. When nurses are telling you they are not just physically tired but somehow more than that, keep an eye out for emotional exhaustion. So, for example, if you hear that your nurses can’t find the motivation to get up and get moving, they may be suffering from emotional exhaustion. With depersonalization, nurses begin providing an impersonal or unfeeling response to patients. Their passion may have lost its spark. Finally, nurses may experience dissatisfaction with personal achievements, such as a lack of feeling competent and a loss of interest in usually enjoyable and fulfilling activities.
Pivot to a different strategy
Hospice and home health agencies must find a way to support fewer nurses with fewer resources. To help reduce burnout, agencies can outsource after-hours calls. In addition to relieving some of the burdens on current nurses, adopting outsourced triage can help to attract and retain top nursing talent, ending the burnout cycle. Nurse triage service also reduces extended hours for the organization’s nursing staff. New, reasonable work hours and a manageable workload often eliminate burnout-associated symptoms of fatigue and reduced enthusiasm.
An illustration of outsourcing:
- “Hand” your after-hours calls to a professional nurse triage team composed of licensed, registered nurses with years of experience in hospice care.
- Professional triage nurses address a large percentage of your organization’s after-hours patient calls.
- This allows your on-call staff to gain much-needed rest and recovery.
- Now, nurses are less stressed because they are not overwhelmed by phone calls while:
- trying to care for patients and
- performing all the other duties they face during their workday.
- This level of outsourced support can acknowledge and address other symptoms of burnout, such as feeling overworked and under-appreciated.
As the demand for skilled nurses continues to grow, the duties of a nurse will expand to include training other nurses. Outsourced nurse-first triage can help here as well. For example, removing the responsibilities of an already overburdened nurse significantly decreases burnout. These responsibilities often include:
- answering the phone
- training others on answering phones
- staffing an advice line
Bernadette Smith is vice president of marketing for IntellaTriage. In her role, she is responsible for marketing strategies and the coordination of marketing operations. Before joining IntellaTriage, Smith led marketing and communications at QIRT (now McBee Associates) and was most recently managing director of the LTC100 Intelligence Group at Lincoln Healthcare Leadership.
