Burnout among psychiatric nurses is high. What can hospitals do to improve?
Improving staffing and the workplace environment can reduce burnout and turnover, the study found.
As a former psychiatric hospital nurse, Justinna Dixon knows what it’s like to feel passionate for a job and overwhelmed by it at the same time.
Dixon graduated from nursing school at the height of the COVID-19 pandemic, and threw herself into her work, caring for people struggling with mental health and addiction issues. But her new-nurse shine quickly dulled under the burden of long hours, high caseloads, and insufficient support.
Now a postdoctoral fellow at Penn Nursing’s Center for Health Outcomes and Policy Research, Dixon is studying the burnout she experienced. She hopes her work will help hospital systems better understand what contributes to burnout and what they can do to improve.
Two out of five inpatient psychiatric mental health registered nurses experience high burnout, according to Dixon’s latest study, published in July in the Journal of Psychiatric and Mental Health Nursing. The study, based on data from 740 registered nurses across 10 states, found that workplace improvements — such as increasing staffing — can help nurses feel more supported and provide better care.
Dixon spoke to The Inquirer about her research and experience as a nurse in an interview lightly edited for length and clarity.
What in your experience as a nurse made you want to study burnout?
I’m a Ph.D.-prepared registered nurse. After I finished my bachelor’s degree in nursing in 2020 from Rutgers University, I worked as an inpatient psychiatric registered nurse for two years. I worked within the same types of units that I talk about in this study. I have personally seen and even felt myself how, when we didn’t have enough leadership support and adequate staffing, it made the job much harder. It made me and my other fellow colleagues give worse care to our patients and made our patients suffer even more than they already were.
What were the study’s most significant findings?
One of the main takeaways is that 40% of current inpatient psychiatric nurses right now are burned out. One of the other takeaways: Staffing was a huge driver of these outcomes, the impact of the work environment on the poor job outcomes of the nurses.
Were you surprised by what you learned?
To be honest, I’m actually not struck by any of my findings, because I have lived it. Normally, on medical-surgical units in a general acute hospital, nurses are assigned around four to five patients to take care of for their shift.
I worked on a substance-abuse detox unit in a psychiatric hospital. In this unit, one of the most medically complex units in the psychiatric hospital, I was typically assigned around 10 to 12 patients. One time, we were very short-staffed and had a full house or an almost full house, and we had one patient who was just so sick from actively withdrawing. We were so overwhelmed with all the other patients on the unit, taking admissions on top of caring for our other patients, being short a nurse.
To be honest, we just couldn’t take care of him the way we wanted to, we couldn’t get him the medication he really needed to quell his uncomfortable symptoms. He was in a lot of distress, and he ended up getting so overwhelmed he threw a chair into our nursing station. It was terrifying for the nurses, but imagine how the other patients felt. It made us delay their care because now we have to deal with this situation, and they’re all sick, too.
What could hospitals do to reduce nurse burnout?
Nurse staffing is a very complex issue. But there are some things I think could move the needle. In the current system, hospitals are not financially incentivized to improve their staffing. Hospitals are typically able to bill individually for physicians or other prescribing provider services. But for registered nurses, there’s really no financial structure that allows hospitals to bill insurance companies to pay for a nurse’s contributions to patient care. Nurses are actually lumped in with hospitals’ overhead costs.
I think that a potential solution to incentivize hospitals to improve hiring is giving them a financial incentive to do so. Another thing that I think could really help is enlisting the public. As nurses, we try to advocate so much for our patients. But maybe we could let our patients advocate for us, too.
