From Vicious Cycle to Virtuous: How Combating Nurse Burnout Leads to Improved Healthcare

Adjusting nurse-to-patient ratios, improving work schedules, and increasing pay may seem like the best solutions for reducing nurse burnout. However, burnout is often the result of problems within systems that can be addressed only with a shift in workplace culture.

While some hospitals struggle to stay afloat, others manage to make progress. Learn how healthcare organizations can make the transition from a vicious cycle of nurse burnout to a virtuous cycle of continuous improvement.

According to a 2023 Press Ganey article, many healthcare organizations are struggling with various aspects of performance, including employee engagement, financial affairs, patient experience, and employee safety. Societal factors play a role in whether an organization is high- or low-performing.

Costs of medications and medical supplies and equipment have increased with inflation. Increases in patient acuity levels has led to rising labor costs. Hospital expenses increased 17.5% between 2019 and 2022.

Healthcare staffing shortages are ever-present and expected to worsen. Not only are nurses projected to leave the profession within the next few years, but 47% of all healthcare workers plan to leave their current roles by 2025.

The COVID-19 pandemic has placed a strain on healthcare facilities. The healthcare worker shortage has worsened since the beginning of the pandemic, and nurse burnout and workplace discrimination have increased.

Older adults are living longer due to healthcare advancements. By 2030, one in five people in the U.S. will be over age 65. By 2060, older adults will make up approximately 25% of the population.

These factors, among others, can lead to a burdened health system, resulting in a cycle of workplace burnout for many employees.

A vicious cycle occurs when areas of low performance result in limitations elsewhere in an organization. For example, frequent nurse turnover may result in a cycle of financial issues and poor patient experiences. A virtuous cycle occurs when areas of high performance drive improvement in other areas.

Nurse engagement is an area of performance that has been linked to burnout. A 2023 PRC research report showed that nurses who were engaged at work were less likely to experience burnout. The report also revealed that nurses who trusted their employers were more likely to be engaged.

“Organizations must make strategic decisions in how they think about employee engagement and experience, taking an approach that’s inherently more connected and human-centric,” wrote Chief Clinical Officer Jessica Dudley, MD, in the Press Ganey article.

Dudley, an expert in clinician burnout and leadership development, recommended a three-step strategy to stop the vicious cycle of employee burnout: Build trust, listen, and be transparent.

“When people perceive you as authentic (i.e., genuine and true to yourself), logical (exhibiting good judgment and competence), and empathetic (showing care and concern for them), they are more likely to trust you,” she wrote. “They’re also more likely to be empathetic toward you and/or the organization.”

When initiating workplace changes, organizations should be honest about the things they are unable to fix or need help fixing, and make it clear that everyone’s voice has been heard. Employees should be included in decision-making through surveys, interactive brainstorming, and individual feedback.

These strategies help to create an environment where employees feel comfortable speaking up. From here, an organization can nurture a virtuous cycle.

Moving from a vicious cycle to a virtuous cycle in healthcare benefits both nurses and patients. Nurses are supported in their provision of high-quality patient care and empowered to inspire change within the organization.

To foster a virtuous cycle of continuous improvement, organization leaders must:

Dudley’s strategy for moving from a vicious to virtuous cycle in healthcare can be used to help facilities address various challenges in nursing, for example new graduate nurse retention.

Approximately 18% of new graduate nurses leave the profession within the first year due to stress, lack of leadership and supervision, and understaffed facilities. New nurse exits can result in financial losses for hospitals and suboptimal patient experiences — a vicious cycle.

To move to a virtuous cycle of continuous improvement within a hospital, leaders can implement a series of facility-wide new graduate nurse feedback surveys to keep new nurses engaged and identify areas for improvement. New nurses can be encouraged to join performance improvement committees or meetings and give suggestions on how to improve the hospital’s new graduate nurse residency program. Leaders can establish peer support groups and mentorships for new nurses and provide leadership training for nurse preceptors.

In a vicious to virtuous cycle transition, changing the workplace culture at a foundational level ensures that improvements in one system automatically lead to improvements in others. When nurses are respected, listened to, supported, and empowered in their roles, they can serve as valuable change agents within organizations to tackle burnout and other barriers to healthcare improvement.