Nurse managers' 4-day workweeks: How it's going at Mount Sinai

In fall 2022, New York City-based Mount Sinai Health System launched its four-day workweek program for nurse managers. More than a year later, the program continues to improve staff engagement, satisfaction and has become an important retention strategy, Beth Oliver, DNP, RN, chief nurse executive for the system, told Becker's.

Dr. Oliver added, experienced nurse managers play a critically vital role in supporting staff retention and engagement, championing organizational culture, and ensuring quality and safety of patient care.

"It's the nurse manager that retains our staff," Frances Cartwright, PhD, RN, vice president of nursing at Mount Sinai Health System Oncology Services, told Becker's. "Our recent Your Voice Counts survey revealed that nurse managers were most at risk for burnout, and while the majority reported that they found great meaning in the work they do, they also found it difficult to decompress when they were home. When I collaborated with our system nursing leadership and examined the literature, it became obvious that a four-day, 10 hour workweek would go a long way in supporting their work-life balance."

Although nurse managers may typically be scheduled to work five days a week, they can end up working more due to being on call. Giving managers the ability to completely disconnect was one of the aspects built into the four-day workweek at Mount Sinai. Each manager works four 10-hour days and has one day completely away from work responsibilities. That day is covered by another manager. The program also ensures there is a manager presence on the unit on both the morning and night shifts and at the change of shift.

"What we are learning is that nurse managers are able to be present and support best practice aligned with efficient workflows to advance safety, quality and coordination of care," Dr. Cartwright said. "Nurses feel supported on both shifts. The nurse managers are very vigilant about scheduling the four days to ensure the units are covered as needed. Nurse managers have the option to work five days, and some managers prefer that schedule because they feel like they cannot complete all their work in only four."

The new schedule was launched systemwide across more than 100 units and practices. The four-day workweek has improved employee engagement and the culture of safety for nurse leaders and nurses, Dr. Cartwright and Dr. Oliver said, who added that the program has received overwhelmingly positive feedback. The system's turnover rate for registered nurses is currently 17% and the vacancy rate is 7%, compared to the national rates of 22.5% and 15.7% respectively. 

Other systems are considering four-day workweeks for managers as part of their efforts to support nurse leaders.

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