Staff Burnout: Radical Changes to Address Radical Challenges

Starting in the 19th century, hospital spaces were arranged for the efficient delivery of care as medicine became process-oriented, sacrificing personal comfort, privacy and a patient’s control.

In the 1970s, people began to challenge process-oriented patient care and advocated for what was then a radical change to the healthcare industry. Organizations like Planetree enlisted healthcare systems to provide private rooms, which gave patients control of their environment and access to family. Now the norm, these changes dramatically raised the cost of construction for new hospitals. Nonetheless, the improvements to patient safety and well-being have been well worth it.

Today, the best new hospitals send a clear message that patients are human beings who deserve dignity and individualized care. But what do they say about the way we treat clinical staff? As we enter our third year of living with COVID-19, healthcare workers have all but reached their limits in what has become an endurance race. For many organizations, this overwhelming stress has caused crisis levels of turnover.

With the average cost of replacing a nurse clocking in at around *US $40,038, hospitals have been struggling to provide the best care while remaining in the black. Is it time for a new project like Planetree; a holistic approach that emphasizes staff well-being and not just safety and efficiency?

Whatever the approach, one thing is clear—clinical staff are in desperate need of a better workplace experience if hospitals expect to recruit and retain these vital frontline personnel.

Where to Start

Many healthcare organizations and designers have focused on staff safety and satisfaction long before COVID-19. The strategies employed typically fall into two categories:

  1. Stress Prevention—Design buildings to prevent as much staff stress as possible.
  2. Stress Mitigation—Develop strategies to mitigate the stress that will inevitably occur.

Stress Prevention

Nursing comes with a certain amount of physical, mental and emotional stress. In my observation of nurses working in a 1970s-era medical/surgical unit, long travel distances and corridors handling mixed supply, staff and family traffic both contributed to constant irritations and wasted time.

When designers plan new healthcare facilities, we study how to reduce travel distances by distributing and standardizing support rooms. Proper lighting, acoustics, adjustable ergonomic seating and the elimination of overhead paging can all contribute to a calmer atmosphere.

A more radical approach to stress prevention that our healthcare group borrowed from workplace designers is to utilize a flexible workplace design strategy to accommodate clinicians of different generations. For one of our recent projects, this involved a variety of open, closed, individual and group workspaces for charting that accommodated tablets, laptops and desktop computers, giving staff more personal choice. This strategy paid off during the pandemic since the multiple workstations allowed for social distancing and facilitated an easier transition to mobile health.

Stress Mitigation

Even with an ideal facility design and a supportive hospital administration, we must look for opportunities to help clinicians deal with stress. Every hospital provides staff break rooms, but are they convenient with appealing designs and access to natural light? Research not only links the positive effects of daylight and vistas to improved patient outcomes but also to reduced caregiver stress.

Another effective approach our healthcare group has implemented is to provide clinicians access to shaded, well-furnished outdoor respite areas. These spaces have been especially important during the pandemic as they allow staff to remove uncomfortable PPE and breathe fresh air “off-stage.” In one instance where outdoor space wasn’t available, we incorporated a river-rock floor into a hospital’s respite room, which allowed nurses to stand in sock feet and experience a tactile connection to nature.

Shifting the Paradigm

Stepping up efforts to curb staff stress and turnover will require shifting the spending paradigm to provide more staff amenities. With the construction cost of a new general hospital averaging up to US $625 per square foot, the cost of replacing two nurses could be used to pay for 140 square feet of staff amenities.

This represents just one example of how we think about the relative costs of assets, and makes a case for spending more money on spaces that enhance the work environment for clinical staff. As each percentage change in RN turnover will either cost or save the average hospital an additional *US $270,800 annually, this staggering figure must be carefully considered by healthcare organizations.

When historians study contemporary American hospitals, they will see that the patient experience was a high priority. But what will they say about how much we were willing to invest in protecting staff well-being? Only time will tell.

*From the 2021 NSI National Health Care Retention & RN Staffing Report

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