How to build resilience and reduce nurse burnout through better care team communication

Sept. 14, 2018
Terry Zysk
Healthcare organizations today are making decisions motivated by two overriding imperatives: The need to cut costs and the need to improve care outcomes. Decreased reimbursements driven by value-based care and rising costs of care are shrinking already-small margins at U.S. hospitals. At the same time, the focus of healthcare is changing rapidly, from providing acute care to otherwise healthy people to managing chronic conditions and comorbidity in an aging population. Very often, those imperatives seem to be at odds. Nowhere is this clearer than on the front lines of patient care—in the nursing workforce.

Labor is the single biggest cost for hospitals, making it a large and obvious target for cost-cutting efforts. For nurse labor, that could include changing the skill mix, decreasing nurse-to-patient ratios, or finding opportunities to improve workflow efficiencies. While each of these strategies all have the potential for success, organizations employing them must also consider their potential to spread the nursing workforce too thin.
Many nurses feel they’ve already been stretched too far. Pulled between a commitment to excellent patient care and the perception that they can never keep up with increasing demand, 70% of nurses have experienced burnout, and nearly half have considered leaving the profession entirely.1 Rather than increasing efficiency, nursing burnout costs hospitals heavily:

  • Increased absenteeism, at an average of cost of $1,685 per employee per year
  • Higher rates of hospital-acquired infections, at an average cost of $768 per patient2
  • Higher rates of turnover, at an average cost of $90,000 per RN departure
Courtesy of LiveProcess

Nurse burnout can have several drivers: Too much work, difficult patients or coworkers, burdensome administrative tasks, frequent interruptions, and inadequate staffing levels. There’s another factor that doesn’t receive enough attention: Emotional burnout, caused by feeling isolated, undervalued, unsafe, or simply exhausted by the highs and lows of working with people at their most intense moments, good or bad.

Understanding and addressing burnout as a result of both emotional and physical labor is critical to building an environment in which nursing resilience can thrive. Because burnout and resilience are both holistic phenomena, affecting them takes a commitment to culture change.

Communication plays a central role healthcare culture change

Leadership icon Frances Hesselbein wrote, “Culture changes when the organization is transformed—the culture reflects the realities of people working together every day.” In other words, culture is defined by the way people interact. Changing the culture of an organization or a healthcare facility starts and continues with communication.
When the Advisory Board’s Nursing Executive Center interviewed nurses, nurse leaders, and hospital executives for their 2018 report “Rebuild the Foundation for a Resilient Workforce,” they discovered four key areas that threatened nursing resilience:

  • Frequent exposure to violence or threatening behavior
  • Perceptions of unsafe staffing levels
  • Lack of time to recover from traumatic patient experiences
  • Feeling isolated in a crowd due to care protocols and new technology

Among the most fascinating findings of the NEC’s interviews was the degree to which restoring or enhancing connections among nurses or between nurses and other staff was as important as addressing the stated problem.

For example, many nurse leaders and security professionals indicated in the NEC report that workplace violence in hospitals has been increasing over the last decade. From 2005 to 2014, the rate of reported incidents of violence against healthcare workers increased by 110%. Some hospitals have been increasing their security budgets accordingly, investing in metal detectors to keep out weapons and adding more security personnel. These changes could certainly prevent or mitigate unusual events like an active shooter, but for most nurses, the threat of violence more often arises during interactions with patients or their family members. Ameliorating their concerns required a different approach.

Hospitals found measurable success by finding ways to make connections between nurses and the appropriate personnel, through a variety of means, including formalized regular check-ins between security and the charge nurse, structured documentation, and sharing of risk areas at shift changes, and specialized codes to assemble the appropriate response team. Hospitals featured in the NEC report described specialized codes that could include a trained de-escalation team or behavioral health responders, as well as a more general code to bring security guards to prevent a tense or uncomfortable situation from developing into something more serious. As a result, nurses at these hospitals reported feeling safe on the job at rates of 75% to 95%.

The key to these improvements was improving care team communication. The strategies employed by these hospitals made communication easier, more frequent, more specific, and more structured. Nurses had access to the support they needed, and they were able to work as part of a larger care team to solve problems and care for patients appropriately. Better communication strategies also applied to the other issues named earlier:

Prioritizing investments in healthcare communication technology

As healthcare organizations face decisions about managing costs, they will face decisions about aligning new expenditures with maintaining the resilience of their workforce. The evidence is strong that a culture of nursing resilience depends on maintaining and enhancing connections. Enhanced healthcare communication technology can provide a strong foundation for those connections.

For example, in the case of workplace safety, an investment in more security guards will not have the same impact as an investment in making sure security is highly accessible and responsive. To meet that objective, a hospital communication system should support mobile communication from any point in the hospital and one-touch code calling, so nurses can ask for help from anywhere and receive it quickly. Communication should also be two-way, so nurses know that their message has been received and supporters are responding. Simply accelerating the response process can help reduce the level of tension, in addition to decreasing the risk of further escalation of threats or violence.

Other important features include pre-defined contact groups to simplify the notification process and detailed message tracking. For workplace safety, contact groups could include the behavioral health response team or a de-escalation team, or a team including law enforcement for active shooter situations. This same feature can be used for more common hospital operations, such as calling a cardiac or sepsis response team. Message tracking ensures receipt and response information is available to supervisors or other leadership to enhance accountability. Tracking also enables documentation for later analysis, so that hospitals can adjust staffing levels or skill mix and identify other factors impacting workplace safety.

More generally, an enhanced hospital communication system can support facility-wide situational awareness, from operation and logistics to patient flow and staffing needs. Such a system would permit monitoring of ED throughput and patient census in real time, so that staff and supplies are allocated where they are most needed, moderating pressure on frontline nurses while optimizing resource usage. As care coordination for chronic conditions becomes a routine element of patient care, real-time two-way communication for safe and swift discharge will be critical for both care outcomes and patient satisfaction.
Costs and care outcomes are likely to stay at center stage as healthcare transforms. Communication technology will play an essential role in enabling and accelerating this transformation. Choosing the right communication strategies can make the difference between wearing out already exhausted care providers and empowering them to excel in this new environment.

To learn more, register for the webinar, How to build resilience and reduce nurse burnout through better care team communication at


  1. All statistics are taken from the Advisory Board’s Nursing Executive Center national presentation, “Rebuild the Foundation for a Resilient Workforce,” 2018.
  2. $768 is the average cost per hospital-acquired urinary tract infection.

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