Say goodbye to FRED: How to improve healthcare resilience

July 10, 2018
Terry Zysk, CEO, LiveProcess

Does your healthcare facility know FRED? Chances are FRED exists in your own hospital or health system. In a Nursing Executive Center (NEC) report,1 one frontline nurse described the nursing model of the American hospital as: Frantically Running Every Day.

How do you recognize FRED In your own facility? Here are a few clues:

• Ringing ears from constant pages and alarms
• Jittery hands from redial syndrome
• Grumbling tummy after a too-quick lunch
• Holes in knees of scrubs from praying for full staff coverage
• Worn tread on shoes from hospital laps

Why FRED isn’t funny: The high costs of a weary workforce

Those little annoyances caused by FRED can become so commonplace that staff takes them for granted, as if they were a normal and expected part of the workflow. While that level of dedication is admirable, it comes with some dismaying costs.

Nursing fatigue and burnout

The NEC report cited several studies confirming what many hospital leaders know: Nurses are often running on fumes. Three out of four reported concerns about overwork, nearly half said they were tired all the time, and 70% said they felt burned out.

Reduced productivity

Pushing staff to the edge of their endurance eventually becomes counterproductive. Researchers have found a link between nurse burnout an increased rate of hospital-acquired infections.2 The study found the strongest link between nurse burnout and patient urinary tract infections, which cost on average $768 per patient to treat. A higher cost comes from nurse absenteeism, which costs healthcare organizations $1,685 per employee per year.

Nursing turnover and staffing shortages

Nearly half of all nurses say they have considered leaving the profession.3 With the Bureau of Labor Statistics projecting 1.2 million registered nurse (RN) vacancies by 2022, reducing staff turnover must be a priority. The financial impact of those vacancies is high: According to the NEC report, the average hospital faces a $90,000 cost from the departure of one RN. The report calculated a $6.6 million average total cost of RN turnover at hospitals.

How healthcare organizations can support a resilient workforce

I think one of the most important takeaways from the NEC report is that nurses are already resilient. Both CNOs and frontline nurses observed that nurses provide a strong foundation for the entire healthcare team while also acting as a critical source of support for patients and families at their most vulnerable time.

The task for healthcare leadership is not to make nurses more resilient, but to invest in and create an environment in which nurses have the time and tools to do their work professionally, at a high standard, with less stress. The NEC has identified four ways in which healthcare organizations can help build that environment:

1. Reducing concerns about safety due to threats and violence in the workplace
2. Addressing perceptions of inadequate or unsafe staffing levels
3. Providing time to recover from stressful events
4. Preventing isolation caused by lack of connections among staff members

The role of healthcare communication technology in creating an environment for resilience

Each of the problem areas identified by the NEC can be ameliorated by a healthcare communication solution. In later blogs, I’ll review how enhanced communication technology can address safety, staffing, and isolation to help build the type of work environment that allows nurses to keep nursing.

Even in areas not directly managed through communication, however, technology can play an important role. Nurses may experience a variety of traumatic events in the course of their regular workload, such as treating patients who are victims of violence, or the death of a very young patient. Many nurse leaders have developed strategies to allow nurses to recover, including time in a quiet room, storytelling sessions, or relaxation training. While helpful, each of these tactics requires time to implement.

Saying goodbye to FRED

Healthcare facilities can be inherently stressful environments. As sites of grief, loss, fear, and urgency, hospitals and other facilities sometimes show people at their worst. Nevertheless, as one CNO reported to the NEC, “I see nurses’ resilience every day. They negotiate the demands of the job and deal with the high stress, but still walk into patients’ rooms with a smile.”

While healthcare leadership cannot change the kids of stresses nurses and other care providers face, they can implement technology to give their staff the tools they need to prevent Frantically Running Every Day and build an environment that supports their dedication and resilience.

Next steps

Read more blog posts about agile healthcare and clinical resilience


  1. The Advisory Board, Nursing Executive Center, “Rebuild the Foundation for a Resilient Workforce,” 2018.
  2. Cimiotti, Jeannie P., et al. “Nurse staffing, burnout, and health care–associated infection,” American Journal of Infection Control, November 2012,
  3. Mulero, Ana. “Survey: Nearly Half of Nurses Might Leave the Profession.” Healthcare Dive, 1 Mar. 2017,

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