The time is now: Addressing the wellbeing of nurse executives | Viewpoint

Undeniably, the healthcare nursing workforce has faced unprecedented stressors exacerbated by the pandemic.

Barbara Seymour

While the majority of research on burnout has focused on nurses and physicians from the clinical perspective and chief executive officers (CEOs) from a leadership perspective, there is a need for more research on the factors that may contribute to the burnout of chief nursing officers (CNOs) and system chief nurse executives (CNEs).

Faced with a heavy burden of stress and needs from their overstretched teams, CNOs and CNEs are a distinctive specialty within nursing that have unique challenges. While many provider organizations have made efforts to help address the wellbeing of front-line nurses, few programs exist that are tailored for the specialized role of these nurse executives.

With the cost of CNO and CNE turnover for health systems at more than $1.5 million per employee, burnout is not only a workforce issue but a financial sustainability challenge that hospital leaders cannot afford to ignore.

Contributors to burnout: the research

A 2023 Vizient Member Networks survey of 43 system CNEs with purview over a million nurses focused on staff wellbeing, but as a pulse check asked the CNEs to forecast their own career.

Fully 27% of respondents forecasted career changes on their horizon, identifying preferment — how members of the workforce decide to spend their time such as transitioning into part-time or consulting roles or teaching, mentoring or volunteering as a way to keep a connection to nursing — or retirement within 12 months.

To help illuminate these factors of burnout, in February 2024 Vizient distributed an additional survey to 694 CNOs who participate in Vizient Member Networks. The study — drawing 106 responses (15% participation rate) of these health executives who oversee 350,000 nurses and nearly 700,000 patients daily in their care — gathered insights on five contributors of burnout, which are based on current literature specific to nurses. Categories are below:

• Leadership fatigue: The burden of leadership results in decreased motivation, loss of purpose and disconnection with their employees.
• Secondary trauma: The set of observable reactions resulting from working with people who have been traumatized, mirroring the symptoms of post-traumatic stress disorder.
• Compassion fatigue: The mental and emotional distress that can follow when healthcare professionals connect and empathize with patients and other staff.
• Moral distress: The suffering experienced when an employee makes a moral decision and then either does not — or feel that they cannot — follow through with their chosen action because of institutional constraints.
• Moral injury: The result when an employee engages in, fails to prevent or witnesses acts that conflict with their values or beliefs.

When asked to rate these five contributors on a scale from 1 to 10, with 1 being a low contribution to burnout and 10 being the highest contribution, results showed higher levels of leadership fatigue and secondary trauma with over a third of respondents rating secondary trauma a 6-8, giving a glimpse into the serious nature of the burnout experienced by these nurse executives.

While most burnout contributors show a general downward trend across the survey data, secondary trauma and leadership fatigue have a U-shaped pattern of responses, indicating more CNOs suffer from high levels of these contributors when compared to the other three.

Key takeaways: drivers of turnover

The intention of these analyses is to help healthcare leaders create specific interventions to improve wellbeing and retention for nurses and nurse executives.

Consistent with the 2023 survey, the 2024 survey found that the largest drivers of nurse executive turnover are retirement and preferment, identified by 20% of respondents as a reason for leaving their professions., But other drivers exist including emotional distress, challenging work environment, culture of hierarchy and discrimination, or disappointment about the reality of managing nursing at the executive level.

Another common factor noted by respondents was lack of actionable results from verbalizing feedback. While they feel comfortable raising their voice to other leadership regarding problems with patient care, they feel less strongly that their voice is being heard, acknowledged or influences decision-making.

Investing in wellbeing

When nurse executives were asked how they invest in their wellbeing and how often, their comments were sorted into four themes: physical wellness, emotional and mental wellness, work-life balance and time off and personal growth and development.

The survey team also examined qualitative comments about specific actions nurse executives take to promote their personal wellbeing:

• 43% mentioned spending time with family and taking time off as discrete investments in wellbeing.
• 28% of respondents said they engage in these normal course-of-life activities only one to three times monthly.

The lack of investment in wellbeing activities further exacerbates burnout and can push these leaders toward leaving the profession.

A call to action for change

The call to action is clear: reform is needed to mitigate nurse executive burnout. Healthcare executives, including the boards of trustees, should be educated about the specific needs of nurse executives identified in this survey and assess their organizations for cultural norms that either support or hinder their wellbeing, especially in leadership fatigue and secondary trauma.

Additionally, it’s time for intervention. Leaders and executives must develop programs to promote wellbeing with a quality improvement framework. Strategies to help leaders take the initial steps in targeting interventions for specific contributors of burnout and distress include:

• Create workplace norms that prioritize work-life integration and model those behaviors.
• Adopt policies that protect employees’ abilities to nurture their personal relationships.
• Set the organizational example in making social connection a strategic priority at all levels of employees.
• Set time to understand the perspectives of your nurse executives and pay attention to leadership fatigue and secondary trauma as unique contributors to their burnout.

By taking action to reduce CNO and CNE burnout, health systems are one step closer to building a better workforce to continue meeting the needs of patients everywhere.

Barbara Seymour, DNP, RN, NE-BC, is assistant vice president, member networks at Vizient