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Stress and burnout levels among nurses and patient aides have been troublesome trends in health care for some time, particularly in the context of long-term care. COVID-19 has only exacerbated this, with 94% of staff RNs indicating some degree of burnout. So while employment in long-term care has seen substantial growth which is expected to continue as baby boomers age, stress and burnout are concerning obstacles.


Why care about mounting stress among long-term care nurses and aides?

Direct and Indirect Costs


Stress among skilled nurses contributes to high turnover rates for nurses and aides, which can range from 55-75%. This turnover in long-term care facilities results in both direct and indirect costs. According to ita group, the average hospital loses about $300k per year for each percentage increase in annual nurse turnover. Given that the national average RN turnover rate was 17.8% in 2019, this cost adds up. The average hospital spends $3.6-6.1M each year on rehiring, retraining, and overtime.


A Self-Fulfilling Prophecy

A clear indicator of the current nursing staffing crisis is the increasing vacancy rate, which currently stands at about 9%. While this is an industry average, that number is even higher in long-term care settings as entrants fail to keep up with nurses and aides leaving the industry.

Higher turnover rates mean unfilled jobs have to be covered by RNs. At the same time, many report having to pick up the slack as newcomers learn the ropes in terms of organizational processes. Both of these combined exacerbate nurse and aide feelings of being overworked, stressed, and dissatisfied. This leads to even more turnover.



Turnover and Patient Outcomes

Research shows that the higher the nurse-to-patient ratio a healthcare institution has, the lower their mortality rate. In the face of high turnover and high vacancy rates, it’s even harder to provide the real-time care that is particularly critical for senior patients. This can lead to adverse patient outcomes and higher mortality rates. Not only is this hard on staff and concerning for the patients themselves, but these adverse outcomes are impacting providers financially as Medicare shifts its reimbursement structure from fee-for-service to value-based incentives.


3 Key Reasons for Turnover in Skilled Nursing Facilities


1. Difficulty Communicating with Physicians and Management


Breakdowns in internal communication create stress when nurses and aides can’t reach doctors and administrators for real-time patient concerns. This stress quickly adds up and accelerates employee turnover rates.

The fix: Long-term care and senior living workers are more likely to stay with an employer if they have a strong relationship with their manager and feel that he or she understands their daily challenges and triumphs.

Increasing communication and involving nurses in interdisciplinary care plan meetings gives them a voice as well as a sense of ownership when it comes to planning patient care. Because nurses and aides are the people interacting with patients the most, they can provide helpful insights that result in more effective planning.

2. Too Many Tasks Requiring Too Much Time

Particularly in senior care, satisfaction often comes from creating bonds with residents and helping them achieve the best quality of life possible. It’s when people don’t find this sense of satisfaction in helping others or are discouraged by the often tough nature of the job, that they are likely to look for new opportunities.

Nurses are often being pulled in many different directions between administrative demands, patient care, and communicating with patient family members. Being stretched thin across these three dimensions often leads to anxiety and a feeling spinning their wheels, particularly when not recognized for their accomplishments and contributions. The disconnect that often arises between what providers care about—caring for patients—and the reality of their day to day—paperwork and chasing down doctors—contributes to higher rates of burnout.

The fix: Implementing processes and technological tools—like IM Your Doc’s HIPAA-compliant messaging and image sharing—enable care providers at every level to spend less time on faxes, voicemails, and tracking down team members and more time doing what they care about: providing resident and patient with top-notch care.


3. Lack of Moral and Decision-Making Support

Particularly for organizations that use an agency structure where nurses and aides aren’t necessarily coming into the headquarters, feelings of isolation can abound. That isolation not only creates dissatisfaction but can also degrade the level of care that patients receive when the work environment precludes employees from bringing their best selves to the table or feeling they have the necessary support to react quickly to emergent situations.

Imagine tending to an older patient whose health is spiraling, and you can’t get in touch with a Medical Director—the patient’s care decision maker—to order the appropriate course of action based on the strategy laid out upon admission. Now imagine that happening day after day. The anxiety of these situations can accumulate quickly and take a toll on senior care providers.

The fix: Implementing an easy-to-use communication platform with customizable access as well as one-on-one and group messaging can provide remote workers with a way to keep in touch and support one another. As mentioned above, it can also facilitate real-time communication if a patient has a sudden downturn in health. Dr. Wester, Medical Director of Skilled Nursing and Rehabilitation Services at Ambassador Health Omaha, observes, “Because I have ‘MD’ after my name, it can be scary to call me. Having text messages [via IMYD] has taken that fear out, and people reach out a moment’s notice when they see something’s off with their client.”

In Long-Term Care, Communication is a Keystone for Success


The more experience, empowerment, and acknowledgement skilled nurses and aides have, the more satisfied and engaged they are with their work, the better the care they are able to provide, and the greater the likelihood that they will stay with the organization. There are many resources available to help think about appropriate wages and other benefits to achieve this kind of engagement.

However, simply by leveraging technology like IM Your Doc to facilitate scheduling, care coordination, and communication, long-term care organizations can check many boxes with one stone. To see first hand how long-term care organizations like LECOM Institute for Successful Aging are seeing a breadth of benefits by integrating IM Your Doc’s easy-to-use, HIPAA-compliant video and messaging platform, check out our recent long-term care webinar here. For more information, sign up to demo the service today.