Conveying depression, sadness, anxiety, stress, COVID 19.
Before the pandemic, 1/3 of nurses reported burnout and annual turnover rates were about 17%. Since COVID-19, half of nurses report burnout and RN turnover rates are between 20 and 30%.

An icon of a stethoscope to signify scholarship in compassionate care.Hospitals that employ burnout reduction strategies for nurses—through wage increases, professional mobility, stress reduction, and opportunities for learning and leadership—spend about one-third less per year on burnout-attributed nurse turnover costs than hospitals without such initiatives.

That’s the finding of a new study by UVA Health emergency room nurse and nursing doctoral student Jane Muir, whose work—“Evaluating the Costs of Nurse Burnout-Attributed Turnover”—is published in the latest issue of the Journal of Patient Safety. In a moment when health systems across the nation are reeling from acute nursing shortages and more than half of American RNs reports burnout, Muir asserts that making investments to purposefully fight RN burnout and consequent turnover make sound economic sense.

30% less

hospitals with burnout reduction initiatives spent nearly 1/3 less per nurse per year employed on burnout related costs

Many of the challenges nurses faced before COVID-19 have been exacerbated by the pandemic and driven them to leave, retire, or take jobs that pay more, such as travel nursing. Prior to the pandemic, more than one-third of nurses reported burnout, and annual nurse turnover was about 17%; since COVID-19, nurse burnout has hovered around 50% while RN turnover rates are estimated to be between 20-30%.

And while the growth of hospital well-being programs “accelerated when the pandemic started,” Muir said, “it hadn’t been a priority until it was too late.”

Muir compiled data from more than 20 separate studies and found that hospitals with burnout reduction initiatives spent $11,592 per nurse per year employed on burnout-related costs—about 30% less than hospitals without such programs, which spent, on average, $16,736 per nurse per year employed.

Muir also found that nurses working at hospitals with burnout reduction programs stayed at their jobs about 20% longer compared to nurses working at hospitals without such initiatives.

“Data don’t lie,” said Muir. “There is an economic argument to be made for properly compensating and supporting nurses.”

An image of PhD in nursing student Jane Muir in late 2021.

“Data don’t lie. There is an economic argument to be made for properly compensating and supporting nurses.”

Jane Muir, PhD in nursing candidate and an ER nurse at UVA Health

At UVA Health, programs like Wisdom & Wellbeing help healthcare staff move beyond burnout by addressing sources of “stress injuries”—an occupational trauma that can trigger debilitating distress, anxiety, substance abuse, and even PTSD—that contribute to work strain by building peer support, education, and one-to-one and on-unit consulting. Richard Westphal, Wisdom & Wellbeing co-director and a professor of nursing, said that stress injuries have great human and fiscal costs—from turnover and absenteeism, reduced work productivity, erosion of team cohesion, and increased sick days—and affirmed that health systems’ return on investment to mitigate these challenges “is great.”

“Preventing the stress-related turnover of just a few nurses or physicians more than covers the annual cost of well-being initiatives across the entire organization,” he said. 

UVA School of Nursing Dean Pam Cipriano—who lamented the loss of departing RNs’ expertise and wisdom as well as the potential reduction in care quality when nurses are “disengaged and fatigued”—said “the benefits of embedding well-being as a value and supporting the workforce cannot be underestimated.”


RNs who work at hospitals with burnout reduction programs stayed at their jobs longer than hospitals without them

But too few hospitals routinely and intentionally measure burnout and its link to attrition, Muir said, despite the fact that both are “topics that’ve exploded” during the pandemic. Exit surveys lack consistency across units or hospital to hospital, and “some may not even be using validated surveys that address burnout, but instead offer more opaque reasons like, ‘I’m leaving for personal reasons,’ or, ‘the hours don’t work for me,’ or ‘I feel disengaged or have a lack of self-efficacy,’” Muir explained. “We’re not asking specifically about burnout, which leaves some fundamental gaps, and these inconsistencies in measuring clinician burnout limits our ability to address the issue.”

Gold-standard burnout assessment tools like the Maslach Burnout Inventory are easily adaptable to clinical environments and “a great way to keep track of where nurses are,” Muir said, who added that “hospitals that don’t track this data do so at their economic peril, given the expense of hiring travel or contract nurses to fill staffing gaps.”

In the same way they assess other key economic indicators, Muir said that healthcare institutions that routinely assess burnout can more nimbly adjust salaries, bonus cycles, expand well-being programs, and professional development practices to anticipate and prevent nurse attrition, which costs a typical hospital $4.4 to $6.9M each year, according to the 2019 National Healthcare Retention and RN Staffing Report.

Framing nurse burnout and attrition in purely economic terms may also push hospitals to shift the way nurses’ work—often “invisible,” Muir said, and something that “comes with the hospital room rate”—is seen and valued.

UVA Health recently made plans to distribute more than $30M in salary adjustments among its staff, including its nurses, starting in early 2022, and last summer offered a $3,000 bonus to full-time nurses and a $1,500 to part-time nurses to improve hiring and retention.

“The well-being of our employees,” said UVA Health Chief Nursing Officer Kathy Baker, who echoed the importance of assessing RN burnout during exit interviews and having professional growth ladders for nursing staff, “is a high priority at UVA.”

For Muir, herself on the COVID-19 frontlines throughout the pandemic, it’s time to move the needle on the issue.

“An important way to get hospitals to invest in making the environment more sustainable for nurses is to quantify how cost effective it is to retain them,” said Muir, who noted that patients now routinely ask nurses about burnout. “If you’re not shedding light on the economics of this issue, you’re being complacent to the value of what nurses bring and if they’re being compensated.”

Muir’s co-authors include Jessica Keim-Malpass and Virginia LeBaron, associate professors in the School of Nursing, and Jennifer Lobo and Tanya Wanchek, professors of public health science in the School of Medicine.