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When Nurse Managers Said They Felt Overwhelmed, a Study Aimed to Pinpoint the Extent of Their Workload

nurse managers
Moira Hoch and Darren Girardeau (top row L-R) along with Cindy Brockway and Cheryl Monturo (bottom row L-R) collaborated on the research study at Chester County Hospital that led to a solution to reduce nurse manager burnout

Many nurses are driven to the profession due to the positive and helpful impact they have on patients’ lives. But while the joys of nursing drive many caregivers each day, it can be a challenge as most nurses work in high-stress environments — especially for nurse managers who juggle patient care while supporting nursing staff and overseeing unit operations.

Combating and preventing nurse burnout is of upmost importance for health systems. In a 2014 study, 62 percent of nurse managers shared that they planned to leave their jobs within the next five years, with burnout being the most common reason listed for their intent to leave. These findings on burnout and turnover continue to rise in the health care industry as a whole, especially after the COVID-19 pandemic.

At Chester County Hospital, supporting the workforce and reducing burnout is a top priority. “Our managers and employees are our strategic advantage — so retaining these talented individuals is paramount to the hospital’s success. We take concerns of burnout and overwhelm seriously and work diligently with our teams to find solutions,” says Angela Coladonato, DNP, RN, the senior vice president for Nursing and chief nursing officer, at CCH.

Among those solutions was the addition of assistant nurse managers — a new role that was introduced after a unique collaboration between clinical managers and the hospital’s Research department.

Research Brings the ‘Aha Moment’

In 2017, Darren Girardeau, MSN, BM, RN, the director of Emergency Services and Moira Hoch, MSN, RN, director of Clinical Care Services, both clinical managers at the time, began the conversation to bring on additional support for nurse managers. They didn’t know then that a new role would be the end goal, but they knew they could be proactive about protecting nurses’ well-being, team morale, and ultimately patient care, by trying to take on and solve for potential burnout.

“We had a feeling that there was too much work assigned to nursing managers, who face dual roles as caregivers and administrators, but we did not have hard data to illustrate that hunch and drive potential solutions,” Hoch says.

So Hoch and Girardeau approached the hospital’s Research department for help in determining the nurse managers’ workload. They realized that any solution needed to begin there.

Cindy Brockway, MSN, RN, CCRP, director of the Research department, along with Cheryl Monturo, PhD, MBE, its senior nurse scientist, curated a master list of all nurse managers’ responsibilities over a month-long period. The list was analyzed and categorized. The team worked closely with clinical managers throughout the hospital to ensure accuracy in their findings.

“Then we said, ‘Let’s try to quantify what this looks like,” Monturo says. “That was this project’s ‘aha moment,’ quantifying how much time nurse managers spent doing all these things.”

Every responsibility was assigned a time value, down to the minute. The researchers also accounted for how frequently it needed to be addressed — daily, weekly, monthly, etc.

What they discovered was that each nurse manager was responsible for accomplishing 24.3 hours of work during a typical eight-hour shift. The findings were presented to the hospital’s senior administrators in 2019 after the extensive quality and process improvement study, who unequivocally supported the solution of an additional position — assistant nurse managers — to ease the workload.

“As leaders, it was important for my colleagues and I to ensure that our care teams received the support and help they needed. It seemed to be a rational decision to bring on another position to assist our nurse managers in light of the effects burnout could have on all involved,” Coladonato shares.

“Fighting nurse burnout is an incredibly important task for hospital systems. Nurses themselves are at risk for developing depressive disorders or other behavioral health conditions, potentially leading them to leave their positions or even the profession. For health care organizations, nurse burnout can potentially impact patients, so it’s imperative for health systems to learn from the data and innovate accordingly.”

Monturo believes their research is a shining example of the progress that can be made when scientific thinking is applied to everyday challenges.

“It’s reinforcing a culture of inquiry here at Penn,” she says. “By employing a variety of research and evidence-based practice strategies, we were able to take information and use it for the betterment of our patients and staff.”

The research study was published in Nursing Management in July 2021, furthering its success and exemplifying this collaboration as a best practice within the industry.

A New Position Improves Well-being and Patient Care

“The addition of the assistant nurse manager is essential for clinical managers. Thanks to my assistant nurse manager, I can give the right time and energy to each important task at hand,” Girardeau says. “I believe these roles can be an important strategy for fighting nurse burnout across the nation, and I hope other health care institutions take note.”

Hoch reiterates this sentiment.

“As a nursing leader you not only have to set an expectation of delivering good care, but you also must care for the caregivers. I have found that caring for the nursing staff, meeting their needs, being open and honest, and removing barriers for them when possible, allows them to focus their energy on the patient.”

Her assistant nurse manager helps her do just that by taking on the tasks she’s often unable to get to during the day, and most importantly, by maintaining a presence among staff.

“By alleviating some of the pressure on nurse managers, they can do a better job of supporting frontline staff, which, in turn, ensures that patients receive the level of attention they have every right to expect,” Hoch says.

She continues, “Nursing is more than patient outcomes. It’s about connecting with another person in their time of need and being a pillar for that patient and their families when they need someone to lean on. To be able to be that pillar, the nursing staff must be cared for.”


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