Critical Care Nurses Are Experiencing Burnout at Alarming Rates

Texas hospitals hit by staffing crisis as burnout depletes workforce and COVID-19 surges

Critical Care Nurses Are Experiencing Burnout at Alarming Rates

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Texas nurse Jenna Price gets half a dozen solicitations a day from hospitals and staffing agencies that want to pay her four times her current salary to leave her job at a suburban Central Texas emergency room and take a temporary assignment in another hospital that needs nurses.

“The money is ridiculous,” Price said.

Not to mention tempting — especially after the most traumatic year of her career on the front lines of the coronavirus pandemic.

In Texas, where hospitals are struggling with historically low staffing levels while hospitalizations from the COVID-19 delta variant are skyrocketing, nurses Price are a hot commodity.

There are 23,000 more unfilled jobs in Texas for registered nurses than there are nurses seeking to fill them, according to a labor analysis by the Texas Workforce Commission.

“There's no pipeline of staff that we see ready to just hop in and start helping,” said Carrie Kroll, vice president of advocacy, quality and public health at the Texas Hospital Association.

Burnout is causing nurses of all specialties to leave the profession in droves — or to accept better paying nursing jobs in an increasingly competitive market, nurses and hospital officials say.

Registered nurse Lori Kelley dons an N95 mask before entering a room with a COVID-19 patient at Goodall-Witcher Hospital in Clifton on Wednesday. Credit: Jordan Vonderhaar for The Texas Tribune

“Our workforce is fatigued,” said W. Stephen Love, president and CEO of the Dallas-Fort Worth Hospital Council. “These health care heroes have been at this for 18 and 19 months. Many of them are just leaving the workforce, saying ‘I can’t do it anymore.’”

Kroll said one hospital system in Central Texas reported a 25% turnover in the last year, far higher than average.

“We've had a significant number of people, [after] the first two waves, who just stepped away from the profession,” Kroll said. “It’s too stressful. It was really life and death.”

Now, a spike in the number of hospitalizations of mostly unvaccinated people due to the delta variant is again straining hospital staffs across the nation, making it more difficult for understaffed hospitals to transfer patients out or bring contract nurses in from other regions.

“In some cases, no matter what you’re willing to offer, it’s difficult to get the individuals with the right critical training and experience,” said Dr.

Bryan Alsip, chief medical officer at University Health in San Antonio, which is experiencing a 10% shortage of staff. “The surge we’re seeing isn’t particularly regional.

So those crucial resources are in demand in many states, not just ours, and they’re all facing the same challenges that we are simultaneously.”

The result is an overheated nursing labor market in Texas that some argue is paying nurses what they’re worth for the first time in their careers — but that, at the same time, threatens to shut out hospitals that can’t afford to compete for nurses.

“We’ve got to figure out how we slow that down because that's not good for any of us or for the future of health care,” Nim Kidd, chief of the Texas Division of Emergency Management, told the Tribune.

The situation threatens to lower both access to and quality of health care — and that’s a problem for everyone in the industry, health care officials say. No matter how many beds a hospital may have, it can use only the ones that have staff to cover them.

“If we don't have enough nurses, we close units,” said Joycesarah McCabe, chief of nursing at Goodall-Witcher Healthcare hospital in Bosque County, near Waco. “We close hospitals.”

Most Texas nurses who work full time at hospitals are paid around $75,000 a year, depending on the market, in line with national trends, according to the U.S. Bureau of Labor Statistics.

But hospitals say they’re losing nurses who opt to become traveling contractors for much higher pay or who answer the call of bigger hospitals offering signing bonuses and other perks that competitors can’t afford.

“There’s a lot of competition for the same group of nurses in Dallas,” said Donna Richardson, chief nursing officer at Parkland Hospital in Dallas, the county’s 882-bed public hospital.

“I can’t find ICU nurses [to hire]. I’m getting minimal response from the staffing agencies. During the last surge, we were more worried about equipment and [personal protective equipment].

This time, we’re more worried about staffing.

“I could add 100 beds if I had the staff to support it,” Richardson said. “The things that keep me up at night are staffing and worrying about having enough staff to take care of patients with the quality of care they deserve.”

And the state, which used federal relief dollars to flood Texas hospitals with highly paid supplemental staff last year, has stepped the staffing game, instructing local health and government officials to take the lead on hiring the nurses with federal dollars that are now coming directly to them.

It all comes at a time when Texas is recording nearly five times as many hospitalizations from COVID-19 than it was a month ago — with an increase of nearly 50% just in the past week — as the highly contagious delta variant sends more unvaccinated Texans to the hospital every day. New cases are up 92% since last week, and deaths are up 15% in the same time frame, state health officials said Wednesday.

The number of new confirmed cases has reached levels the state hasn’t seen since February, shortly after the deadliest peak of the pandemic thus far in Texas.

Forecasters are predicting that without major social and behavioral changes, widespread masking and social distancing, hospitalizations could reach new highs within two weeks — just as millions of unvaccinated students return to school in mid-August.

Gov. Greg Abbott has barred school districts and local governments from enacting new mandates or restrictions.

Price said her hospital diverted incoming ambulances to other area hospitals last weekend because it had reached capacity.

“That’s happened maybe five times in the 10 years I’ve worked there,” she said.

Goodall-Witcher Hospital has open nursing positions, but its CEO says they aren't receiving any applicants during the latest surge in COVID-19 cases. Credit: Jordan Vonderhaar for The Texas Tribune

State stops sending relief staff to hospitals

Using federal relief funds allocated to the state, Texas spent $5.36 billion to send nurses and other health care personnel to facilities that were being overwhelmed with COVID-19 patients starting in April 2020. Hospitals grew to depend on those nurses.

From the hospitals’ point of view, it was a quick, easy solution during a crisis: no applications for funding or grants, no haggling, no time wasted. The state asked how many the facility needed, and the workers showed up.

The state contracted the nurses and personnel through staffing agencies at market rates — some 14,000 of them fanned across Texas in early February during the winter surge.

As the vaccination effort picked up steam in the spring, those nurses were demobilized as hospital numbers returned to manageable levels. The last state-supported nurses were pulled from hospitals in mid-May.

A month later, the national vaccine effort began hitting a wall of resistance, and the delta variant began to surge through the roughly half of the population that had still not been vaccinated against COVID-19. After reaching a low in early June, hospitalizations began to rise.

Hospitals and local officials appealed to the state for help again. Last Friday, the state informed cities and counties that it would not restart the state-supported nursing program.

Instead, they told local officials, the money — some $10.5 billion in coronavirus recovery funds allocated to Texas cities and counties by Congress earlier this year as part of the American Rescue Plan Act — is now in their hands to use where they see the most need, including contracting with medical staffing agencies to hire more nurses.

“Shortages in health care, whether it’s workers or commodities or supplies or bed space, it can be a matter of life and death. Nobody disputes that,” Kidd told the Tribune. “But nobody hires doctors and nurses better than hospitals do. It’s what they do.”

ARP funds spent before the end of September on expanding medical capacity can be reimbursed by the Federal Emergency Management Agency, Kidd said.

“A year ago, nobody [at the local level] had money to do any of this,” Kidd said. “I'm grateful to the Biden Administration and Congress for putting 10-and-a-half billion dollars into Texas cities and counties to address COVID response and recovery. That’s what we should be doing.”

But local officials criticized the move and accused the state of abdicating its duties at a time when Texas hospitals need help the most.

Kidd said “that’s just not true.”

“The doctors and nurses that are in the hospitals, that have been working their tails off, we’re very grateful for their service.

I know they’re working hard, I know they’re fatigued, and they’re heroes in my eyes,” Kidd said. “We are not abandoning the people of Texas. …

What we're trying to do is to help make sure those closest and with the best possible solutions to the problems are the ones that are solving those problems.”

Bexar County Judge Nelson Wolff said his county, which has seen some of the sharpest spikes in hospitalizations in the state in recent weeks, will work directly with Kidd’s office to leverage the federal funds when it’s time to hire more nurses.

“We’ll have to do it on our own, but he’s agreed to be the conduit,” Wolff said.

Some critics of the state’s response said that decentralizing that program could waste time and add confusion to the process at a time when COVID-19 hospitalizations are outpacing resources at an alarming rate.

“Are there going to be 254 counties with staffing contracts? And how long will that take?” Kroll, of the Texas Hospital Association, said.

Kidd said he hopes hospitals will be able to increase their capacity and reduce the pressure on staff by returning to some of the strategies they used early in the pandemic halting or limiting elective surgeries.

Such steps are already being taken by many hospitals, including those in Bexar County, where officials announced Wednesday that elective surgeries would be limited to patients who did not require overnight hospital stays.

“Pulling out all the stops”

Some hospital administrators say that even federal money can’t always cover the costs of staffing during a bidding war, and that sustaining that level of pay for the long term is not an option even for the systems with more resources.

The 25-bed Goodall-Witcher Healthcare hospital in Clifton can’t find anyone to even apply for their open nursing positions — much less accept jobs at the rate the hospital can afford to pay, said CEO Adam Willmann.

“People are just not looking at us,” he said. “I guess the only way I'm going to be able to get staff again is to let them get really tired at these big hospitals, and then maybe they’ll come back our way. I’m at a point where I can’t keep up with the Joneses if I want to keep my lights on.”

Willmann said the hospital’s nurses regularly receive postcards and texts from other hospitals and travel nurse agencies dangling signing bonuses of $15,000 to $60,000 to become nurses elsewhere, either temporarily or as full-time hires. Some of them move 30 miles away to Waco for pay that is several times the standard rate, he said.

“How is that sustainable, even in these large systems?” he said.

It isn’t, said Richardson, the chief nursing officer at Parkland Hospital in Dallas. She said nurses in general have historically been paid below their value, “but you can only go so high on salaries and there's a cap to it. It’s just gasoline during a hurricane.”

At Titus Regional Medical Center in Mount Pleasant, employees are being offered higher bonuses to work extra shifts in the COVID unit on their days off, and the hospital is increasing its hiring bonuses and part-time wages to attract more nurses with free time and local ties, retirees or school nurses, said CEO Terry Scoggin.

So far, he’s able to cover the 12 beds that are currently filled with COVID patients, mainly with the incentives for current employees, and he’s managed to hire a new nurse as well.

“We’re definitely pulling out all the stops,” he said.

“A boom for nursing”

Price, Honny Pils is receiving increasingly large offers from recruiters desperate for her services.

Pils, a registered nurse in Franklin, a small town near Bryan-College Station, spent the past year working at hospitals in COVID-19 hot spots across the U.S. as a travel nurse, leaving her family for months at a time and making more money than she had in her entire career.

Pils said she’s sometimes awakened by memories of patients calling out her name. She had planned to take an extended break after her contract with a staffing agency ended in March. She wants to spend the next several months with family and concentrate on running her business, a local deli she opened before the pandemic.

But these days, her phone is lighting up with texts from staffing agencies offering nursing placements, both inside and outside of Texas, for $8,000 per week and climbing.

Pils figures that if the offers keep coming, she’ll soon be faced with one she can’t refuse.

“This is a boom for nursing. In all corners of the country, they’ve just been slogging along, working ungodly hours, under really bad circumstances,” Pils said. “It’s an astronomical amount of money in some ways, but in other ways I feel it’s been earned.”

Disclosure: The Texas Hospital Association and Parkland Health and Hospital System have been financial supporters of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune's journalism. Find a complete list of them here.

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Is Nurse Burnout on the Rise? Startling Statistics on Nurse Well-Being

Critical Care Nurses Are Experiencing Burnout at Alarming Rates

Nurses fill many roles at the patient's bedside: caretaker, educator, interpreter for the doctor's guidelines, emotional lifeline, and more. So, it's little surprise that nurses are prone to mental, physical, and/or emotional fatigue. But if that fatigue turns into exhaustion that doesn't go away after a short rest, it may be burnout.

What Is Burnout?

The term burnout was originally coined in the 1970s to describe the consequences of severe stress and high ideals in the helping professions, but it's often ascribed to overwork or poor working conditions as well.

Nurses suffering from burnout show many signs and tend to be so fatigued that they struggle to cope or perform normal job duties. They may feel alienated, emotionally distant or numb about their usual activities, and both job satisfaction and job performance may suffer.

BUT FIRST: Everything you've ever wanted to know about nurse burnout.

Statistics on Nurse Burnout

Nurses all over the country experience symptoms of burnout. Regional studies have shown discrepancies in burnout levels between areas; however, national surveys verify that nurse burnout is a nationwide concern. 

It's also important to consider the specialties in which nurses feel the most burnout. High-pressure jobs will undoubtedly bring on more stress and fatigue for nurses, not to mention the trauma that can occur on a daily basis in emergency units.

National statistics

According to a 2013 report from the Department of Professional Employees, almost half a million registered nurses had already left their profession nationwide.

Many of them cited high workloads and limited staffing as reasons for their departure, and more than 60 percent of the nurses surveyed reported being forced to work «voluntary overtime.

» In the same report, about one-third of nurses surveyed reported an emotional exhaustion score that qualified them as «high burnout.»

The working environment can also have a drastic effect on burnout. A massive analysis of nationwide survey data showed that rates of burnout and job dissatisfaction tended to be highest for nurses that were providing direct patient care in hospitals and nursing homes (34 percent of hospital nurses and 37 percent of nursing home nurses reported feeling burned out).

In a 2017 study done by Kronos Incorporated, 257 registered nurses working in U.S. hospitals were surveyed. The following statistics were uncovered:

  • 98 percent of hospital nurses reported their work is mentally and physically demanding
  • 85 percent of the surveyed group said their jobs make them fatigued overall
  • 63 percent of the nurses noted that their work has resulted in nurse burnout
  • 44 percent reported being worried that their tiredness will cause their patient care to suffer
  • 41 percent of the surveyed group have considered changing hospitals in the past year (2017) due to burnout

Regional statistics

Where you live matters, too. In a 2010 study, 36 percent of nurses in Pennsylvania reported burnout, while only 29 percent of California nurses reported the same. The good news is that this means you can make a difference by adjusting office or hospital policies to give nurses mental, physical, and emotional safeguards against burnout.

Specialty statistics

A study featured in the American Journal of Critical Care found that nurses working in high-risk are more «vulnerable to burnout because of patients' intense needs» and «uncertain outcomes.» «The highly charged context of the nurse's work, particularly the impact of ongoing witnessing of suffering and death,» attributes to 

Job satisfaction

The nationwide analysis also showed that patient satisfaction correlates directly with nurses' job satisfaction. For every 10 percent of nurses at a given hospital who reported feeling unsatisfied with their job, patient satisfaction decreased by about 2 percent, even after other factors were taken into consideration.

Nurse Burnout Is Shrinking the Workforce

In a recent nationwide survey, almost half of the nurses surveyed indicated that they were thinking of leaving their profession.

The leading reason for leaving was feeling overworked (27 percent).

Add in the second-leading reason — a lack of job enjoyment (16 percent), which can also be a sign of burnout — and you've accounted for almost half the nurses contemplating their departure.

When paired with a projected nursing shortage that is already being felt in many cities across the nation, those statistics signal a troubling trend toward even higher workloads for those who remain in the profession. In fact, 62 percent of nurses report that the national nursing shortage is already strongly impacting them.

What You Can Do Now

The good news is that burnout is preventable — once you understand that it's a risk. We recommend using tools the Well-Being Index for regular assessments of nurse well-being. It's also a helpful aid for locating resources that can help reduce burnout and measure progress over time.


Study Reveals Alarming Statistics on Nurse Burnout

Critical Care Nurses Are Experiencing Burnout at Alarming Rates

Healthcare market research and consulting company PRC recently announced the results of its National Nursing Engagement Report. The report was survey findings from over 2,000 healthcare partners and revealed key data about nurses in the workforce today, as well as what the future will hold for nurses and how hospital administrators can help support nurses going forward.

The Buzz on Nurse Burnout

One of the main focuses of the study was to examine how many nurses in the workplace today report feeling burned out. According to the report, 15.

6% of all nurses reported feelings of burnout, with the percentage rising to 41% of “unengaged” nurses.

What’s really interesting as well, is that 50% of nurses who reported feeling burned out also reported that they had no plans to leave their organization—pointing to the importance of supporting and meeting nurses where they are at in the workforce.

The report explained that unengaged nurses are nurses who,

  • May not be part of a team with their colleagues, 
  • Have diminished morale, 
  • Feel emotionally checked out from their work, which also ultimately affects their patient care. 

Factors such as autonomy, nurse-to-nurse teamwork and collaboration, staffing and resources, interpersonal relationships, and leadership access and responsiveness were all factors in nursing engagement. 

ER nurses also seemed to be at a higher risk for burnout, with 20% of ER nurses reporting feeling unengaged. 

“Burnout is an important topic in healthcare today,” the report’s authors, Cynthia King, Ph.D., MA, Director Client Organizational Development, PRC and Leigh Ann Bradley, Ph.D., MSN, MA, BS-CHE, RN, Executive Coach & National Speaker, PRC Excellence Accelerator, explain. 

“We are asking nurses to do more with fewer resources. At the same time, nurses must be compassionate caregivers, technical experts, clinicians, and experts.”

Supporting Nurses = Better Patient Care

King and Bradley tell that one of the most exciting findings of the data was the fact that there is a statistical significance between nurse engagement and patients having better experiences. “To us, this highlights the sacred nature of the patient/nurse relationship,” they note.  

You mean when nurses feel more supported at work, they are better able to do their job and care for patients? What a revolutionary idea! 

Fortunately, however, 85% of nurses did report feeling engaged or fully engaged, so continuing to support nurses, while also exploring ways to support those who are finding engagement to be lacking, is imperative. 

“We believe it is important for healthcare leaders to support and grow an engaged workforce,” they add. “At the same time, leaders need to determine ways to restore joy and purpose to nurses whose engagement has diminished.” 

And as the report details, the demand for nurses will increase by 15% by 2026, so it’s more important than ever that nurses feel supported and engaged in the field. King and Bradley also explain that the report revealed that in order to improve engagement, hospital administrators need to primarily focus on three things:

Involve nursing leaders and professionals as active participants in decision making impacting the organization and patient care. It is important that nurses know their opinions are valued by leadership.

Create environments in nursing units where there are respect, teamwork, and collaboration between nurses and other healthcare professionals.

Make leadership accessible to nurses and be responsive to their needs. Having trusting relationships between nursing and the senior leadership of an organization is critical.

The Needs of Millennial Nurses

Despite the reputation that millennials get about working, King and Bradley tell that their research found that all generations—millennials included—are “deeply committed” to the nursing profession. Despite the fact that millennials have a slightly lower percentage of engagement, they also share the same goals and dedication as all other generations studied. 

Thus, the report only reveals how important it is for nurse leaders to invest time in building relationships and exploring ways to support millennial nurses.

Millennial nurses, as part of a different generation of nurses, may have their own unique needs than past or even future generations, but the paper authors point out that uncovering those expectations and needs will only help improve nurse engagement, retention, and patient care. 

Overall, the report provides an important landscape for defining what factors are necessary to help nurses feel engaged in the workplace, what may lead nurses to experience burnout, and how to move forward to ensure that the needs of nurses in all generations are identified and valued. 

“Too often nurses are so focused on caring for others, we need to create a safe place to care for nurses,” King and Bradley summarize. “We want to create climates where employees can speak up for help if they are experiencing signs and symptoms of burnout.”


Burnout rates in ICU staff fueled by shortages, overtime

Critical Care Nurses Are Experiencing Burnout at Alarming Rates

Health care professionals working in critical care settings have been overburdened because of the plethora of COVID-19 cases, which has led to symptoms of burnout in both physicians and nurses, findings from a new study show.

“Overburdening ICU professionals during an extended period of time leads to burnout,” said lead study author Niek Kok, MSc, of IQ healthcare, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands. “All ICU professionals are at the risk of this, and in our study, the incidence of physicians experiencing burnout was significantly higher than that of nurses in June 2020.”

This burnout can be explained by conditions caused by the pandemic, he noted, such as the scarcity of staff and resources and having to work with colleagues who were not qualified to work in critical care but who were there necessity.

Mr. Kok presented the findings of the study at the Critical Care Congress sponsored by the Society of Critical Care Medicine.

Burnout highest among critical care physicians

The ICU can be a stressful environment for both patients and health care personnel, and burnout is not uncommon among ICU clinicians.

However, COVID-19 has amplified the degree of burnout being experienced by clinicians working in this setting.

Critical care physicians now top the list of physicians experiencing burnout, at 51%, up from 44% last year, according to the Medscape report ‘Death by 1000 Thousand Cuts’: Physician Burnout and Suicide Report 2021.

The Medscape Nurse Career Satisfaction Report 2020, while not restricted to those working in critical care, also reported higher rates of burnout, compared with the prepandemic period. The percentage of nurses reporting being “very burned out” prior to the pandemic was 4%. Six months into the pandemic, that percentage soared to 18%.

In this study, Mr. Kok and colleagues examined the prevalence and incidence of burnout symptoms and moral distress in health care professionals working in the ICU, both before and during the COVID-19 pandemic.

“When the COVID-19 pandemic surfaced in the Netherlands, the health care professionals in our hospitals were motivated to do everything they could to provide the best care possible,” said Mr. Kok. “Many of the ICU professionals immediately realized that they would have to work longer hours.”

However, the health care professionals that he spoke with did have mixed feelings. Some were afraid of being infected with the virus, while others said that “it was very interesting times for them and that gave them extra motivation to do the work.

“Some physicians [and] the WHO warned that COVID-19 is not going to weathered by a heroic sprint – it is an arduous marathon that is going to go hand in hand with burnout symptoms,” Mr. Kok added. “It will eat away at our qualified ICU staff.”

Before and after data on burnout

It was widely believed that the COVID-19 pandemic would increase burnout symptoms, as had been demonstrated in studies of previous pandemics. However, Mr. Kok emphasized that there are no before and after measurements that transcend cross-sectional designs.

“The claim [has been] that it increases burnout – but there are no assessments of how it progresses in ICU professionals through time,” he said. “So what we really need is a comparison [of] before and after the pandemic.”

It is quite difficult to obtain this type of information because disruptive events the COVID-19 pandemic cannot be predicted, he said. Thus, it is challenging to get a baseline measurement. But Mr. Kok pointed out that the study has both “before and after” measurements.

“By coincidence really, we had baseline data to measure the impact of the COVID-19 pandemic and had information that was collected before the pandemic,” he said.

In January 2020, a study began looking at the effects of ethics meetings on moral distress in ICU professionals. Data had been collected on moral distress and burnout on ICU professionals in December 2019. The first COVID-19 cases appeared in the Netherlands in February 2020.

A follow-up study was then conducted in May and June 2020, several months into the pandemic.

The longitudinal open cohort study included all ICU personnel who were working in five units within a single university medical center, plus another adult ICU that was based in a separate teaching hospital.

A total of 352 health care professionals responded to a baseline survey in October through December 2019, and then 233 responded to a follow-up survey sent in May and June 2020. The authors measured burnout symptoms and moral distress with the Maslach Burnout Inventory and the Moral Distress Scale, respectively.


The overall prevalence of burnout symptoms was 23.0% prior to the pandemic, and that jumped to 36.1% at post-peak time. Higher rates of burnout were reported by nurses (38.0%) than physicians (28.6%).


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