Understanding the factors that contribute to burnout among assisted living nurses can drive interventions to ease high turnover rates, according to an expert in the field.
Keeping nurses has been especially difficult for assisted living communities, with turnover around 40%, which limits the ability to develop sustainable practices in workforce leadership and care oversight, according to an article by Burton Korer, DNP, MSN, RN-BC, in Caring For the Ages, a publication of the Post-Acute and Long-Term Care Medical Association.
Korer said burnout is common among nurses and associated with high turnover rates. In a 2018 survey of more than 50,000 registered nurses who reported leaving their employer, 31.5% reported that burnout had contributed to their decision to leave their jobs. And high turnover rates can negatively impact care, staff morale and organizational costs.
As nursing practice continues to evolve in assisted living, nurses are working with a growing population of residents moving into the setting with multiple chronic conditions and requiring higher levels of care, according to Korer. The American Health Care Association / National Center for Assisted Living reported that 43% of assisted living residents have Alzheimer’s disease or dementia, and 50% are on multiple medications.
In addition, assisted living nurses practice under state-specific regulations and individual organizational policies. Caring for residents involves not only coordinating resources within a community, but also could include multiple external providers. Assisted living nurses who understand the complexity of their environment may be better prepared to coordinate care delivery from multiple providers with less burnout and turnover, Korer wrote.
Pointing to a report in 2019 form the National Academies of Sciences, Engineering and Medicine, Korer said the Systems Model of Clinician Burnout and Professional Well-being model identified learning and continuous improvement processes as “necessary for identifying, evaluating and implementing effective improvements at all levels” to reduce clinician burnout and promote professional well-being.
Frontline care delivery, or interactions among the care team, residents and families; organizational culture, including human resources, leadership and management; and external environments, including political, market professional and societal factors all influence each other and impact how workers experience their workplace. Adverse actions in all of these systems also can contribute to burnout and well-being.
“A ‘chronic imbalance’ between what a job demands and the resources available can impact well-being and lead to clinician burnout,” Korer wrote. “For instance, when job demands remain chronically high — including excessive workload, inadequate staffing, administrative burden and poor workflow — and job resources are low — including a lack of meaning and purpose at work, poor organizational culture, and limited job control and flexibility — an individual is more likely to eventually experience burnout.”
The model, he said, can help organizations identify interventions that can address the specific burnout factors in the “unstable system” of assisted living. Korer said this model could be valuable for studying the complex work environment in assisted living.
“Addressing the turnover of assisted living nurses is vital to the mission of organizations providing care to older adults — and understanding the factors contributing to burnout — and then promoting effective adaptation in the workforce can help address the impact of burnout on turnover,” Korer concluded.
