Melinda Leach has been a nurse for seven years in AdventHealth's Fish Memorial Hospital. She typically works 12-hour shifts monitoring four patients a day, learning about their histories, inputting medication information into the hospital system, and addressing whatever else a patient might need. It's enough to put any nurse through "burnout," a condition that reduces a nurse’s energy and manifests in emotional exhaustion, lack of motivation, and frustration, according to the National Library of Medicine.
Leach said she's been able to get through the toughest of days thanks to her faith in God, but over the last year, she's received additional help avoiding burnout thanks to the hospital's Virtual Nursing program.
While Leach is in a patient's room, the TV overlooking a patient's bed begins chiming like a phone call.
"I'm going to turn the camera on now," a remote nurse said from outside of the hospital. A camera on top of the TV lights up and a nurse appears on the screen. The remote nurse can see everything via a web camera.
"She'll talk to the patient and make sure all their medications are put in the system correctly. She'll ask about their history, as well, as family history," Leach said.
AdventHealth started the trial program about a year ago in select hospitals around the state as a means of addressing nursing burnout, which has become more prolific throughout the industry since the start of the pandemic. It's just one of many different ways the hospital system is addressing one of the more existential threats to the industry.
The toll of burning out
The National Library of Medicine describes burnout as one of the biggest drivers of the ongoing nursing shortage.
About two-thirds of all nurses experience burnout, according to the American Hospital Association. The phenomenon isn't just a sense of exhaustion, it's a workplace injury, said Dr. Maureen Leffler, chief wellbeing officer at Nemours Children's Health.
"Like a needle stick injury or getting hit on the head by construction a beam at a construction site," Leffler said. "Burnout means that our nurses are at an increased risk of depression, anxiety, suicidality, substance abuse or misuse, or relationship problems. So it hurts them, and then indirectly, or directly harms our ability to care for patients and families."
According to a recent study released by Florida Nurses Association, more than 80 percent of nurses feel that demanding work conditions puts patients' lives at risk. Another 51 percent of nurses report having anxiety or depression.
Other concerning points the report found included:
- Almost two-thirds of nurses have witnessed inexperienced or unqualified personnel attending to a patient due to a shortage of qualified nurses.
- Another two-thirds have seen safety rules at a hospital ignored or applied inconsistently due to a shortage of qualified personnel.
- Nearly 9 of 10 have worked in a setting that they felt did not have enough nurses on staff
- 59% of nurses have difficulty sleeping
- 29% say the stress of work has strained their marriage
"Nursing burnout has also been a constant in the profession which is one of the factors that cause a shortage," said Willa Fuller, executive director of the Florida Nurses Association. "There is some research that states that there is no shortage of nurses, just a shortage of nurses willing to tolerate the stress and risk of working at the bedside. There is a general feeling of not being able to provide adequate safe care."
Pushed to the brink
Nursing is a calling for Melinda Leach, but she recognizes it isn't for the faint of heart. She loves what she does, but there are hard days.
Some of the hardest came during the beginning of the COVID-19 pandemic.
"None of us knew what we were up against. It was a scary time for many," she said.
The hospital was short on supplies and had a plethora of patients. Leach felt AdventHealth did everything it could to keep its staff safe, but some of her colleagues didn't feel the same.
"And I think that's what frustrated them. Some of them would say, 'Hey, I'm out. I don't want to deal with this anymore,'" Leach said. Colleagues were feeling burnt out and underappreciated. "(They feel) They're not being heard, their needs are not being met. And then they, for lack of better words, they just say 'I give up. I need to think of a different career. I don't want to feel this way anymore.'"
Ian Barnett has been a nurse at AdventHealth for six years. He, too, felt it was a calling. But the stress of the pandemic nearly pushed him out of the job.
"We didn't know what we know now about COVID and the stress level was quadrupled back then when you were taking care of (patients)," he said. "There were times where it was like, it's time to look for something else."
What made it harder was quarantine. Barnett felt he couldn't share his stress with anyone. He felt lonely. The places he'd meet his friends were closed, and he felt his family couldn't relate to the struggles he faced at work.
"You just look for the light at the end of the tunnel," he said.
Light in the tunnel
Nationally, more than 600 thousand nurses are expected to leave the industry due to stress over the next four years, according to the American Hospital Association.
To better address burnout, Nemours Children's Hospital has established a peer support program and hired a well-being psychologist, Leffler said.
"I think that that's another way that we're paving the road towards the future where self-compassion and self-care is a priority," Leffler said.
Over the last year, AdventHealth's Virtual Nursing program has received lots of positive feedback from staff. So much so, the hospital system has been adding more cameras to rooms for the program. Leach has been a fan, not only because it lightens her load but it allows her more time to do her favorite part of the job.
"To sit with our patients, even if it's an extra couple of minutes, just to make them feel like they're not alone. That's the most important thing," she said.
AdventHealth’s chief nursing officer for the north region of Central Florida, Michele Goeb-Burkett, said the hospital takes staff mental health seriously and offers access to chaplains, a 24/7 support hotline as well as smartphone apps with connections to staff trained to help. The goal is to stop nurses from blaming themselves for things beyond their control. For example, angry and sometimes violent patients.
"And they're not directing that negativity toward you as much as they are in the situation. And I think sometimes as a nurse, we think we're the, the cure-all in the superhero, and we can fix everything And so you know, you can't fix everything," Goeb-Burkett said.
AdventHealth has seen a 50% reduction in turnover since 2022, Goeb-Burkett said. The hope is to reduce those numbers even more.
Two years ago, the hospital system tried a different approach to help with burnout – music.
Barnett, who lives in New Smyrna, heard about AdventHealth’s 60-staff-member orchestra and wished to try out as a bassoonist. He wasn't confident he'd make the cut due to living far from the orchestra based out of Orlando. However, that was not the case. Barnett is currently the orchestra's principal bassoonist.
He has to drive 90 minutes to rehearsal in Altamonte Springs, but he says it's been worth it.
The demands of working during COVID almost ended his career but music helped change that, Barnett said.
"I said the light at the end of the tunnel, and this is the light now. I'm continuing to grow and heal and this orchestra has been a huge help with that," he said.
Barnett said while nursing is difficult he knows it’s what he’s meant to do, and the orchestra allows him to not only continue in the profession but also study to become a nurse practitioner, he said.
"I know, I was put on this path for a reason," Barnett said.
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