A cost-effective approach to teaching and applying mindfulness
- Burnout impacts nurses mental, emotional, and physical well-being, leading many to leave the profession.
- While nurses can perform various forms of self-care, promoting programs within the hospital setting allows for consistent care of a larger number of nurses to be cared for consistently.
- Programs targeting burnout have positively impacted nurses’ personal and professional wellbeing.
The past few years have brought drastic changes within healthcare systems. The pandemic has, in many ways, altered how the system operates, which has impacted the roles of all healthcare workers, including nurses. According to the American Nurses Association, nearly 18% of new graduate nurses leave the profession within the first year, citing stressful working conditions and understaffed locations. The association also found that 69% of nurses under 25 experience burnout of some kind.
Nurse burnout results from long-term and unmanaged workplace stress. Not unique to healthcare, it presents especially grim implications for healthcare professionals. Soósová notes that burnout can lead to anxiety, depression, reduced work performance, and increased turnover rates.
Ending burnout and stigma in nursing
Battling burnout and languishing
Various organizations, such as the Institute of Medicine (IOM) and The Joint Commission, have identified burnout as a threat to healthcare workers. IOM has created action committees to research burnout, implement countermeasures, and identify areas of improvement. The Joint Commission recommends solutions to reduce burnout that include enhancing meaningfulness in the work setting, facilitating the attainment of nurse goals, and providing autonomy.
The nursing profession requires comprehensive and multifaceted strategies to combat burnout. Leadership training and adequate staffing can help address the issue, but they’re not the only solutions. A study at Shannon Medical Center explored and analyzed various interventions, many of which offered practical solutions that nurses, units, or the larger organization could implement. Mindfulness courses offer an opportunity to educate nurses on the concept of burnout while simultaneously providing resources for combatting it. If implemented effectively, these interventions could significantly improve nurse retention rates.
Mindfulness as an intervention
During a literature review—using terms such as “nurse burnout,” “nurse burnout interventions,” and “hospital interventions for nurse burnout”—I found various tactics and strategies implemented by an array of organizations and individuals to combat burnout. These strategies include self-care recommendations (yoga, journaling), mindfulness workshops, and leadership training.
Kurosaka and Payton found that personal interventions can aid in recharging after a difficult day. Green and colleagues reported job satisfaction and reduced nurse burnout when organizations implement team huddles, staff recognition events, and modified staff assignments.
Although all interventions yielded positive outcomes, mindfulness courses and interventions displayed a notable impact. For example, the Project7 Mindfulness Pledge, identified by Monroe, and mindful group projects described by Xie and Bianchini, had optimal results that helped reduce nurse burnout. When nurses prioritized a mindfulness course, they experienced the best results, even 3 months after completion, according to Xie.
A combination of individual, group, and system-wide interventions has the potential to lower nurse burnout and improve mental health. Shannon Medical Center, for instance, offers Oxygen for Caregivers (adventuresincaring.org/oxygen-for-caregivers), an online resource available through Adventures in Caring, which focuses on addressing nurse burnout. This program asks nurses to take time once a week for 3 weeks to learn and practice mindfulness techniques, such as prompted writings, journaling, and conversations among like-minded individuals.
Intervention
The Shannon Medical Center women’s and children’s director initially introduced Oxygen for Caregivers as an elective course in the pediatric, neonatal intensive care, and women’s health units as part of the onboarding process for new nurses. Program objectives included defining compassion fatigue within the nurse’s area, understanding how it impacts each nurse, and offering general and personal tools that nurses can implement during their day.
In my role as LEAN specialist, I found this program intriguing as a way to reduce burnout throughout the hospital. I spoke to the women’s and children’s director and worked with the LEAN department to identify needs and areas for improvement to support extending the program’s reach.
Implementation
Implementation of the expanded program began by identifying key stakeholders, including the education department staff tasked with tracking the participants and the innovation department, which assisted in bringing the key stakeholders together, offered guidance, and developed implementation plans. The women’s and children’s director assigned child life specialists (nurses trained to manage sensitive topics) to act as lead educators. Their extensive knowledge and expertise in communicating complex issues made them the ideal candidates to lead the program.
Before the go-live date, the team of stakeholders attended three biweekly meetings to identify course objectives as well as barriers that might surface during the pilot. Based on feedback from staff about the need for smaller groups to aid meaningful conversation, one of the hospital’s child life specialists recommended limiting the number of participants to allow for discussion of delicate topics. Ultimately, we set the max at 18, the number allowed for in the budget. Other identified barriers included budget constraints and clinical staff time availability.
Before rollout of the pilot intervention, the stakeholder team asked the med-surg, ICU, and step-down unit managers if they had nurses or nurse aids who might benefit from the course. Before sending a team member, some managers chose to attend the course so they could assess outcomes. During the pilot, 12 individuals, ranging from frontline staff to managers, attended; 11 successfully completed the course.
At the beginning of the course, participants completed the Copenhagen Burnout Inventory, an open-access tool to determine baseline burnout. In addition to group discussions, each participant received a personal copy of the course workbook in which they could write about their own thoughts and experiences.
After completion of the course, the participants retook the burnout inventory, which indicated an average overall reduction in burnout of 8.9%.
Despite the positive outcomes, the team identified several barriers during the pilot. For example, many veteran nurses voiced doubt over the existence of burnout. These managers said they wouldn’t attend a class like this because they don’t believe it offers anything of value. These responses indicate the need for a culture change, a return to a degree of normalcy, and ongoing implementation of this strategy along with other tactics.
Because the initial program received some pushback from management, I explained the purpose of the course in detail to managers and invited them to participate. I also shared their anonymous survey results, showing the improvements in reduced stress after the course. This helped them recognize the positive impact and encouraged them to refer their staff as we rolled out the program.
In addition, I presented the initiative in our organization’s Kaizen Fair, where we showcase various projects. During my presentation, I had the opportunity to speak with senior leadership and administration, who expressed genuine excitement about the initiative and offered their support. Additionally, I advocated for our marketing department to highlight the course in the organization’s newsletter. Overall, engaging with different leaders about the initiative allowed for open conversations about burnout, which rallied support for the course and brought focus to the implications of burnout on frontline staff.
Resources and budget
The Oxygen for Nurses program costs approximately $2,400 (including staff time, educators’ time, resources, and materials). According to NSI Nursing Solutions, a single nurse turnover (including investments in recruiting and training) costs an organization about $56,000. (See Budget justification.)
Budget justification
The cost of replacing a nurse who leaves a position as a result of burnout far exceeds the cost of providing mindfulness training to help nurses manage work stress. The following budget is based on the cost of items and salaries in fiscal year 2023.
Nurse instructor
Salaries for nursing educators stand at about $44 per hour. The cost of paying them for three 90-minute Oxygen for Caregivers courses runs about $198 per class.
Staff nurse
Staff nurse salaries receive about $25 per hour depending on their level of education. The cost of paying 15 nurses while they attend the mindfulness classes would cost $2,025.
Course cost
The Oxygen for Caregivers course, offered through Adventures in Caring, provides a comprehensive training package and lifetime online access for $185, including videos, a leader’s guide, and required documents.
Documents
The course includes four one-page documents. Making copies of each document costs about $0.25 per page ($1.00 for the four documents). The course requires 18 sets of the documents ($18 for the entire course).
Total cost
Ultimately, the number of nurses who participate determines the final costs. However, assuming 18 nurses attend, the total cost comes to approximately $2,426.
Evaluation and outcomes
The stakeholder team evaluated outcomes using the Copenhagen Burnout Inventory. The team chose this assessment tool because of its recent creation and close connection to the World Health Organization’s position on burnout. The assessment measures personal, work-related, and client-related stressors.
Although the pilot course had only 12 participants and one month post-course completion, pre- and post-survey indicated a decrease in all areas of stress (personal, workplace, and patient-related). (See Course outcomes.)
Course outcomes
Nurses completed the Copenhagen Burnout Inventory prior to and after participating in the Oxygen for Nurses course. The 19-item inventory asks nurses to rate three areas of burnout (personal, workplace, and patient-related).
Daily attention
Burnout, a persistent issue for nurses exacerbated by the COVID–19 pandemic, has resulted in high turnover rates. In response, Shannon Medical Center successfully implemented a pilot intervention with promising results, which instilled confidence in our collective ability to address this challenge. The course serves as one of many approaches organizations can take to address burnout.
To better serve patients, nurses must be mentally and emotionally equipped to handle difficult situations. The stakes remain high due to the impact that nurse burnout has on nurse well-being and patient outcomes. Burnout requires daily attention.
Jocelyn Perez is a LEAN Specialist at Shannon Medical Center in San Angelo, Texas.
American Nurse Journal. 2025; 20(3). Doi: 10.51256/ANJ032523
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Key words: burnout, mental health, nurse retention, mindfulness
