Burnout Brings Hospice Nurses to an ‘Urgent Crossroad’

Recent data may give hospice providers deeper insight around the driving forces of nursing shortages.

Hospices may see a mass exodus of registered nurses in coming years, particularly younger, newer and less experienced nurses experiencing pandemic-related burnout, according to an analysis from the National Council of State Boards of Nursing (NCSBN).

Nearly 900,000 of the nation’s 4.5 million registered nurses expect to leave the health care workforce by 2027, representing roughly one-fifth of the nation’s overall health care workforce, the NCSBN research found.

Almost a quarter (188,962) of these nurses will be younger than 40-years-old who have experienced “unprecedented” workloads during the pandemic.

Additionally, a majority of less experienced nurses indicated that high levels of stress and burnout have led them to consider leaving the industry.

The data paint a picture of what the hospice clinical workforce could look like without some critical changes, according to Maryann Alexander, chief officer of nursing regulation at NCSBN.

“The data is clear: The future of nursing and of the U.S. health care ecosystem is at an urgent crossroads,” Alexander said in a statement. “The pandemic has stressed nurses to leave the workforce and has expedited an intent to leave in the near future, which will become a greater crisis and threaten patient populations if solutions are not enacted immediately.”

Around 62% of the surveyed hospice nurses indicated that their workloads had increased during the pandemic. More than half reported feeling “emotionally drained” or “used up” — 50.8% and 56.4%, respectively.

Burnout and fatigue were also among the most frequently cited issues for 3.3% of nurses who have less than 10 years of experience, according to NCSBN.

Younger and newer generations of hospice clinicians are placing work-life balance at the forefront of their career considerations in the field, say some hospice leaders. This is leading hospice providers to increasingly hone their recruitment and retention strategies with flexible scheduling in mind.

Younger generations of clinical staff also are seeking more manageable patient caseloads, as well as more control, autonomy and input in their daily schedule, according to Nancy Linscheid, clinical education specialist and nurse residency program director for UnityPoint at Home.

Clinical staff highly value options like autonomous scheduling, Linscheid previously stated.

To bolster their ranks, a rising number of hospices have partnered with community colleges and state universities to build medical fellowship programs. Some have also enhanced their own staff education programs to engage a broader base of clinicians.

Meanwhile, legislation aimed at building up nursing educational and career pathways in hospice has stalled on the Congress floor. The Palliative Care and Hospice Education Training Act (PCHETA) has percolated among lawmakers for the last few years without passing. The bill would have authorized $100 million over the course of five years to support programs designed to bolster clinical education in hospice and palliative care, as well as other interdisciplinary roles.

It would also establish fellowships through new education centers providing short-term, intensive training in the field.

Today, Chemed (NYSE: CHEM) subsidiary VITAS Healthcare established an annual $40,000 scholarship grant at the Miami Dade College (MD) Benjamín León School of Nursing. The grant initiative is designed to make nursing education more affordable for four students each year.

Among the reasons that VITAS selected MDC is that the college enrolls the highest numbers of students of color nationwide, compared to other institutions of higher learning, a VITAS spokesperson told Hospice News.

The pandemic has only exacerbated the fact that the hospice nursing workforce is reaching a crucial tipping point, according to Alexander.

“There is an urgent opportunity today for health care systems, policymakers, regulators and academic leaders to coalesce and enact solutions that will spur positive systemic evolution to address these challenges and maximize patient protection in care into the future,” Alexander said.