On average, one year in a nursing home costs $91,000. This begs the question: what are long-term care facilities doing to keep their costs down for their residents and their families, if anything? On Twitter, one response we got from a nurse was particularly troublesome: There were four residents per room at her nursing home, with one nurse covering every 20-25 residents.

Although this staffing strategy may very well be effective in keeping costs from rising even higher, is it the best strategy for patients and their families?

The consequences of over-burdening skilled nursing staff are significant: lower patient satisfaction and problems with quality of care. In fact, a recent survey conducted by University of Pennsylvania researchers found that 37 percent of nurses in nursing homes reported feeling burnt out in their current jobs (compared to 22 percent of nurses in other settings); 47 percent of nursing home nurses said that their workload resulted in significant changes in their patient’s condition (compared to 21 percent in other settings).

With pressure mounting from the Centers for Medicare & Medicaid Services (CMS) to maintain superb outcome metrics in order to maximize reimbursements through a “value over volume” approach, how can nursing homes and skilled nursing leaders help combat the issue of nurse and caregiver burnout?

Signs of Nurse Burnout

Caregiver stress can exhibit itself in a number of forms — by recognizing them, you’ll be better equipped to identify and address staffing inefficiencies in your facility. If you don’t have the ability or capacity to pay attention to these symptoms, consider conducting an employee satisfaction survey or individual interviews to accurately gauge the level of stress among your clinical staff.

Some common signs of nurse and caregiver burnout include:

• Anxiety, depression and irritability
• Mental and physical fatigue
• Overreacting to minor issues
• Health problems presenting themselves or getting worse
• Difficulty concentrating
• Increase in unhealthy habits, such as drinking, smoking, or overeating
• Neglecting or failing to complete important tasks

Stress and burnout among caregiving staff can have myriad effects, both personal and professional. Medication doses can be missed or dispensed incorrectly. Patient falls can be ignored, responded to late, or not tracked. Residents that need to be turned won’t be, resulting in pressure ulcers that are costly to treat (or litigate). You also run the risk of losing your valuable caregivers to other facilities, resulting in an even tighter staffing strain. Can you afford to stress out your staff?

Caring for Caregivers

If you find that your staff displays the symptoms of caregiver burnout, consider implementing the following initiatives:

Ongoing Education

Use orientations and training seminars to clarify caregivers’ responsibilities and expectations, including ways to prioritize responsibilities, reduce time constraints, and deal with more difficult residents. Team-building activities can also be a great way to foster personal connections among staff to reduce stress.

Revisit Your Staffing Strategy

Of course, a burnt out staff can also indicate much larger issues in your approach to staffing. Revisit how consistent your schedules are (inconsistent assignments can be inconvenient for caregivers), give caregivers more influence when it comes to scheduling, and/or increase your nurse-to-resident ratio.

Honor and Recognize

Employee recognition programs can be superb tools for reducing burnout, positively reinforcing expectations and priorities, and creating an opportunity for employees to succeed. In a business where residents’ health naturally declines over time, recognizing successes, however small, can be a huge morale boost.

Automate

Many of the tasks that take up caregiver time can now be automated, thanks to new nursing technology. The temperature, air quality, and lighting in a resident’s room can now be adjusted automatically per individual preferences. Wireless patient monitoring solutions can be installed to measure residents’ risk of falling, alerting staff when events like falls or incontinence events do occur. Pharmacy robots can be used to simplify the prescription filling and delivery processes.

Nursing home operators have a lot on their plate. But recognizing staff burnout and addressing its symptoms can be an crucial first step toward building a home that residents and families love — and that the healthcare system rewards.