Tiffany A Moore, PhD, RN, FAWHONN, Alyson E. Hanish, PhD, MSN, RN

Burnout is an enduring and significant barrier to well-being. The National Academies of Sciences, Engineering, and Medicine and the Committee on the Future of Nursing 2020–2030 published a ‘call to action’ to improve nurses’ personal and professional well-being. The health and well-being of nurses are affected by the demands of their workplace, and in turn, nurse well-being affects patient care and safety. 

Nurses are stressed, and not just those nearing their retirement. In May 2023, the American Nurses Foundation (ANF) conducted a follow-up Mental Health and Wellness survey. Of the 7,419 respondents, 56% reported experiencing burnout, and 40% reported their work as hectic and felt little control over their workload. Over half of the nurses surveyed reported feeling ‘stressed,’ ‘frustrated,’ exhausted,’ or ‘overwhelmed,’ yet only one-third of the nurses in the study received mental health support. Of interest, the nurses more likely to be experiencing these burnout symptoms in their current role were the nurses with less nursing experience. Specifically, over 70% of nurses <35 years of age reported feeling stressed or exhausted in the past 14 days, with 43% reporting their stress continuum levels in the “injured” or “ill” categories. These staggering and sobering statistics offer a glimpse into the push behind national priorities for nurse wellness initiatives. 

Not only does burnout affect an individual’s physical and mental health, but burnout is also a public health crisis. A significant consequence of burnout is its impact on the other ‘crisis,’ the nursing shortage. An estimated shortage of over 78,000 registered nurses (RNs) is expected in 2025. According to the National Council of State Boards of Nursing, 100,000 nurses left the workforce during the pandemic. By 2027, almost 900,000, or almost one-fifth of 4.5 million registered nurses, intend to leave the workforce due to stress, burnout, and retirement. This means the nurses who stay in the field will be exposed to additional nursing shortages and excessive workloads, further contributing to burnout. This threatens the national healthcare system at large if solutions are not enacted. 

But what about nurses in the Neonatal Intensive Care Unit (NICU)? Are they immune to burnout? One pre-pandemic multisite study reported that the average burnout rate among 2073 NICU providers was 26%, ranging from 8-54% across 44 NICUs in the United States. A recent publication on burnout in NICU nurses (n=136) reported high levels of accomplishment in the majority of their NICU nurses; however, most nurses also reported high/moderate (n=63/51) levels of emotional exhaustion and high/moderate (n=41/74) levels of depersonalization. Although the authors did not find a direct correlation between burnout scores and turnover rates, these pre-pandemic levels of burnout among NICU nurses are alarming and consistent with the current trends found by ANF. Another recent systematic review searched for relevant studies addressing burnout and coping in the NICU. The authors identified five studies that measured burnout in NICU nurses and concluded that nurses working in the NICU experience high rates of burnout with minimal resources to utilize their coping skills. Specifically, the review highlighted the lack of evidence-based coping mechanisms offered to NICU nurses, and the difference between ‘just coping’ and ‘coping well’ is not understood. So, the answer is no: NICU nurses are not immune to burnout. In fact, given the severe nature of the ICU environment, these critical care nurses are at an even higher risk of burnout. 

Between empirical data and mainstream headlines, well-being initiatives for the nursing workforce are a national priority. Many organizations (e.g., National Institutes of Health and Centers for Disease Control- National Institute for Occupational Safety and Health) continue identifying feasible and sustainable interventions to target burnout and well-being, incorporating individual and system-level interventions. There also is an increased drive for policy changes and legislation related to health workforce well-being. Highlighted below are example sentinel reports and legislation related to health workforce burnout. 

• In 2022, the Office of the Surgeon General released an advisory addressing health worker burnout. The advisory highlights the urgent need to address the health worker burnout crisis across the United States, including action items for healthcare organizations, federal, state, local, and tribal governments, health insurers and payers, healthcare technological companies, academic institutions, accreditation bodies, as well as family, friends, co-workers, and health workers themselves. Dr. Vivek Murthy, Surgeon General of the United States, reflects on our choice to make this moment a collective commitment- where health workers can look ahead and see a future where their health, safety, and well-being are as much a priority as the people and communities in their care. 
• The National Academy of Medicine released the National Plan for Health Workforce Well-Being, highlighting the need for taking collective action for the future of the nation’s health system. This National Plan’s vision is a thriving health workforce with an environment that fosters well-being as they improve population health, enhance the care experience, reduce costs, and advance health equity- thus achieving the quintuple aim. The plan highlights seven priority areas for health workforce well-being, including workforce culture and technology. It addresses compliance, regulatory, and policy barriers for daily work, with relevant goals, associated actors, and action items. 
• The Dr. Lorna Breen Health Care Provider Protection Act is a landmark, first-of-its-kind legislation supporting health workforce mental health and well-being. Since its passage in 2022, the Lorna Breen Act has funded (through the Health Resources and Services Administration- HRSA) 44 health organizations $103 million to implement evidence-informed strategies that reduce and prevent suicide, burnout, mental health conditions, and substance use disorders. As of June 2024, The Dr. Lorna Breen Health Care Provider Protection Act is up for re-authorization. 

In 2022, HRSA funded our team through the inaugural cohort of grantees via the Dr. Lorna Breen Health Care Provider Protection Act. Our grant, the Nebraska Collaborative Investment in Nurses, aims to deliver wellness-based interventions and resources to address and reduce burnout and mental health conditions for those working in rural and medically underserved areas (MUA) across Nebraska. Here are a few strategies we have found to have a meaningful impact on our health workforce, including nurses, in and beyond Nebraska. 

1. Burnout and mental health conditions are multidimensional, requiring integrated individual and system-level action. Our team found organizational partnerships, including partnerships with the Nebraska Center for Nursing and the Nebraska Board of Nursing, critical to our success and impact. One of our shared goals was to reduce the stigma of mental health. This partnership led to the Nebraska Board of Nursing as the first nursing recipient of the ALL IN: WellBeing First Champion Badge, indicating that the nursing licensing applications in Nebraska were free from overly broad and invasive mental health questions. Clinicians often avoid mental health care because of the fear of losing their licenses and credentials, as language on applications can be seen as broad and invasive. 
2. Our team identified the need for a broader nursing career focus on wellness to address burnout and mental health conditions. Our team implemented the Wellness How One Lives Effectively (WHOLE) program for nursing students (during orientation) and practicing professionals focusing on rural and medically underserved areas. The WHOLE program is an adaptive and flexible curriculum that utilizes Acceptance and Commitment Therapy, Mindfulness-Based Stress Reduction, Stress Management and Resiliency Training, and the Eight Dimensions of Wellness. Our programming aimed to create a psychologically safe space to share, build comradery, and learn from each other. In addition, our team delivered mental health first aid (students and faculty) and psychological first aid (health workforce) with associated certification options. 
3. From 2022-2024, our team offered no-cost continuing education on topics identified by nurses. Our team implemented Heal the Healer summits, webinars, and in-person retreats, which were highly attended (1000+ participants). Topics included burnout, workforce well-being, workplace incivility and violence, compassion fatigue, communication techniques, NICU debriefing models, and systems-level burnout interventions, including return on investment calculations. 

Leaders have tremendous responsibility and opportunity to address issues at the root of burnout. Addressing the factors contributing to burnout is fundamental to fostering professional well-being and a thriving health workforce. We must acknowledge a large gap between where we are with nurse workforce burnout and well-being and where we need to be. We must work collectively on our future of health workforce well-being. 

References: 

1. Sullivan, D., Sullivan, V., Weatherspoon, D. & Frazer, C. Comparison of Nurse Burnout, Before and During the COVID-19 Pandemic. Nurs Clin North Am 57, 79–99 (2022). 
2. Martin, B., Kaminski-Ozturk, N., O’Hara, C. & Smiley, R. Examining the impact of the COVID-19 pandemic on burnout and stress among US nurses. Journal of Nursing Regulation 14, 4–12 (2023). 
3. National Academies of Sciences, Engineering, and Medicine, National Academy of Medicine & Committee on Systems Approaches to Improve Patient Care by Supporting Clinician Well-Being. Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being. (The National Academies Press (US), Washington, DC, 2019). doi:10.17226/25521. 
4. US Department of Health and Human Services, Office of the Surgeon General. Health Worker Burnout https://www.hhs.gov/surgeongeneral/priorities/health-worker-burnout/index.html. 
5. National Plan for Health Workforce Well-Being. (NAM Special Publication, Washington, DC, 2024). doi:10.17226/26744. 
6. Committee on the Future of Nursing 2020–2030, National Academy of Medicine, & National Academies of Sciences, Engineering, and Medicine. The Future of Nursing 2020- 2030: Charting a Path to Achieve Health Equity. 25982 (National Academies Press, Washington, DC, 2021). doi:10.17226/25982. 
7. American Nurses Foundation. Understanding and Prioritizing Nurses’ Mental Health and Well-Being. https://www.nursingworld.org/practice-policy/work-environment/health-safety/disaster-preparedness/coronavirus/what-you-need-to-know/survey-4/. 
8. Health Resources & Services Administration. Nurse Wordforce Projections, 2021-2036. (2024). 
9. NCSBN. NCSBN Research Projects Significant Nursing Workforce Shortages and Crisis. https://ncsbn.org/news/ncsbn-research-projects-significant-nursing-workforce-shortages-and-crisis (2023). 
10. Profit, J. et al. Burnout in the NICU setting and its relation to safety culture. BMJ quality & safety 23, 806–813 (2014). 
11. Thomas, A. O., Bakas, T., Miller, E., Johnson, K. & Tubbs- Cooley, H. L. Burnout and turnover among NICU nurses. MCN: The American Journal of Maternal/Child Nursing 47, 33–39 (2022). 
12. Butcher, I. et al. Burnout and coping strategies in pediatric and neonatal intensive care staff. Clinical Practice in Pediatric Psychology (2023). 
13. Ramírez-Elvira, S. et al. Prevalence, risk factors and burnout levels in intensive care unit nurses: a systematic review and meta-analysis. International Journal of Environmental Research and Public Health 18, 11432 (2021). 
14. Lima, A. et al. The burnout of nurses in intensive care units and the impact of the SARS-CoV-2 pandemic: a scoping review. Nursing Reports 13, 230–242 (2023). 

Acknowledgment: This project is supported by the Health Resources and Services Administration (HRSA) of the US Department of Health and Human Services (HHS) under U3NHP45394-01-00, Nebraska Collaborative Investment in Nurses: Resiliency, Retention, & Well-being, $2,245,694. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, or the US Government. 

Disclosure: The authors have no conflicts of interests to disclose