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Grant Nurses the Serenity… to Avoid Burnout

Burnout in healthcare was a problem long before the pandemic came along, but the pandemic turned a festering problem into a cankerous boil.

Burnout in healthcare was a problem long before the pandemic came along, but the pandemic turned a festering problem into a cankerous boil. A NurseGrid survey of more than 10,000 respondents found that 61% of nurses reported high levels of burnout in December 2020. The problem has led researchers, administrators, and nurses to seek solutions. A recently published study revealed the fruits of one of those efforts: A pilot program using “serenity lounges” as a holistic approach to burnout was successful enough that the hospital expanded it shortly after the pandemic began. 

The study, published in the American Journal of Nursing in the May 2022 issue and authored by a team of nurses at Cedars-Sinai Medical Center in Los Angeles, cited the definition of burnout from the World Health Organization’s ICD-11, which centers on three components: ”feelings of energy depletion or exhaustion; increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; and reduced professional efficacy.”

While burnout hampers nurses’ job satisfaction, mood, and mental and physical health, its dangers—as nurses well know—go beyond harming nurses themselves. Burnout also hurts nurses’ performance, which can endanger patient safety. And, of course, it can hurt the hospital’s bottom line too, which is sometimes the most effective argument for getting hospital administrations to take the major steps necessary to address burnout.

The question is, what do those steps look like? The study authors first reviewed the existing research on approaches to reduce burnout, including stress management programs, resilience training, and mindfulness. Some hospitals also used staff recognition boards, increased leadership rounding and support, peer support groups, chaplains to provide spiritual care and support, and “restorative breaks” in “zen rooms” to reduce stress and fatigue. These specialized rooms were linked to an improvement in nurses’ job satisfaction and performance, and adding a massage chair ”had a positive effect on perceived emotional stress, blood pressure, heart rates, and musculoskeletal overstrain, as well as pain and quality of life, while also being cost-effective,” the authors reported. 

That was the direction the Cedars-Sinai group decided to go with their quality improvement initiative to address burnout—creating a “serenity lounge,” including a massage chair, to promote rejuvenation and calmness. The pilot program began before the pandemic, in February 2019, with the conversion of a locker room into a lounge with calming decor:

  • Walls painted a calming shade of blue
  • “Zen-themed” wall decorations, including images of nature and inspirational quotes
  • Two recliner chairs (donated) 
  • Electric percussion massagers
  • A Himalayan salt lamp
  • An essential oil diffuser
  • A table fountain on a donated table
  • An audio system that played nature sounds, such as ocean waves and rain

The room had no windows so that the lights could be dimmed or fully darkened, and nurses notified the charge nurse when they used the room so that interruptions were less likely. The lounge was used daily by 8 to 10 nurses per 12-hour shift for about 30 minutes each. Surveys collected by the authors found that stress levels on a 5-point scale dropped from 4 or 5 to 0 or 1 after using the lounge for 80% of the nursing staff. ”These results indicated that the serenity lounge was a promising intervention that could promote a healthier work environment, decreasing stress levels and possibly preventing high levels of staff burnout,” the authors wrote. 

Then came the pandemic, the explosion of stress, and, even worse, burnout. Given the success of the serenity lounge pilot program, nursing leadership converted 10 other rooms in different inpatient nursing units, including the Covid-19 units, into serenity lounges from April through June 2020. Each room had a massage chair and sanitizing wipes, gloves, and shoe covers to follow infection control protocols.

The rooms had previously been meditation rooms for patients’ families, but restricted visitation during the pandemic opened them up to their new use. Some lounges operated on a first-come, first-served model, and others used a sign-up sheet. 

”Both approaches established a workable unit-specific communication process that kept the charge nurse, the break relief nurse, and the assistant nurse manager informed so they could assist with patient care and maintain safety measures while a given nurse was in the lounge,” the authors wrote. Assessment of the QI initiative involved surveying 67 workers (94% nurses) on their feelings of emotional exhaustion, burnout, frustration, and being worn out before and after using the lounges. All the respondents reported high levels of those feelings before using the room, and as a group, they had missed an average of 4 shifts or days of work in the previous three months.

Respondents reported an average one-point reduction on a 4-point scale for each of those feelings after using the room. Those who used the massage chair for 10-20 minutes experienced lower levels of exhaustion, anxiety, and feeling worn out than those who used it for less than 10 minutes. 

”While many nurses can benefit from a week-long vacation away from the stressful work environment, even a 10-to-20-minute relaxation break on a massage chair in a serene space in a workday may be effective in preventing the long-term negative effects of chronic stress,” the authors wrote. “The results shed light on the importance of comprehensive, holistic interventions in helping to provide a serene environment in which staff can promote overall wellness.”

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