1. Koppel, Jenna BA
  2. Virkstis, Katherine ND
  3. Strumwasser, Sarah AB
  4. Katz, Marie MPH
  5. Boston-Fleischhauer, Carol JD, MS, RN


The nursing workforce is at the center of many changes associated with care delivery transformation. To achieve this transformation, frontline nursing staff must be engaged in their work, committed to their organization's mission, and capable of delivering high-quality care. To identify top opportunities for driving nursing engagement, researchers from The Advisory Board Company analyzed engagement survey responses from more than 343 000 employees at 575 healthcare organizations. In this article, the authors describe 3 strategies for addressing 1 of the greatest opportunities for improving nurse engagement: ensuring nurses feel their organization helps them reduce stress and burnout.


Article Content

Advisory Board Survey Solutions (ABSS) offers a suite of validated surveys focused on enhancing workforce culture. The Employee Engagement Survey1 was developed to understand and impact current trends in nurse engagement. Researchers of ABSS used these survey data and conducted a series of qualitative analyses to identify the top 5 opportunities for improving nurse engagement. Further detail on the authors' research background and methodology was reported in Perspectives on Engagement in the April 2015 issue of The Journal of Nursing Administration.2


A Top Opportunity for Improving Nurse Engagement

Failing to Prevent Stress and Burnout Among Frontline Nursing Staff

Among the top 5 opportunities for improving nurse engagement, the area in which organizations have the lowest performance is reducing nurse stress and burnout. The nursing workforce is at the center of many changes associated with care delivery transformation. Considering the magnitude and overwhelming pace of change taking place in the healthcare industry, it is no surprise that the healthcare workplace has become a more stressful environment for nurses. However, there is widespread sentiment among nurses that their organization is not doing enough to support them in this time of change: less than half of nurses agree or strongly agree with the statement "My organization helps me deal with stress and burnout."1


Participants from the telephone interviews confirmed 2 main reasons why nurses do not feel their organization adequately helps to reduce stress and burnout. First, organization-driven tactics to reduce or manage stress are implemented only after nursing staff already feel "burned out." Second, the tactics do not address the overwhelming pace of change nurses face, a key driver of their stress. The pace of change is not expected to lessen in the near term; in fact, researchers from the Nursing Executive Center (NEC) anticipate that changes will occur even more rapidly in the future. In short, while many organizations do have tactics in place to reduce nurse stress and burnout, they either come too late or fail to address key drivers of nurse stress.


Despite the rapidly changing healthcare environment, leaders can address these challenges by confronting disorganized scheduling and communication that exacerbates staff stress. Disorganized change scheduling and communication result from 4 common missteps: leaders often provide too much or too little information, messages lack clear action steps, communications are often branded with excessive urgency, and staff are not given sufficient visibility into the reason behind the change. Because organizations have limited control over the volume of change they must introduce, leaders must effectively regulate the flow of change as well as how it is communicated to staff, focusing staff attention on highest-priority changes that are evenly paced where possible. NEC researchers identified 3 primary strategies for reducing nurse stress and burnout by modifying how change is communicated to frontline staff: limit the volume of organization-wide communication, highlight most critical information, and regularly resequence changes.


Limit the Volume of Organization-Wide Communication

Nursing staff are often inundated by a large volume of e-mail communication informing them of both urgent and less important organizational changes or priorities. As a result of this e-mail overload, staff may have trouble discerning which information is most important for them to know and unintentionally delete critical messages. To avoid this, top-performing healthcare systems limit organization-wide e-mail communication to only the most urgent and important information and use other venues of communication for less urgent changes or priorities. For example, at a hospital on the West coast, leaders vet communication appropriate for e-mail by requiring any individual requesting to send an organization-wide communication to justify the reason for the communication in a standardized form. The request is then evaluated by an executive leader. Staff can access less urgent information through other venues, which may include a centralized intranet, posters, and table tents. Leaders purposefully limit staff's immediate attention to only urgent information by rigorously vetting what information is sent through e-mail; this prevents staff from becoming overwhelmed by a large volume of e-mail communication.


Highlight Most Critical Information

In addition to limiting the volume of organization-wide e-mail communication, high-performing organizations provide guidance to staff on which e-mails contain the most important information or require immediate next steps. For example, at 1 organization, leaders use specific words in the e-mail subject line to indicate the priority level of the content. They mark the subject line of e-mails with critical or urgent content "white" or "red" depending on the level of follow-up required and mark nonurgent e-mails providing simply nice-to-know information "green." The 2nd method is to use colored font in the subject line or the body of the e-mail to delineate the priority level of information contained in the message and call attention to the most important updates. For example, at a health system on the East coast, leaders delineate action items in red font, "nice to know" information with green font, and all other communication in black font. By indicating the priority level of messages in this manner, leaders enable staff to quickly prioritize which e-mails to open 1st and to differentiate action items from general information.


Regularly Resequence Changes

While organizations have limited control over the volume of change that impacts staff workflow, leaders can spread change initiatives throughout the year to avoid unnecessary overlap and resequence new initiatives as needed to ensure that specific groups do not feel overwhelmed. By deliberately pacing change initiatives, leaders are able to communicate to staff when to expect periods of intense change. For example, facility executives at a hospital in the Midwest meet regularly to discuss current organizational initiatives and schedule the rollout of new initiatives. Leaders record upcoming changes on an inpatient nursing change calendar, with the goal of spreading activities as evenly as possible across the year and avoiding overburdening any 1 unit or department. Leaders' discussions include details on scale of change, impact of change on strategic goals and implementation, level of priority for other departments, and manager feedback.


Some organizations are now using a facility-wide change calendar to ensure changes are paced appropriately throughout the year. At progressive organizations, leaders share the change calendar with frontline staff to communicate upcoming initiatives. By sharing the change schedule, leaders give staff the opportunity to ask questions and better understand the rationale for each change and how it relates to the organization's mission. Sharing the change schedule also shows staff that leaders are responsive to their feedback, such as when leaders reschedule new initiatives in response to frontline feedback.



An organization's ability to operationalize its care transformation efforts is dependent on an engaged and energized nursing workforce. Meaningfully regulating the communication of change to staff is critical to building an engaged workforce. Highly engaged nurses feel their organization helps them deal with stress and burnout, which increases their sense of buy-in to organizational priorities and energy to operationalize new strategy. NEC researchers found organizations that successfully support staff in managing stress and burnout have implemented 3 primary strategies: limiting the volume of organization-wide communication, directing staff to highest-priority information, and mitigating the pace of change.




1. Advisory Board Nurse Engagement Survey. Washington, DC: Advisory Board Survey Solutions, The Advisory Board Company; 2014. [Context Link]


2. Strumwasser S, Virkstis K. Meaningfully incorporating staff input to enhance frontline engagement. J Nurs Adm. 2015; 45(4): 179-182. [Context Link]