Embedded therapist reduces burnout on critical care nursing team

Key takeaways:

• The stress of the COVID-19 pandemic prompted a health system to hire a full-time therapist for its nursing team.
• Nurses saw improvements in their perceived ability to manage their own mental health.

SAN FRANCISCO — Nurses in a critical care unit reported less burnout and more resiliency once a full-time therapist joined their team, according to an abstract presented at the American Thoracic Society International Conference.

This addition to the team also reduced turnover and absenteeism, which decreased costs as well, Julie-Kathryn Graham, PhD, APRN, ACCNS-AG, assistant professor, San Diego State University School of Nursing, said during her presentation.

“We wanted to quantify that the initiative was as meaningful as our hearts were telling us,” Graham told Healio.

Julie-Kathryn Graham

Health care systems typically address the stress that critical care nurses feel by offering off-site employee assistance programs (EAPs) or by training them to be peer supporters, the researchers said.

“Employee assistance programs are well known to be underutilized by nurses,” Graham said.

Few nurses take advantage of EAPs because they may not be aware of them or know how to access them, the researchers said.

“Additionally, nurses often find that outside therapists lack the insights into critical care operations and have a tough time understanding the trauma and stressors critical care nurses face,” Graham said.

Further, the researchers said, peer supporters may not be adequate for treating the stress that their colleagues feel, particularly since they may be experiencing the same stress themselves.

But a therapist embedded in the team, Graham said, would overcome these shortcomings.

“Also, as nurses, we know the critical value of establishing a rapport to healing,” she said. “Nothing can beat the rapport between members of a team.”

During the COVID-19 pandemic, the nursing team at the Sharp Chula Vista Medical Center in Chula Vista, California, reported significant mental strain. The turnover rate among ICU nursing staff reached 29%, the researchers said, with daily emotional breakdowns.

The facility partnered with an affiliated mental health hospital and embedded a trained therapist among the care team (n = 116; 78% women; mean experience, 12 years), which the researchers surveyed.

“Interactions included but were not limited to rounding, presence at codes, coaching, provision of and teaching utilization of self-care tools, and checking back,” Graham said.

The addition of the therapist was associated with improvements in job satisfaction (P = .003; d = 0.86), burnout (P < .001; d = 0.793) and resilience (P < .001; d = 0.622), as well as with a statistical impact on self-efficacy (P = .008; v = 0.258), defined as the nurses’ perceived ability to manage their own mental health.

There were no statistically significant relationships between years of experience, day vs. night shifts, clinical vs. non-clinical roles, gender or ethnicity and burnout, resiliency or job satisfaction.

Further, turnover fell once the therapist joined the team full time, falling to 1%. This rate was not sustained, the researchers said, but turnover remains very low.

“This saves the organization hundreds of thousands of dollars a year,” Graham said. “A nurse turnover rate of 1% is unheard of in the literature, and it is a critical problem facing hospitals across the country.”

Improvements in turnover led to these savings, the researchers said, considering the expenses of replacing nurses who leave. These improvements also led to decreased reliance on contracted staff and greater productivity. Adding a therapist to save these costs would be an investment, the researchers said.

Looking at these results, Graham called the rapport between the therapist and the members of the nursing team “the critical element missing from other mental health modalities available.”

The researchers now plan on a follow-up prospective cohort study with the San Diego State School of Business of outcomes including absenteeism and turnover.

“The study will be repeated with rigorous parameters of quantitative and qualitative research,” Graham said.

Graham also advised other health systems to embed therapists with their critical care nursing teams.

“Do it. It will save you tons of money and save your staff,” she said. “This model needs to catch on across the country, and we don’t have time to waste.”

Reference:

• Having a team therapist reduces burnout in critical care nurses. [https://www.newswise.com/articles/having-a-team-therapist-reduces-burnout-in-critical-care-nurses/?sc=sphr&xy=10017347] Published: May 8, 2025. Accessed: May 8, 2025.

For more information:

Julie-Kathryn Graham, PhD, APRN, ACCNS-AG, can be reached at jegraham@sdsu.edu.