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A New Jersey hospital moves its nurse managers to a four-day work week due to burnout


The four-day work week - it's a concept winning converts in offices, government agencies, even manufacturing. Now it is also making headway in an unlikely setting - a hospital. NPR's Andrea Hsu takes us there.

DANIELLE DILELLA: One Meadow (ph), it's Danielle.

ANDREA HSU, BYLINE: For Danielle DiLella, the days are long and the to-do lists even longer.

DILELLA: This is actually a fairly calm day (laughter).

HSU: DiLella is a nurse manager at AtlantiCare, not far from Atlantic City. In navy blue scrubs, she's cheerful, but all business, as she goes about her job overseeing all of the bedside nurses who staff her unit around the clock.

DILELLA: I have 86 employees.

HSU: And she's kind of like their CEO. She recruits them and schedules them and handles their payroll. She's also responsible for the care they're providing. It's her job to minimize things like falls and infections, to deal with patient complaints and to get people out of the hospital as soon as they're ready.

DILELLA: If we don't get discharges out, then the ED gets backed up.

HSU: The emergency room - and because hospitals never close, the responsibilities never end.

DILELLA: You are accountable for your unit 24/7. And, like, for me, that weighs on me.

HSU: That weight - that burden is what got AtlantiCare thinking about moving nurse managers to a four-day work week, down from the standard five. It's something a handful of other hospitals, including Mount Sinai in New York City and Temple in Philadelphia, had done. Driving that decision was soaring turnover. Barbara Cottrell is AtlantiCare's chief nursing officer.

BARBARA COTTRELL: We've seen that across the country. The pandemic was really, really crippling.

HSU: Before the pandemic, Cottrell says, nurse managers might typically stay in the job about five years. As of last fall, the average tenure was just two years. That, in turn, was leading to high turnover among bedside nurses, too - not what you want in health care.

COTTRELL: It would create an unsafe environment for our patients if we don't stabilize the workforce.

HSU: Now, when AtlantiCare told its nurse managers of the four-day week plan, the response from most of the team was jubilation.

UNIDENTIFIED PERSON #1: Yea (laughter). Yes.

HSU: But not everyone was immediately convinced, including a few senior nurse managers.

UNIDENTIFIED PERSON #2: There were some that were a little nervous.

HSU: Barbara Cottrell says their main concern was that quality might slip. That might be OK in some workplaces as they work out the kinks with the four-day week, but not at a hospital.

COTTRELL: People's lives are at risk.

HSU: And so taking this step took a lot of thought and planning. Danielle DiLella says the nurse managers split up into pairs, sat down with calendars and coordinated what days they wanted off, looking at two months at a time.

DILELLA: And we said, OK, like, I have a doctor's appointment on this day. I think I want to make this day my day off. And then she says, oh, good, because I want this day off so you can cover me.

HSU: And by cover, she means respond to any immediate needs, like a patient issue that the team cannot resolve on their own. Each nurse manager is still responsible for all the scheduling and payroll and for ensuring quality care on the unit. But, DiLella says, having that extra day away from the hospital makes all that more doable. She has so much more energy, more brain space on the four days she is here.

DILELLA: And I think, like, it has actually made us stronger because, when you're covering that other person's team, you have to build rapport with that team. You have to develop trust with that team. And so it kind of gives you a more global perspective of what's happening in the hospital.

HSU: Now, it's still early days, but AtlantiCare says the results from the four-day week so far are positive. Patients aren't doing any worse, and no one's quit since its launch last year. Danielle DiLella is using her extra day off to catch up on life. She's going to the doctor, getting that oil change, taking her dog to the vet.

DILELLA: Just those things that you just keep putting on the back burner and putting on the back burner.

HSU: She says, as a caregiver, it sometimes feels odd to prioritize herself and her own needs, but the four-day week has led her to an important realization.

DILELLA: You can't ever fill from an empty cup, and it's actually really beneficial when you kind of pull back and take care of yourself first.

HSU: So that you can do a better job taking care of others.

Andrea Hsu, NPR News.


NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

Andrea Hsu is NPR's labor and workplace correspondent.