A new study suggests that the nursing shortage is easing, but that doesn’t mean the health care system can stop worrying about retaining new and experienced clinicians. One potential solution: paid sabbaticals for nurses and other health care workers. If professors get sabbaticals to refresh and rejuvenate to sustain their academic productivity, why not frontline health care workers?
This is not a new idea. In 1991, I assumed the position of director of nursing education and research at Beth Israel Medical Center, a teaching hospital in New York City that is now part of the Mount Sinai Heath System. The nurses’ union, 1199, had negotiated a new contract for nurses that included a sabbatical for those with 25 years of tenure at the hospital. Irene, a tough, no-nonsense nurse who had worked in the hospital’s surgical intensive care unit for 25 years, was the first nurse to pursue this opportunity.
But sabbaticals were a foreign notion outside of academia. Irene wanted to break up her month and use the time for four different educational conferences. Much to her dismay, the chief nurse told her that she would have to meet with me to design her sabbatical, since her plan was a deviation from the intention of having a solid month to refresh.
Irene was not happy when she came to my office. “Let’s make a list of things you might want to do on a sabbatical. What would you really like to do?” I asked her. With arms folded and a scowl on her face, she retorted, “You want to know what I really want to do? Sit on a beach!” I wrote this down and replied, “Great start. Let’s think about where you might sit on a beach.”
We proceeded to design a sabbatical in Greece, the home of her ancestors, where she would explore Planetree, Hippocrates, definitions of health — ancient and contemporary — and beaches. She backed up her fully paid month of sabbatical with added vacation time, so she had more than six weeks to do this.
When the sabbatical ended, she presented what she learned from her project to hospital administrators and clinicians. Her closing slide was of her swimming in the Aegean Sea.
Irene was transformed by the experience. She returned to work with renewed energy and passion for providing the best of care to vulnerable post-surgical patients.
Sabbaticals started at Harvard in 1880 but are thought to be based on the Jewish concept of shabat as a time of rest every seven days. Most universities provide faculty the opportunity to apply for a sabbatical every seven years for either a full year (sometimes at half pay) or half year. In 2021, an estimated 10% of non-academic businesses provide paid sabbaticals, and close to 30% provided unpaid ones.
There is very little evidence that sabbaticals have been used in health care, but there are some proponents who suggest that they can help reduce burnout and retain experienced nurses; they suggest that the experience include designing a project aimed at improving patient outcomes.
I envision a model in which the health care organization would set eligibility criteria related to length of continuous service and performance evaluations, and require a project that aligned with the nurse’s clinical interests and, perhaps, organizational priorities. Ideally, the time of service would be about five to seven years, as it is for academic and some business environments; waiting until the employee has 25 years of service misses an opportunity to retain nurses, one-third of whom — pre-Covid — were likely to leave their first jobs less than three years later.
A review committee would set criteria for evaluation of the project and provide guidance on its design. It would behoove the reviewers to recognize that an all-consuming project would defeat the purpose of a sabbatical and to guide applicants in designing a feasible, manageable project. For instance, an oncology nurse might visit a hospital known for its high oncology patient satisfaction ratings, identify potential updates in care processes for her own unit, and return from her sabbatical to lead one of these changes.
The number of sabbaticals granted each year would depend upon the organization’s own cost-benefit analysis, with the length of the sabbatical being one factor. A sabbatical leave of six months at full pay or 12 months at half-pay, as is common in academia, is substantially different from the four weeks Irene was offered. One hypothetical cost-benefit analysis conducted in 2012 found the costs were outweighed by benefits of a three-month fully paid sabbatical with an obligation to return to work at the health care organization for at least one year.
Of course, this idea is complicated by the workforce shortage itself and the financial strains that many health care organizations are experiencing. But nurse turnover is very costly. The 2023 nurse turnover rate in hospitals was more than 23%, with replacement costs that averaged more than $46,100 per nurse lost. Paying for coverage for a nurse on sabbatical for three months is a bargain compared with the cost of hiring an expensive travel nurse for six months to a year to replace someone who resigns from burnout. And the dollar costs don’t capture the hidden benefits that may accrue when a nurse returns to work refreshed and recharged. Although there is only anecdotal evidence of the effectiveness of sabbaticals in reducing turnover of nurses, data from sabbaticals in other work settings suggest they are transformative for the organization and the worker.
Sabbaticals aren’t a quick fix for the workforce challenges we face, and we need research on their use in health care. But we should design and evaluate sabbaticals in health care now. Frontline clinicians are working under highly stressful conditions that would wear out the hardiest among us. When clinicians are exhausted and burned out, the safety and quality of care and patients’ lives are in jeopardy. If Covid has taught us anything, it’s that nurses and other health care workers cannot be taken for granted.
Diana J. Mason, Ph.D., R.N., is a senior policy service professor at the Center for Health Policy and Media Engagement at George Washington University School of Nursing.