These nurse managers were burnt out. Then their hospital gave them a 4-day workweek

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Nurse manager Danielle DiLella sits in her office, with a long to-do list on her whiteboard behind her. / NPR

The four-day workweek has won converts in offices, government agencies, even manufacturing. Now it's making inroads into health care.

Since the pandemic, a handful of hospitals, including AtlantiCare Regional Medical Center in New Jersey, have begun offering a four-day workweek to nurse managers, who are akin to CEOs in their level of responsibility overseeing big teams of nurses and ensuring proper care.

The move to the shorter workweek was prompted by alarming rates of turnover since the pandemic. Ten months in, AtlantiCare has seen no negative impact on patient care. No nurse managers have quit.

Instead, they are reporting greater job satisfaction and better work-life balance. After an extra day off, AtlantiCare's nurse managers report coming back to work feeling recharged, even smiling more.

Accountable 24/7

To understand why it's working, it pays to spend some time with a nurse manager.

On a recent afternoon, Danielle DiLella is cheerful but all business as she goes about her job overseeing 86 bedside nurses on her unit known as One Meadow.

Her days are split between administrative and clinical tasks. She's responsible for all of the recruiting, scheduling and payroll of her large team. She’s also accountable for the care they provide, working to minimize falls, pressure injuries and infections, and handling patient complaints.

Throughout the day, she’s checking to ensure patients are getting discharged in a timely way, so that One Meadow can receive patients waiting in the emergency room.

The days are long and her to-do lists even longer. And because hospitals never close, the responsibilities never end.

“You are accountable for your unit 24/7,” says DiLella. “That weighs on me.”

'Like a godsend'

The vast majority of nurse managers come from the ranks of bedside nurses, who typically work three 12-hour days.

The move to a standard workweek can be a deterrent for those considering leadership roles.

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Kathryn Dixon worked as a bedside nurse for 15 years before taking a job as a nurse manager. / NPR

“Sometimes I say it was way more easier at the bedside in the ER which sounds bananas,” says Kathryn Dixon, the nurse manager on Two Meadow, who worked in the emergency room for 15 years prior to her current role.

As a single mom, Dixon says it's nice to once again have a day when she's home before her teenager.

“That extra day is like a godsend,” she says.

In a recent study by the American Organization of Nursing Leadership, two-thirds of nurse leaders identified their own emotional health as a major challenge.

It's no wonder turnover among nurse managers soared during the pandemic.

"We’ve seen that across the country. The pandemic was really, really crippling,” says AtlantiCare’s chief nursing officer Barbara Cottrell.

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Barbara Cottrell, AtlantiCare's chief nursing officer, says the four-day workweek for nurse managers has not had a negative impact on patient care and none of them has quit. / NPR

Before the pandemic, she says, nurse managers would typically stay in the job about five years. Cottrell herself did the job for eight. As of last fall, nurse managers at AtlantiCare stayed on average just two years.

That, in turn, was leading to high turnover among bedside nurses. Cottrell knew this was a serious problem.

“Ultimately, it would create an unsafe environment for our patients if we don’t stabilize the workforce,” she says.

A popular move that came with hesitation

When AtlantiCare decided to pilot a four-day workweek last September, the response from most of the nurse managers was jubilation.

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

“There were some that were a little nervous,” recalls Cottrell.

Their main concern was quality could slip.

While enduring such growing pains might be the norm in other workplaces, it'd be unacceptable in a hospital.

“People’s lives are at risk,” says Cottrell.

Even today, about a quarter of AtlantiCare's nurse managers have opted to stick with a five-day workweek.

Dedicated to making it work

The team at AltantiCare put a lot of thought and planning into the move to a shorter workweek, learning about how other hospitals, including Duke University Hospital and Temple University Hospital, had done it.

"I think our whole team was very, very dedicated to making it work," says DiLella.

Now, every couple months, the nurse managers split into pairs, sit down with calendars and coordinate which days they want off.

Each nurse manager then covers for her partner on those days off, responding to any immediate needs, such as a patient issue that the team cannot resolve on their own. They remain fully responsible for their own team of nurses, including their scheduling, payroll and quality of care.

“I think 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,” she says. “So it kind of gives you a more global perspective of what's happening in the hospital.”

Having that extra day away from the hospital makes the administrative work seem more doable, DiLella adds. She has more energy and brain space on the four days she is there.

'You can't ever fill from an empty cup'

DiLella uses her extra day off to catch up on personal tasks, such as going to the doctor, getting an oil change, or taking her dog to the vet.

“Just those things that you keep putting on back burner,” she says.

As a caregiver, she says it sometimes feels odd to prioritize herself and her own needs.

But the four-day week has led her to an important realization:

“You can't ever fill from an empty cup,” she says. “It's actually really beneficial when you kind of pull back and take care of yourself first, so that you can do a better job taking care of others.”