4-day workweek improves job satisfaction, work-life balance among nurse leaders
Key takeaways:
- A 4-day workweek improved job satisfaction and reduced guilt about taking time off work.
- The program also helped with recruitment.
A pilot 4-day workweek program improved several measures related to job satisfaction and increased confidence among nurse leaders, an analysis in Nursing Economic$ showed.
The program “just promotes wellness in a very busy environment,” Jennie Gilliland, MSN, RN, OCN, clinical director of infusion services at Fox Chase Cancer Center, said in a press release.
Poor work-life balance, withdrawal and burnout remain significant problems among health care professionals because recent research showed that burnout levels remain substantially higher than those before the COVID-19 pandemic.
In the study, Gilliland and colleagues assessed the effectiveness of the center’s program, implemented in 2021, through pre- and post-implementation surveys.
According to the release, nurse managers who participated in the program remained accountable for performance indicators for their business unit with the expectation that they revert back to the traditional work schedule as needed if metrics showed negative trends.
Participants also had to be available in the event of an emergency.
The study included 43 nursing directors, managers and assistant nurse managers, of whom 18 responded to the pre-program survey. Of these respondents:
- 67% were very or extremely satisfied with their job;
- 67% were confident their units could run efficiently in their absence;
- 78% felt guilt when taking time off;
- 28% were satisfied with work-life balance
- 73% felt that the 4-day workweek would improve their current rate of satisfaction; and
- 66% worked 10 or more hours per day.
Eight nurse leaders who responded to a survey 3 months following the program’s implementation reported improvement in work-life balance, job satisfaction and guilt for taking time off.
Gilliland and colleagues found that these improvements continued further down the line. The 15 nurse leaders who responded to a survey conducted 15 months after the program’s implementation revealed a 6% increase in job satisfaction; 45% increase in satisfaction with work-life balance; 1% improvement in those working 10+ hours a day; 52% improvement in feeling guilt for taking time off; and 36% increase in confidence in ability of units to run effectively in their absence.
Nurse managers learned they had to be more productive during the 4-day workweek to take advantage of time off, while also having to be more flexible,” Gilliland said in the release.
“Yes, it’s a remote day, but one still has to be available,” she explained. “If you prefer to not be contacted about work-related matters, the expectation is to take a vacation or personal day.”
The researchers acknowledged some study limitations. For example, nurse leader turnover occurred during the time the surveys were administered, which narrowed the pool of eligible survey participants.
Still, the program “was popular and helped recruitment,” the release pointed out.
“I hired two nurse managers during this time, and they both said one of the top reasons they considered leadership was the availability of the 4-day workweek,” Gilliland said.
References:
- Four-day workweek for nurse managers improves work-life balance, Fox Chase Cancer Center study finds. Available at: https://www.foxchase.org/news/four-day-workweek-nurse-managers-improves-work-life-balance-fox-chase-cancer-center-study. Published Feb. 17, 2025. Accessed Feb. 28, 2025.
- Gilliand J, et al. Nurs Econ. 2025;43(1):in press.
Perspective
Back to Top
I should emphasize that my responses are made through the lens of a physician leader drawing on experience of 50 years in medicine as a student, surgical trainee, attending surgeon and officer of many medical organizations and leader of many teams consisting of team members with many different but critical roles in patient care. Although nurses have been an important part of every team I have worked with in that time, I am not an authority in the least on nursing leadership or management but am drawing on concerns about burnout, health care worker turnover and the environment in which we are all working to provide health care today.
I would congratulate the authors on the energy, expertise and risk-taking they obviously invested in this effort to explore alternatives to their leadership work structure for the reasons they well describe.
The data suggest that going to a 4-day week may decrease some of the stressors in these nursing leaders’ environments by increasing satisfaction with work-life balance and decreasing anxiety about time taken away from work. As the authors note, studies in work environments other than health care have documented the effectiveness of this type of work restructuring.
There are some interesting questions raised by the data presented: What were the characteristics of the large number of leaders who declined to participate as compared with those who did? Does this indicate that leadership staffing models should offer the 4-day week as an option rather than a mandate? Is there an inherent selection bias in the data? (Are those who did not participate somehow different than those who did?)
The sample size is more than likely too small to analyze statistically. Should a larger study be considered?
Would the same results obtain with different nursing environments (ICU, operating room, psychiatric, etc.)?
What effect did this restructuring have on the perception of the unit nursing staff of their leadership? What effect on patient perceptions? (The transition of physician clinicians to administrative roles introduces a tension between front line physicians and those now perceived as “corporate”... I have observed similar tensions in nursing staffs).
I have some concerns about the strategy, in that the 5th day was not really time off but remote, or “at-home time,” with the nursing leaders on call. One of the major drivers of burnout for physicians revolves around the dramatically increased documentation time in electronic health records for every minute spent with patients. This has resulted in hours spent at home outside of work entering data primarily to enhance billing and satisfy increasing regulation and has been labeled “pajama time.” Pajama time is so universal and pervasive that it is accepted as a normal fact of life for physicians, and respected centers publish studies on reducing it rather than advocating strategies that eliminate it! Unfortunately, the current work environment is more likely to be demanding more patient throughput of everyone in the same amount of time with ever-increasing burdens of documentation after "work hours.” I suspect that the administrative demands of nursing leaders have also increased dramatically in a similar fashion and question if it would not be better for institutions to work on ways to use technology to make their tasks more efficient so that they could be accomplished in a 40-hour week of either 4 or 5 days.
I do think that a shortened work week is a healthy alternative for many of us in health care. If we wish to increase retention, prevent early retirement and decrease burnout while simultaneously delivering health in a high-quality and safe manner, we will probably need to be even more flexible. Our physicians are choosing part-time employment with increasing frequency, and we desperately need their talents in the face of shortages that are going to get worse by any assessment. The nursing profession has been dealing with similar issues for quite a while, and this is a helpful study that I hope will lead to further exploration of this critical issue.
Like health care itself, addressing the often-toxic environment that has evolved for our caregivers is a complex issue with no quick fix.
Collapse
Press release.
Read more about