Nature-Based Solutions Are Answering The Call

Stress and burnout among our country’s health workers are at an all-time high and continue to be on the rise. Last year, U.S. Surgeon General Dr. Vivek Murthy sounded the alarm and urged our nation to make “confronting the long-standing drivers of burnout among our health workers … a top national priority,” projecting a shortage of more than three million essential health works in the next five years, in addition to a projected shortage of nearly 140,000 physicians by 2033. And it’s not just nurses and doctors that are finding their well-being impacted; over 75% of all healthcare executives experience heightened feelings of stress and anxiety.

Further, worker shortages and poor mental health aren’t just a concern for hospital leaders trying to staff facilities – but rather, a factor that directly impacts the quality of care we all receive. The health of our families, friends, and communities depends on having a mindfully present and engaged caregiver, nurse, or doctor, free of distraction and anxiety.

There is good news though. Exposure to nature is a simple, cost effective, and efficacious solution that healthcare systems are increasingly incorporating to benefit the well-being of their providers. And according to the data, it’s working.

While health personnel burnout is a growing, complex problem – fueled by increasingly overloaded schedules, excessive patient loads, and time burdensome administrative tasks – we can start with this relatively inexpensive approach. Data show that immersion in or exposure to nature improves overall well-being and substantially reduces feelings of anxiety, depression and mental fatigue (all well-established contributors to job burnout). In fact, just being around nature for short periods of time has a direct impact on your body’s physiology: blood pressure and heart rates go down, our stress hormone, cortisol, levels drop, and cognitive development and mental health improve.

But what do we mean by nature? When it comes to hospital settings, nature can be an outdoor garden on hospital property, a wooded walking trail on the health system campus, or even greenspace next to a medical center. In fact, it could even be a carefully orchestrated landscape view of greenery, shrubs, flowers and trees through a hospital or clinic window.

And this is where healthcare, as an entire sector, can move more innovatively and more aggressively. Providing easy, convenient access to features of nature, even for short periods of time, is a low-cost, high-reward intervention proven to measurably reduce stress and improve well-being. So, we should more proactively bring exposure to and immersion in nature to health facility settings — for staff, patients, and families to benefit.

The science and data are clear. For example, one study conducted in a Portland, Oregon level one trauma center assigned nurses to either six weeks of a work break in an outdoor hospital garden or six weeks of indoor-only breaks, switching at the end of each six-week period. The results were notable: nurses found a significant reduction in emotional exhaustion when breaks were spent in the greenspace setting.

Another study of the therapeutic benefits of hospital gardens surveyed garden visitors at four different hospitals. Nearly all respondents reported that they came to the gardens to “relax”, and 95% of the users reported they “feel different” after spending time there. The researchers were surprised to find, however, that nearly 6 out of 10 visitors to the gardens were employees, with interviews confirming the mental and emotional importance to employees of having time away from the sterile hospital environment.

Even large, appropriately placed windows providing a view of trees or plantings or greenery can make a difference to hospital staff and patients. I remember so vividly as a young child when my physician father would take me on hospital rounds with him. He would point to the end of the long, colorless hospital hallways and tell me that if the architects had placed a big window there, patients would have better outcomes and nurses and hospital employees would be much happier. They would be more content if they could see trees, sunlight, and greenery. He also emphasized that every patient’s room should similarly have a large window for the patient’s mental and physical health; they benefit from natural light and outdoor views. “They heal faster,” he’d explain. Years later, we have the data proving he was right. (He later went on to found Hospital Corporation of America, where his suggestions were incorporated in hundreds of HCA hospitals worldwide.)

Indeed, as reported in Scientific American magazine, “Just three to five minutes spent looking at views dominated by trees, flowers or water can begin to reduce anger, anxiety and pain and to induce relaxation, according to various studies of healthy people that measured physiological changes in blood pressure, muscle tension, or heart and brain electrical activity.”

And today there is a strong financial case to be made for health facilities to invest in nature-based solutions.

Until recently, no one had systematically measured the impact of nature on reducing provider burnout in actual dollars and cents. But now a budget tool developed by Dr. Sean Murphy, an economist at Cornell University’s Weill Medical College, with the nonprofit Nature Sacred, can do just this. The calculator estimates the added cost of burnout via increased turnover, work-effort reduction, and medical liability risk. In addition, it projects the cost of including nature-based interventions, the annual net of these nature-based interventions (including reduced patient lengths of stay for various admission types), and its value in subsequent years. This innovative tool is making the much-needed financial case for the inclusion of nature in every healthcare setting.

Alden Stoner, CEO of the environmentally-focused nonprofit Nature Sacred, which partnered with Dr. Murphy on the tool, has seen the benefit of urban greenspaces in action. Her organization collaborates with community organizations (including health systems) to create outdoor sanctuaries for health and well-being. She noted that, “Based on what we’ve seen and learned over the past 25 years, working with clinicians, researchers, and hospitals, and listening closely to the visitors of these spaces… nature is one of the most powerful and under-utilized resources available to us in addressing stress and burnout and is a low cost, high impact intervention.” Stoner explains further, “Employing nature fully, being intentional in the design to ensure the green spaces are accessible and accommodating of hospital staff and patients, is a game changer.”

Hopefully, this new tool will encourage more health systems to invest in nature to benefit patients and employees and staff alike. Many already are.

The Johns Hopkins Hospital Bayview Medical Center in Baltimore, Maryland created a contemplative labyrinth enclosed by a green and shrub surround that is a hub for community activities and caregiver respite; it became vital as an outdoor waiting room during the height of the pandemic.

The Walter Reed National Military Medical Center created the Green Road, a wondrous woodland section of the campus that surrounds ‘Wounded Warriors’ and

their families with the healing powers of nature in an oasis of respite. It combines a healing, patient-centered approach with rigorous data on what works to improve the health of veterans.

And Legacy Emanuel Medical Center in Portland, Oregon created a 6500 square foot suspended greenspace that is connected to the Family Birth Center as well as the Cardiovascular ICU and family waiting rooms — accessible round-the-clock to all hospital patients, visitors, and employees. It is also, notably, the cornerstone of compelling research on the relationship between nature and health, including the impact of healing garden access on laboring mothers and families, and on nature as a means to combat stress and burnout among nurses.

Anxiety, stress, and burnout within the health sector isn’t new – but recent data and analytic tools make a strong case of including nature-based solutions in addressing these challenges. We can use nature to improve the physical, mental, and emotional health of our healthcare providers and simultaneously invest in our people and environment. Nature has the power to heal. Let’s use it as well to improve the well-being of our health workers.