Embedded therapist significantly reduces ICU nurse burnout
New research demonstrates that having a dedicated mental health professional on critical care teams improves nurse retention and wellbeing compared to traditional support approaches.
The addition of a dedicated team therapist to critical care units can significantly reduce burnout and improve resilience among nursing staff, according to new research presented at the American Thoracic Society (ATS) 2025 International Conference in San Francisco.
The study, which examined an innovative approach implemented at Sharp Chula Vista Medical Center in California, found that embedding a professional therapist within the care team – rather than relying on external resources – led to measurable improvements in job satisfaction and staff retention.
Julie Graham, PhD, APRN, assistant professor at San Diego State University School of Nursing.
Critical challenges in nursing retention
Nursing staff in intensive care units experience disproportionate levels of shared suffering and loss compared to other healthcare disciplines. This emotional burden, particularly evident during the COVID-19 pandemic, contributed to a 29 percent turnover rate among ICU nurses at the study site before intervention.
“Nurses were having emotional breakdowns on a daily basis,” said first author Julie Graham, PhD, APRN, ACCNS-AG, assistant professor at San Diego State University School of Nursing. “They were really asking for help.”
While many healthcare systems offer Employee Assistance Programs (EAPs) to support staff mental health, these resources are frequently underutilised by nursing personnel. Alternative approaches, such as peer supporter programmes, may be insufficient to address the depth of mental health challenges experienced by critical care nurses.
Measurable improvements from embedded support
The research team surveyed 116 nurses to evaluate the impact of having an on-staff therapist compared to traditional support mechanisms. The sample was predominantly female (78%) with an average of 12 years of nursing experience.
Statistical analysis revealed significant improvements across multiple domains:
- Job satisfaction (p = 0.003, d = 0.860)
- Burnout reduction (p < 0.001, d = 0.793)
- Resilience enhancement (p < 0.001, d = 0.622)
- Self-efficacy improvement (p = 0.008, v = 0.258)
Notably, the study found that demographic variables including years of experience, shift pattern, role type, gender, and ethnicity had no statistically significant relationship to the measured outcomes.
Financial implications for healthcare systems
Beyond the clinical benefits, researchers highlighted the potential cost savings associated with reducing nurse turnover rates.
“It’s very, very expensive to replace a nurse who decides to leave the ICU, so when you have high turnover that can be incredibly costly to the organisation,” Dr Graham explained. “The salary for one therapist can potentially save all that money.”
Following the introduction of a full-time therapist position at Sharp Chula Vista Medical Center, nurse turnover rates declined dramatically – falling to as low as 1 percent at one point. While this extremely low turnover rate was not sustained indefinitely, it has remained significantly below pre-intervention levels.
Future research directions
The research team is now collaborating with the San Diego State School of Business on a follow-up prospective cohort study. This investigation will measure additional outcomes including absenteeism and turnover rates to further quantify the return on investment for healthcare systems.
“We want to keep justifying this role and shout it from the rooftops,” Dr Graham added.
The findings suggest that healthcare organisations struggling with nurse retention in critical care settings might benefit from re-evaluating their approach to staff mental health support, potentially shifting resources from external programmes to embedded therapeutic roles.
Reference
Graham, J. E., Damoose, L., & Malagon-Maldonado, G. (2025). One of us: The value of having a team therapist to support nursing staff in critical care areas. American Journal of Respiratory and Critical Care Medicine, 211, A3142.
https://doi.org/10.1164/ajrccm.2025.211.Abstracts.A3142
