Workplace friction is driving staff out the door. Here's how to smooth it out

Clinician burnout is a predictable result of how work is designed, not a failure of individual grit, said an author who warns that the most reliable workers may be the ones most likely to leave.

Terra Bruns, DBA, offered anecdotal examples and low-cost solutions in "The Biology of Burnout: Why 'Self-Care' Can't Fix a Structural Problem," her presentation at the Medical Group Management Association (MGMA) 2026 Annual Conference. She is the author of "The Buffer Effect: How to Escape the Hero Trap and Become a Systemic Leader."

Workplace structures and decisions may be well-intentioned but not helpful to the clinicians caring for patients, Bruns said.

One example: With low morale and tight staffing, ICU nurses were at their breaking point. Administrators built them a relaxation room, complete with a massage chair and a bowl of organic apples.

The room was in the hospital basement. The ICU was on the fourth floor, and the nurses had no time to get there.

"It becomes a monument to the disconnect within the organization," Bruns said.

What does friction really cost?

"Friction tax" is cost paid by staff that eventually shows up as lost margin, Bruns said.

Bruns described a boardroom decision to switch to cheaper sterilization caps. The savings came to 2 cents per cap, or $250,000 a year, based on volume. But nurses who had been able to apply the old caps with one hand, leaving the other free to comfort a patient, now needed two hands and sometimes had to start over. "That's something a nurse does 40 times a shift," she said.

That strain never reached the executives who made the decision, she said. Instead, nurses quietly disengaged and updated their resumes.

"It saved them $250,000, but when Nurse Jenny and three or four other nurses walk out the door, that $250,000 is long gone because we now have to replace them, train new nurses, and get them back up to speed," Bruns said.

The same thing happens outside nursing, she said.

"If you work in discharge and you have to take information from one software program and put it in three different places to get the patient discharged, that is structural friction," Bruns said.

Who is most at risk?

Along with workplace friction, health care organizations have examples of the "hero" employees working hard to make things work. Bruns' presentation stated: "Heroism is a lagging indicator of a broken system."

"Nurse Jenny" is Bruns' name for the employee every leader wants: the one who sits on hold with the electronic health record vendor or runs up two flights of stairs when a medication dispensing machine fails. Bruns said those heroics are a sign of broken processes, not a strategy.

"The problem is she has limits. She is a human being," she said. "She has physiological limits."

When Nurse Jenny leaves, the problems she absorbed land on everyone else.

What can administrators do instead?

Bruns offered tools she said cost nothing and need no executive approval.

• First, stop sending messages that say "ASAP" or "Get it done today." She said those words trigger an immediate stress response. A "context wrapper" instead gives staff the purpose of a request, the reason behind it and the consequences of letting it slide.

"ASAP should be removed from your vocabulary," she said.

The subject line should state the outcome, such as patient safety or team building, she said.

"By giving people all of that context wrapped around what it is you want them to do, they're more available mentally to do what it is that you ask them to do," Bruns said.

• Second, when adding a task, take one away. Bruns calls it a capacity ledger, or "one in, one out."
• Third, and most important, conduct a frontline friction audit.

Supervisors who have lost touch with daily work, including executives, spend two to three hours working alongside staff to find where software, workflows or supplies slow them down. Bruns said the audit should identify the specific stressor, what it costs staff in time and strain, and what leadership can concretely remove.

She said the audit, when done, "will, number one, change lives. Number two, it will change your organization. And number three, it will build cohesion within your team."

Why start now?

In a live poll, only 12% of attendees said their organization's main response to burnout was structural workflow changes. The most common answer, at 44%, was pizza parties, and 24% said staff are simply asked to push through.

Fixing friction doesn't require a new budget line, she said, only the willingness to see the work as staff experience it.

"And that doesn't cost any money. Doesn't take any approval from any group, from any admin," Bruns said. "It just takes the foresight of seeing you are dealing with human beings."