Leveraging the Work Environment to Minimize the Negative Impact of Nurse Burnout on Patient Outcomes

Schlak, Amelia E.; Aiken, Linda H.; Chittams, Jesse; Poghosyan, Lusine; McHugh, Matthew D.

doi:10.3390/ijerph18020610

Cited by 88 publications

(103 citation statements)

References 64 publications

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“…The staff who possess more team resources (higher teamwork climate) and more personal resources (higher job satisfaction) are less vulnerable to burnout. Although working condition was not a significant predictor of exhaustion in this study, previous research did find that good work environments could attenuate the relationship between nurses’ burnout and patient outcomes [ 12 ]. The relationship between working condition and staff exhaustion deserves further exploration.…”

Section: Discussioncontrasting

confidence: 58%

“…Finally, we found that staff exhaustion increased during the pandemic across the board. Existing studies have shown that employee burnout is related to patient mortality and hospital stay [ 12 ]. Hence, hospitals should consider increasing the number of caregivers, giving longer rest periods, providing resting places and better protective equipment and so on to reduce employee burnout [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…Although most SAQ studies did not include staff outcome variables, it is a significant lacking, especially as well-being is going mainstream in the post-pandemic era. Future studies should include more varied indicators of staff well-being (such as health and work–life balance) and potential systemic protectors of staff well-being, such as support [ 31 ] and positive work environment [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…Emotional exhaustion (or briefly exhaustion), characterized as feelings of energy depletion or exhaustion, is the most important and widely studied dimension in the burnout literature [ 11 ]. Burnout remains a persistent issue affecting healthcare staff worldwide [ 3 , 12 ]. Despite the urge to expand the SAQ research to include more outcome measures [ 13 ], very few studies have examined the relation between staff exhaustion and patient safety culture.…”

Section: Introductionmentioning

confidence: 99%

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Post-Pandemic Patient Safety Culture: A Case from a Large Metropolitan Hospital Group in Taiwan

Chen

et al. 2021

IJERPH

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Patient safety is the core goal of medical institutions. The present study focuses on the patient safety culture and staff well-being admit the COVID-19 pandemic. In a large metropolitan hospital group, 337 employees who had participated in the quality improvement interventions completed an anonymous questionnaire of patient safety culture and personal well-being. The multiple regression analyses indicated that managerial role, seniority, female gender and direct contact with a patient were significantly related to the positive attitude on overall or certain dimensions of safety culture. Multivariate analysis also found that dimensions of teamwork climate, safety climate, job satisfaction and stress recognition as patient safety culture predicted staff exhaustion. Finally, comparing with the available institutional historic data in 2018, the COVID group scored higher on the working condition dimension of patient safety culture, but lower on the stress recognition dimension. The COVID group also scored higher on exhaustion. In the post-pandemic era, there seems to be an improvement on certain aspect of the patient safety culture among hospital staff, and the improvement is more prevalent for managers. However, exhaustion is also a poignant problem for all employees. These findings can inform hospital decision-makers in planning and implementing future improvements of patient safety culture and promoting employee well-being and resilience. Our findings also reveal directions for future research.

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Section: Discussioncontrasting

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Post-Pandemic Patient Safety Culture: A Case from a Large Metropolitan Hospital Group in Taiwan

Chen

et al. 2021

IJERPH

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“…This narrative review of the literature and subsequent policy analysis utilizes a patient‐centric lens. While nurse staffing factors, such as nurse‐to‐patient ratios, can also affect the well‐being of nurses, 5–7 this review and analysis focuses on outcomes relative to patients rather than nurses. An overall goal of this paper is to encourage readers to review nurse staffing empirical evidence to inform their perspectives as they engage with nursing organizations, hospital organizations, and state legislatures for nurse staffing policy.…”

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Nurse staffing legislation: Empirical evidence and policy analysis

2021

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Unsafe nurse staffing conditions in hospitals have been shown to increase the risk of adverse patient events, including mortality. Consequently, United States and international professional nursing organizations often advocate for safer staffing conditions. There are a variety of factors to consider when staffing nurses for patient safety, such as the number of patients per nurse, nurse preparation, patient acuity, and nurse autonomy. The complex issue of staffing nurses often is compounded by cost issues and can become politicized. When nurse organizations' recommendations for safe staffing measures are disregarded by hospital administrations, nurse lobbyists and interest groups often pursue legislative action to protect patients and nurses from unsafe staffing conditions. This article presents a narrative review of safe nurse staffing factors and an analysis of nurse staffing legislation. Using a patient‐centric lens, three state‐level nurse staffing policies (mandated nurse‐to‐patient ratios, public reporting of staffing plans, and nurse staffing committees) were evaluated by empirical evidence, cost to hospitals and state governments, political feasibility, and potential to affect patient populations. Although nurse staffing policy analysis can be conducted in several ways, it is crucial that nurses consider empirical evidence related to staffing policies as well as evaluations of implemented policies and political influences.

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Physician and Nurse Well-Being and Preferred Interventions to Address Burnout in Hospital Practice

et al. 2023

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ImportanceDisruptions in the hospital clinical workforce threaten quality and safety of care and retention of health professionals. It is important to understand which interventions would be well received by clinicians to address the factors associated with turnover.ObjectivesTo determine well-being and turnover rates of physicians and nurses in hospital practice, and to identify actionable factors associated with adverse clinician outcomes, patient safety, and clinicians’ preferences for interventions.Design, Setting, and ParticipantsThis was a cross-sectional multicenter survey study conducted in 2021 with 21 050 physicians and nurses at 60 nationally distributed US Magnet hospitals. Respondents described their mental health and well-being, associations between modifiable work environment factors and physician and nurse burnout, mental health, hospital staff turnover, and patient safety. Data were analyzed from February 21, 2022, to March 28, 2023.Main Outcomes and MeasuresClinician outcomes (burnout, job dissatisfaction, intent to leave, turnover), well-being (depression, anxiety, work-life balance, health), patient safety, resources and work environment adequacy, and clinicians’ preferences for interventions to improve their well-being.ResultsThe study sample comprised responses from 15 738 nurses (mean [SD] age, 38.4 [11.7] years; 10 887 (69%) women; 8404 [53%] White individuals) practicing in 60 hospitals, and 5312 physicians (mean [SD] age, 44.7 [12.0] years; 2362 [45%] men; 2768 [52%] White individuals) practicing in 53 of the same hospitals, with an average of 100 physicians and 262 nurses per hospital and an overall clinician response rate of 26%. High burnout was common among hospital physicians (32%) and nurses (47%). Nurse burnout was associated with higher turnover of both nurses and physicians. Many physicians (12%) and nurses (26%) rated their hospitals unfavorably on patient safety, reported having too few nurses (28% and 54%, respectively), reported having a poor work environment (20% and 34%, respectively), and lacked confidence in management (42% and 46%, respectively). Fewer than 10% of clinicians described their workplace as joyful. Both physicians and nurses rated management interventions to improve care delivery as more important to their mental health and well-being than interventions directed at improving clinicians’ mental health. Improving nurse staffing was ranked highest among interventions (87% of nurses and 45% of physicians).Conclusions and RelevanceThis cross-sectional survey study of physicians and nurses practicing in US Magnet hospitals found that hospitals characterized as having too few nurses and unfavorable work environments had higher rates of clinician burnout, turnover, and unfavorable patient safety ratings. Clinicians wanted action by management to address insufficient nurse staffing, insufficient clinician control over workload, and poor work environments; they were less interested in wellness programs and resilience training.

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Leveraging the Work Environment to Minimize the Negative Impact of Nurse Burnout on Patient Outcomes

Cited by 88 publications

References 64 publications

Post-Pandemic Patient Safety Culture: A Case from a Large Metropolitan Hospital Group in Taiwan

Post-Pandemic Patient Safety Culture: A Case from a Large Metropolitan Hospital Group in Taiwan

Nurse staffing legislation: Empirical evidence and policy analysis

Physician and Nurse Well-Being and Preferred Interventions to Address Burnout in Hospital Practice

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