An Emerging Crisis
In recent years, burnout among healthcare providers has emerged as a significant public health problem. It has been reported that as many as 1 in 3 nurses and 1in 2 physicians admit to experiencing high burnout as a result of heavier workloads, time pressures, increase in patient acuity and limited resources. High levels of burnout are known to contribute to an increase in absenteeism and problems with staff retention. Burnout among nurses may also pose threats to the quality and safety of care being provided to patients. In 2017, the National Academy of Medicine responded to mounting concerns over burnout and developed the Action Collaborative for Clinician Well- being and Resilience. One factor that the Committee and others have cited as a root cause to provider burnout is the working conditions (aka “work environment”) that nurses and physicians provide care under. Heavy workloads, demanding schedules and a lack of resources are viewed as key “system-level” factors that influence burnout and pose threats to patient safety.
What We Did
Our study examined the influence of nurse burnout and its effect on patient satisfaction through an evaluation of over 20,000 nurses working in 463 hospitals across 4 states (Pennsylvania, New Jersey, Florida and California). For our study, burnout was defined using the Maslach Burnout Inventory. Patient Satisfaction was obtained from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Information about nurses was obtained from the RN4CAST-US, a survey of nurses that asks about the working conditions in the settings where they are employed and about levels of burnout. Using this data allowed us t to determine whether patient satisfaction was lower in hospitals with higher levels of nurse burnout and to evaluate if the work environment of nurses influenced these results.
What We Learned
We found that 50% of hospitals in our sample employed nurses with high levels of burnout. These hospitals were also more likely to have low patient satisfaction scores and poor nurse working conditions. Conversely, we found that hospitals with better working conditions, as reported by their clinical staff nurses, had lower levels of nurse burn out and higher levels of patient satisfaction.
Take Home Point
The burnout epidemic among nurses has led some organizations to offer interventions such as mindfulness training, culinary classes and yoga. While each of these initiatives has important benefits, little is known about their effectiveness in reducing health care provider burnout and improving patient outcomes in the long term.
Our findings suggest that hospitals could undertake additional measures to reduce burnout and low ratings of patient satisfaction. These measures would focus more attention on drivers of burnouts in the workplace that if addressed would improve nurse wellbeing and patient satisfaction. A healthy work environment is characterized by one where nurses are resourced with adequate staffing levels, are active participants in policy and practice decisions, have strong leadership support, are recognized for their professional expertise and have strong communication with other members of the interprofessional team. Developing healthy work environments requires institutional investment in the healthcare workforce and organizational culture. The results of such investments could benefit both nurses and patients.
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