We might all be familiar with the term “burnout” – the feeling of emotional exhaustion or feeling cynical or ineffective with respect to productivity at work, or in relationships with colleagues or clients. The World Health Organization classifies burnout as an occupational, not personal, phenomenon. Studies suggest that burnout can result from poor work environments – not necessarily dependent on the content of the work itself, but instead the setting in which the work is completed and how the work is managed or distributed. Burnout can be prevented or resolved by improving work environments.
Because it is dependent on the environment, the rate of burnout may vary between different job settings. For example, studies suggest that around 40% of the Nursing workforce in the United States is burned out. That’s almost half of all nurses! Nurses, along with Social Workers who also have a burnout rate of about 40%, are among the professions with the highest burnout rates in the country. Nurses have a unique position, as their actions and responsibilities at work directly impact the wellbeing of their patients. Because the lives of their patients may depend on it, it is important that nurses are attentive, motivated, and effective while at their jobs. In other words, nurses should not be burned out in order to properly care for their patients.
To prevent or resolve burnout in nursing, work environments should aloow appropriate autonomy, or the ability for nurses to use their own discretion and depend on their own expertise to respond to patient care issues. Additionally, positive work environments for nurses include having good working relationships with physicians and hospital administration, and have adequate staffing and resources. If an environment does not include these positive factors, then nurse burnout will likely be prevalent in that clinical setting. Additionally, the combination of a poor work environment and burned out nurses is associated with lower levels of patient care quality and patient outcomes.
A recent study by Columbia postdoc Dr. Amelia Schlak explored how nurse burnout is related to patient care, with the expectation that more nurse burnout would correspond with poorer patient outcomes. Additionally, the researchers investigated how the nurse work environment affects the relationship between nurse burnout and respective patient outcomes. The authors expected to see that nurse burnout will have less of an effect on poorer patient outcomes in better work environments.
In order to investigate these relationships, Dr. Schlak and colleagues measured nurse burnout in over 20,000 nurses across 4 states (CA, PA, FL, and NJ) between 2015–2016 by using the emotional exhaustion subscale of the Maslach Burnout Inventory, which quantifies nurse burnout on a scale from 0 to 54, where higher scores correspond to more burnout. On average, the nurse burnout score in the study was 21/54. They also measured work environment using the Practice Environment Scale of Nursing Work Index survey completed by the same nurses. This measurement accounts for environmental aspects like staffing, access to resources, and nurse-physician relations. The researchers ranked the average hospital environment scores into categories of “poor” (bottom 25%), “mixed” (middle 50%), and “good” (top 25%) environments. They found that the degree of nurse burnout was skewed across the hospital quality category, where most (60%) nurses working in good environments ranked among the lowest burnout levels, while more than 50% of nurses working in poor environments ranked among the most burned out. So, better work environments typically means less burned out and more productive nurses!
The ultimate priority in healthcare work is, of course, the patient! To see how the environment and nurse burnout affects patients, the researchers also collected patient outcome measurements for each hospital such as (1) patient mortality, (2) failure to rescue, or in-hospital mortality after experiencing an adverse event caused by medical treatment, and (3) length of stay, where only patients with length of stay less than 30 days were considered. The authors found that greater nurse burnout was associated with a higher incidence of patient mortality, an increased rate of failure to rescue and a longer patient stay. Nurses who are not burned out, who are energized and effective, tended to have patients that had better outcomes.
The authors also explored how the nurse work environment affects the relationship between nurse burnout and the patient outcome measurements. When the researchers compared hospitals with poor vs. mixed work environments, as well as mixed vs. good environments, they found that the frequency of burned out nurses decreased, the 30-day in-hospital mortality rate was 14% lower, the failure to rescue rate was 12% lower, and the length of stay was 4% lower in the mixed and good work environments, respectively. This means that by simply improving the work environment (i.e. improving employee relations or providing better resources), hospitals can greatly improve nurse burnout and patient outcomes! This relationship is shown in Figure 1 below.
Though this study was based on data from 2015, nurses and other healthcare workers have only become even more burned out in the face of the COVID-19 pandemic, intensified by the overwhelming demand, the pain of losing patients, and the risk of infection that they take every time they go to work. In light of this, hospital management and administration should be proactively addressing healthcare worker burnout, by ensuring that the needs of their healthcare workers are met. This includes, but is not limited to, allowing nurses autonomy or control over their practices, adequate staffing to avoid overworking or long shifts, encouraging and supporting positive relationships among nurses, physicians, and administrative staff, and providing proper resources for nurses to successfully fulfill their responsibilities.
Also, this past week (May 6th – May 12th, 2022) was Nurses Appreciation Week. Thank you to the Super Nurses for the hard work that you do, oftentimes under relentless and stressful circumstances! You truly are Healthcare Heroes! I hope your hospitals, clinics, or other places of work are prioritizing your work environments, to help reduce the burnout you feel from this pandemic. If they aren’t, send them this article 🙂
Edited by: Trang Nguyen, Vikas Malik, Maaike Schilperoort