Reference
Schlak, A. E., Aiken, L. H., Chittams, J., Poghosyan, L., & McHugh, M. (2021). Leveraging the Work Environment to Minimize the Negative Impact of Nurse Burnout on Patient Outcomes. International journal of environmental research and public health, 18(2), 610. https://doi.org/10.3390/ijerph18020610
At a glance
Several studies have explored the negative effects of nurse burnout on patient outcomes. This study analyzed cross-sectional data on nurses and hospitals to explain the impact of burnout on patient health outcomes in terms of mortality, failure to rescue, and length of stay. The surveys confirmed that, in hospitals where nurses reported higher levels of burnout, patient outcomes were worse. In hospitals where care was deemed of higher quality and the work environment was supportive, patient outcomes were better, and nurse burnout levels were lower.
Improving the work environment of nurses is important in mitigating the effects of nurse burnout and ensuring safe, high-quality patient care.
What is already known
Burnout in nurses is a phenomenon associated with the work environment and is a critical problem that exists in all settings where nurses work. A better working environment reduces the level of nurse burnout. Examples of such environments are places where nurses feel they have greater professional autonomy, or within “Magnet hospitals” – facilities recognized for excellence in nursing care.Other studies have also shown that worse working conditions have negative consequences on patients’ clinical outcomes, including mortality. T
he objective of the study was to test three hypotheses: (a) whether nurse burnout is associated with higher levels of patient mortality, failure to rescue, and longer length of stay; (b) whether patient outcomes are better where the work environment mitigates nurse burnout; and (c) whether a Magnet hospital (i.e., where the work environment is good) reduces nurse burnout and affects patient outcomes.
Design and method
This is a secondary analysis of four cross-sectional datasets linked and merged using a common hospital identifier.The study analyzed data on 20,496 nurses in 523 US hospitals, 83 of which were Magnet hospitals. For clinical outcomes, 1,939,878 adult surgical patients (18-99 years old) were analyzed. Multivariate logistic regression was used to explore the relationship between nurse burnout, patient outcomes, work environment, and Magnet status.
Main findings
The study found a significant relationship between nurse burnout and 30-day in-hospital mortality (Odds Ratio = 1.06, p = 0.003). A one-standard deviation increase in the mean nurse burnout score was associated with a 6% increase in the odds of mortality.
The study also found significant relationships between nurse burnout, failed rescue, and length of stay.
The work environment had a statistically significant effect on patient outcomes. When the work environment changed from poor to mixed or mixed to good, the probability of 30-day in-hospital mortality decreased by 14% (OR = 0.86, p < 0.001). Similarly, a change in work environment from poor to mixed or mixed to good decreased the odds of no rescue by 12% (OR = 0.88, p < 0.001), and overall length of stay decreased by 4% (IRR = 0.96, p = 0.003).
An association was observed between Magnet hospitals and an 18% reduction in the odds of 30-day in-hospital mortality (OR = 0.82, p< 0.001). The odds of no rescue were 13% lower (OR = 0.87, p= 0.003).
New findings
The study supports other research in showing that burnout has serious consequences on patient lives in terms of mortality, failure to rescue, and length of stay. The work environment greatly influences the development of burnout syndrome, so there is a need to improve nurses’ working conditions as much as possible. Examples of improvement include: ensuring greater professional autonomy, maintaining appropriate nurse staffing/workload ratios, and supporting workers. Unlike previous studies, this study used direct measurement indices.
Limitations of the study
A limitation of the study was its limited ability to draw causal inferences due to the use of cross-sectional data. A strength was its use of direct indicators to measure patient outcomes. Adjustments were made to minimize error and bias. Burnout and work environment data were analyzed in aggregate to avoid bias, but the sample was large enough to limit bias in the responses.
Areas for future work
Patients’ lives depend on the quality of care they receive. Nurses with a high level of burnout deliver care that results in worse patient outcomes in terms of length of stay, failed rescue, and increased mortality. The environment in which they work can be improved to minimize the negative impact of nurse burnout. The Magnet hospital model, for example, appears to be associated with lower mortality and failed rescue rates because of reduced nurse burnout. This model could be adopted to improve nurses’ working conditions and achieve better health outcomes for patients.
Edited by Daiana Campani daiana.campani@uniupo.it
