JAMA Nursing Study Identifies Top Interventions to Address Nurse Burnout

Burnout is a serious and well-established problem in the nursing community. However, while researchers have identified multiple nurse burnout symptoms and causes, finding effective interventions has remained elusive.

A new study published in JAMA Health Form sought to change that, identifying factors associated with staff turnover, patient outcomes, and safety with the goal of helping clinical leaders and administrators tailor more effective solutions to this persistent problem.

“The hospital workforce remains in disarray despite the ebbing of the COVID-19 pandemic. The US Surgeon General has issued a national call to action in response to widespread reports that healthcare workers are reaching their breaking point,” wrote first author Linda Aiken, Ph.D., RN, and colleagues in the study.

Around 15,738 nurses and 5,312 physicians at 60 hospitals across the U.S took the survey that forms the basis of the study. The survey evaluated the extent of the problem among clinicians and how it might be associated with staff turnover and patient safety.

Fully one-half of nurses and one-third of physicians who responded to the survey reported high burnout. Results varied widely among institutions, from 28% to 66% for nurses. In some hospitals, over 40% of nurses and doctors said they would leave if they could.

Survey respondents indicated there were too few nurses staffing hospitals, which created an unfavorable work environment. Interestingly, both doctors and nurses cited nurse burnout symptoms and job dissatisfaction as reasons for turnover.

The results of the survey also found that the clinicians lacked confidence that hospital management would resolve patient care issues, and rated the need for improvement in the work environment and staffing conditions as more important than their own well-being and mental health.

The researchers suggest the data indicates healthcare institutions must take deliberate actions to improve staffing and patient safety culture, which in turn may help clinician well-being and retention. On average, 23% of nurses and 21% of physicians felt the hospital where they worked had problems with patient safety.

Many respondents focused on solving problems that directly trigger burnout, as opposed to adding programs to address mental health or overall well-being. They indicated that stresses related to nurse staffing issues, workload, and work environment need more tangible interventions, as opposed to beneficial but less-direct programs around wellness or resilience training.

Respondents were given a list of interventions recommended by the National Academy of Medicine on how to prevent nurse burnout, and asked to rank them based on which they believed would be the most effective.

Respondents identified nurse staff levels as one of the most important areas of improvement.

In addition, at least 50% of respondents ranked the following interventions as “very important” to improving their well-being:

The following potential interventions were ranked by less than 50% of the respondents as “very important” to their well-being:

The highest-ranking interventions on how to prevent nurse burnout were improving staff levels and taking breaks without interruption. The highest-ranking interventions by physicians were reducing time spent on documentation and improving the usability of the electronic health record system.

“Clinicians report a lack of confidence in hospital management to act to resolve problems in patient care and to create supportive work environments and a work culture that promotes patient safety,” Aiken and colleagues concluded. “Clinicians want improvements in nurse staffing and working conditions to address burnout and job dissatisfaction.”