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Critical Care Nurse Burnout in Veterans Health Administration: Relation to Clinician and Patient Outcomes
David C Mohr1, Lakshmana Swamy2, Edwin S Wong3
1David C. Mohr is an investigator, Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, and a research assistant professor, Department of Health Policy and Management, Boston University School of Public Health, Boston.
Background:
Critical care nurses have a burnout rate among the highest of any nursing field. Nurse burnout may impact care quality. Few studies have considered how temporal patterns may influence outcomes.
Objective:
To test a longitudinal model of burnout clusters and associations with patient and clinician outcomes.
Methods:
An observational study analyzed data from annual employee surveys and administrative data on patient outcomes at 111 Veterans Health Administration intensive care units from 2013 through 2017. Site-level burnout rates among critical care nurses were calculated from survey responses about emotional exhaustion and depersonalization. Latent trajectory analysis was applied to identify clusters of facilities with similar burnout patterns over 5 years. Regression analysis was used to analyze patient and employee outcomes by burnout cluster and organizational context measures. Outcomes of interest included patient outcomes (30-day standardized mortality rate and observed minus expected length of stay) for 2016 and 2017 and clinician outcomes (intention to leave and employee satisfaction) from 2013 through 2017.
Results:
Longitudinal analysis revealed 3 burnout clusters among the 111 sites: low (n = 37), medium (n = 68), and high (n = 6) burnout. Compared with sites in the low-burnout cluster, those in the high-burnout cluster had longer patient stays, higher employee turnover intention, and lower employee satisfaction in bivariate models but not in multivariate models.
Conclusions:
In this multiyear, multisite study, critical care nurse burnout was associated with key clinician and patient outcomes. Efforts to address burnout among nurses may improve patient and employee outcomes.