Association between full-scope practice, schedule balance, and burnout among nurses in health professional shortage...

Nurse burnout is an enduring concern within the United States healthcare workforce, particularly as health system crises, such as the COVID-19 pandemic, have further exacerbated this challenge. While prior studies have suggested that various job resources can reduce nurse burnout, uncertainties remain about their relative importance and applicability during crisis conditions, particularly in Health Professional Shortage Areas. This study examines the association between job resources and nurse burnout and to identify which job resources were most strongly associated with burnout among nurses working in Health Professional Shortage Areas of the United States.

This cross-sectional study used data from the 2022 National Sample Survey of Registered Nurses. Four job resources: balanced schedule, availability of resources, training opportunities, and the ability to provide services at full scope, were included in an initial logistic regression model to estimate their associations with burnout, adjusting for demographic and socioeconomic covariates. A composite indicator combining full-scope practice and schedule balance was then constructed to evaluate their joint association, informed by estimates from the initial logistic regression model. Propensity score matching was used to address selection bias in estimating the association between this composite resource and burnout. Matched samples were analyzed using Firth penalized logistic regression to reduce small-sample and separation bias.

The final analytic sample included 3660 registered nurses. The ability to provide services at full scope and balanced schedule were identified as key predictors based on initial logistic regression analyses and ordinal regression analyses of burnout frequency from 2019 through 2021. Nurses who had both full-scope practice and schedule balance showed substantially lower odds of burnout compared with their matched counterparts who did not (OR = 0.45, p < 0.001), indicating an approximate 55% reduction in the odds of burnout associated with jointly having ability to provide full scope of service and schedule balance. Age demonstrated a strong inverse association with burnout, while gender, race, household income, and additional education were not statistically significant predictors of burnout.

Nurses who were able to practice services at full scope and who had a balanced schedule were much less likely to experience burnout, even under the intense pressures of health system crises in Health Professional Shortage Areas. Thus, target intervention supporting professional practice and creating manageable work schedules may help protect nurse well-being and strengthen workforce resilience in resource-limited settings, both during crises and in routine care.