The effect of work characteristics on advanced practice provider burnout: a secondary cross-sectional analysis

There are few comprehensive studies looking at burnout and well-being among advanced practice providers (APPs). Most of the studies focus on physicians and nurses. The prevalence of burnout in APPs is limited largely to single center studies or certain APPs specialty. Determining drivers of burnout amongst a heterogenous APPs workforce may strengthen the ability to customize support and interventions. In a multicenter randomized control trial studying the feasibility and impact of online group coaching on APPs, we analyzed baseline data to identify work characteristics associated with APPs burnout.

APPs from Emory Healthcare, Children's Healthcare of Atlanta, University of Colorado, and Children's Hospital Colorado who enrolled in an APP coaching study completed a baseline survey which included demographics and Maslach Burnout Inventory Human Services Survey for Medical Personnel (MBI-HSS (MP)). Univariable and multivariable linear regression was used for MBI-HSS(MP) subdomains and beta estimates were provided. Ordinal and binary logistic regression were used for MBI-HSS(MP) burnout profiles and presented using odd ratios (OR). Predicted probabilities were also provided for logistic regression. 95% confidence intervals (95% CI) were provided for all model estimates.

Of 319 APPs, 305 completed baseline data. 65% (n = 198) are Advanced Practice Registered Nurses (APRNs), 35% (n = 107) Physician Assistants (PA-C), 53% (n = 161) practice with adults, 47% (n = 144) practice with pediatrics, 51% (n = 157) from Georgia, 49% (n = 148) from Colorado, 60% (n = 181) work weekday shifts, 40% (n = 123) work "off" (night/swing/weekend) shifts, full-time 85% (n = 258), 70% (n = 212) work inpatient/ED/Urgent care and 30% (n = 93) work outpatient, 61% (n = 189) report < 10 years' experience and 39% (n = 118) report > 11 years' experience. The mean emotional exhaustion (EE) score was 3.32 (SD 1.21). 27% of APPs (n = 79) experienced burnout in one dimension and 9% (n = 27) in two dimensions. After adjusting for confounding variable, APPs working "off" shifts (shifts other than dayshift) have decreased personal achievement (PA)(95% CI: -0.49,-0.07), APPs who work full-time compared to part-time or PRN (pro re nata) have lower EE(95% CI:0.02,0.80), and APPs working in adult specialties have greater EE (95%CI:0.07,0.68) and depersonalization (DP)(95%CI:0.02,0.64).

The differences in factors contributing to APP burnout by unique work characteristics identified in this study suggest that a "one size fits all" approach to combating burnout may not be effective. Further studies are needed to determine if customized interventions for surgical and adult specialties, APPs who work "off" shifts, and APPs working part-time or PRN can reduce these disparities.