A Delphi Study to Develop a Core Outcome Set for Capturing and Measuring Nurse Well-Being

Poor nurse well-being is a significant concern, adversely affecting patient care quality and satisfaction and contributing to poor job satisfaction, increased sickness absence and workforce retention issues. There are calls for evidence-based policies and interventions to address poor nurse well-being, but no consensus exists on which outcomes should be captured to assess nurse well-being. We used a salutogenic and consensus approach to develop a Core Outcome Set (COS) for nurse well-being.

A Delphi methodology was employed. Participants were recruited from two stakeholder groups: (1) nurse well-being professionals, identified through relevant publications, conference/meeting attendance lists and peer recommendations, and (2) registered nurses working in the UK National Health Service (NHS), recruited via social media, professional nursing bodies and practitioner networks. The stakeholder panel completed two rounds of an online Delphi survey, rating 43 previously identified well-being outcomes on a nine-point Likert scale, from 'not important' to 'critical.' Consensus was defined as ≥ 75% of stakeholders agreeing a well-being outcome was critical for inclusion in the COS.

Fifty-four stakeholders completed the first Delphi round, and 45 participated in both rounds. Thirteen well-being outcomes met the a priori threshold for inclusion in the COS: general well-being, health, sleep, positive relationships, personal safety, psychological need satisfaction, psychological safety, job satisfaction, morale, life-work balance, compassion satisfaction, satisfaction with patient care and good nursing practice. The final COS was agreed by the stakeholder panel, without amendments.

This study establishes a COS defining the nurse well-being outcomes that should be captured when assessing nurse well-being. Appropriate existing measurement instruments can be selected to capture these outcomes; future research is needed to identify and evaluate the most appropriate instruments and assess the feasibility of routinely capturing all 13 outcomes.

The COS provides nurse managers and workforce leaders with an agreed set of outcomes to support consistent nurse well-being measurement, benchmarking and workforce monitoring. Its use can support evaluation of well-being interventions, evidence-informed decision-making and the development of strategies and workplaces that enable nurses to thrive.