Study details and key findings

Researchers performed a meta-analysis of 85 studies published between 1994 and 2024. Overall, there were 288,581 nurses from over 5,300 hospitals in 32 countries. Nurses in any specialty were eligible for inclusion, but midwives, nursing assistants, nursing students, and combined samples of nurses and physicians were excluded. The median sample size was 458 individuals, with a mean age of 34 years.

The majority of participants were female (82.7%) and white (70.9%). In addition, 42% had a bachelor's degree or higher and the average length of work experience was 10.4 years. The mean burnout rate among the participants was 30.7% based on study-specific cutoff rates.

Overall, the researchers found that occupational burnout was associated with a lower safety climate or culture (standardized mean difference of -0.68), lower patient satisfaction ratings (standardized mean difference of -0.51), and lower nurse-assessed quality of care (standardized mean difference of -0.44).

These findings remained true regardless of nurses' age, sex, work experience, or geography. The researchers also found an association between nurse burnout and lower safety grades, along with burnout and a higher frequency of:

• Nosocomial infections (Standardized mean difference: -0.20)
•  Patient falls (Standardized mean difference: -0.12)
• Medication errors (Standardized mean difference: -0.30)
• Adverse events or patient safety incidents (Standardized mean difference: -0.42)
• Missed care or care left undone (Standardized mean difference: -0.58)

However, burnout was not associated with patient mortality, frequency of patient abuse, patient complaints, or pressure ulcers.

According to Tait Shanafelt, one of the study's authors from the Stanford University School of Medicine, higher levels of education could mitigate certain negative effects of burnout among nurses. Although the association between nurse burnout and quality of care was not tempered by educational level, the link between burnout and lower patient safety was weaker among nurses with bachelor's or graduate degrees.

"When making clinical decisions, an individual's level of distress may influence their judgement," Shanafelt said. "However, their training may help mitigate this effect and protect patients."

Commentary

According to Shanafelt, the study's findings "should provide powerful motivation for governments and organizations that care about quality of care to act."

"We need to get serious about addressing the structural problems in the work environment that cause nurse distress rather than simply trying to teach nurses to better tolerate a broken system," he added.

Lambert Zixin Li, a PhD candidate at the Stanford University Graduate School of Business and one of the study's authors, agreed, saying that "despite decades of organizational and national quality improvement efforts, the association between nurse burnout and quality of care has become more negative over the years, implying the urgency of interventions."

"A small reduction in nurse burnout may have simultaneous effects on many patient outcomes," Li said.

Recently, more attention has been brought toward burnout among healthcare workers. For example, the U.S. Surgeon General has released an advisory on healthcare worker burnout with recommendations on how to address the crisis. Congress has also passed legislation to allocate over $100 million in funding to promote mental health, boost resilience, and reduce stigma among healthcare workers.

However, the researchers wrote that "[a]llocation of even more substantive funding, commensurate with the magnitude and adverse effects of health worker burnout, seems necessary to support research and implementation of evidence-based approaches to reduce clinician burnout." (Firth, MedPage Today, 11/5; Lagasse, Healthcare Finance, 11/7; Solomon, Medical Xpress, 11/5; Li et al., JAMA Network Open, 11/5)

'Upsetting yet unsurprising': Addressing nurse burnout is imperative

By Ali Knight and Monica Westhead

This article is upsetting yet unsurprising. Burnout among nurses and declining quality are common themes we hear when speaking with healthcare leaders.  

The reality is that the root causes of burnout have been around for years, though staffing shortages and cost pressures have exacerbated them.  Nurses are a dependable, 24/7 presence, so they often get delegated responsibilities beyond what requires a nursing license. In some cases, this is an intentional choice to counteract cost pressures or unfilled vacancies in support roles. Other times, it is not intentional — but it occurs because nurses are simply the ones in patients’ rooms most often. If something needs to get done, a nurse will do it.

Regardless of the reason, when the burden of increased workload falls on nurses, it has an impact. Nurses joined the profession to help others. When they feel like they are unable to deliver the level of care they would want, or if unintended omissions or errors occur due to workload, nurses can experience moral distress. Repeated moral distress exacerbates burnout. Hospitals can end up in a vicious cycle where burnout leads to turnover, and turnover (and associated vacancies) drive further burnout, neither of which are good for patients.

As an industry, we need to innovate towards a new future of care delivery — one that is both structured to deliver high-quality care and offers a sustainable future for our nurses where they can work and thrive. We need to carefully evaluate our patients’ needs and determine what our staff realistically have the capacity to complete. This may require eliminating work, redesigning processes, adding new roles, or relying on technology. It may mean re-examining employment policies to allow staff flexibility and time to rest.

Getting started can feel overwhelming, but we are here to help. Learn the how others across the industry are redesigning care delivery to reduce burnout and improve outcomes through our presentation, Broaden Your Definition of the Care Team. Or, schedule a facilitated workshop where you will Reimagine the role of a bedside RN and design a future that meets the needs of both nurses and patients.