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Nursing issues
Staff burn-out has implications for organisational and patient outcomes: would an open culture of support with structures in place prevent burn-out?
  1. Jane Peirson
  1. Department of Psychological Health, Wellbeing and Social Work, University of Hull, Hull, Kingston upon Hull, UK
  1. Correspondence to Jane Peirson, Department of Psychological Health, Wellbeing and Social Work, University of Hull, Hull HU6 7RX, Kingston upon Hull, UK; J.A.Peirson{at}

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Commentary on: Jun, J., Ojemeni, M., et al. (2021) Relationship between nurse burnout, patient and organisational outcomes: Systematic review. J Adv Nurs 2021;119

Implications for practice and research

  • Supporting a culture of staff well-being will have benefits on organisational and patient outcomes.

  • Further research is required using a consistent theoretical/measurement approach to investigate the long-term effects of organisational and personal interventions to prevent burn-out.


Growing concerns around staff burn-out and associated health complications have been well researched1 and further evidenced in current practice due to the COVID-19 pandemic.2 The impact on the remaining staff members through absences from work, staff enduring chronic stress, burn-out, health-related conditions and the cyclical nature for further staff being affected by this, is something that the majority of health professionals relate to. This article3 aims to take the alternative view from the individual perspective of the cause of staff burn-out, to identifying the relationship between nursing burn-out from the patient and organisational perspective.


The study conducted a comprehensive systematic review of current evidence around issues of nurse burn-out, identifying the implications of this from the perspective of the patient and organisational outcomes. The Quality Health Outcome model4 guided the review and relevant search terms are derived from this model. An inclusion and exclusion criteria are identified along with the search strategy used. A peer-review process is used assessing the quality of the papers, resulting in identifying 20 articles that are included in the study for further appraisal and synthesis. Limitations of the literature review are identified.


Characteristics of participants in the studies used are primarily women, between 20 and 60 years of age, from 14 countries, nursing experience varies from less than 1 to more than 21 years. Patient safety is the most common outcome. Emotional exhaustion is consistently identified as having a negative impact on patients. Quality of care is perceived by the nurses to be affected, though this was not significantly correlated by the patients. Organisational commitment, assessing staff’s intention to leave is negatively associated with staff burn-out, as is nurse productivity and patient experience.


This paper identifies that burn-out is multifaceted and is associated with a wide range of adverse patient and organisational outcomes, including nurses scoring lower ratings for patient safety when feeling higher levels of burn-out. Interestingly, these results are regardless of demographic characteristics or working conditions, suggesting influences arrive from the actual demands of the role rather than individual factors. This is corroborated by a study5 into National Health Service (NHS) staff’s well-being, which concluded that more support is needed for all front-line staff to help build resilience, recommending 24/7 trauma support.

This review highlights how burn-out can become a negative contagion when working in such close proximity with other staff members and the informal ways in which staff seek to support each other in these situations (peer support). Though this is important, more structured interventions need to be in place such as restorative supervision6

High staff turnover is identified as having implications in practice, negatively impacting on staff morale, teamworking, workforce resources and significant financial implications. Some organisations have implemented individual interventions alongside organisational interventions resulting in longer-term improvements in staff burn-out. To concur with this, organisations need to recognise the impact of staff burn-out, having open and honest conversations with staff regarding this and the support they will offer. Having this open culture will reduce stigma and encourage staff to seek support prior to crisis. A commitment is required by organisations to adequately resource interventions, recognising the initial outlay of costs against the longer-term financial rewards. Organisations need to have financial backing to invest in their staff’s well-being, this will show a commitment to staff regarding a culture of value and support, ensuring efficacy of the intervention preventing it becoming a gimmick.

Ethics statements

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  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.