Relationship between nurse burnout, patient and organizational outcomes: Systematic review

doi:10.1016/j.ijnurstu.2021.103933

International Journal of Nursing Studies

Volume 119, July 2021, 103933

https://doi.org/10.1016/j.ijnurstu.2021.103933 Get rights and content

Abstract

Background

Burnout, characterized by emotional exhaustion, depersonalization, and decreased personal accomplishments, poses a significant burden on individual nurses’ health and mental wellbeing. As growing evidence highlights the adverse consequences of burnout for clinicians, patients, and organizations, it is imperative to examine nurse burnout in the healthcare system.

Objective

The purpose of this review is to systematically and critically appraise the current literature to examine the associations between nurse burnout and patient and hospital organizational outcomes.

Design and data sources

A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses was conducted. PubMed, CINAHL, PsychInfo, Scopus, and Embase were the search engines used. The inclusion criteria were any primary studies examining burnout among nurses working in hospitals as an independent variable, in peer-reviewed journals, and written in English. The search was performed from October 2018 to January 2019 and updated in January and October 2020.

Results

A total of 20 studies were included in the review. The organizational-related outcomes associated with nurse burnout were (1) patient safety, (2) quality of care, (3) nurses’ organizational commitment, (4) nurse productivity, and (5) patient satisfaction. For these themes, nurse burnout was consistently inversely associated with outcome measures.

Conclusions

Nurse burnout is an occupational hazard affecting nurses, patients, organizations, and society at large. Nurse burnout is associated with worsening safety and quality of care, decreased patient satisfaction, and nurses’ organizational commitment and productivity. Traditionally, burnout is viewed as an individual issue. However, reframing burnout as an organizational and collective phenomenon affords the broader perspective necessary to address nurse burnout.

Tweetable abstract: Not only nurse burnout associated w/ worsening safety & quality of care, but also w/ nurses' organizational commitment and productivity. Reframing burnout, as an organizational & collective phenomenon is necessary.

Section snippets

What is already known

•
The prevalence rate of burnout among nurses working in hospitals range widely from 5 to up to 50%, based on the specialties and geographical regions.
•
Burnout, resulting from chronic and constant occupational stress, is associated with a range of individual adverse health outcomes such as chronic pain, gastrointestinal distress, depression, and even mortality.
•
Burnout also potentially endanger patients and colleagues with absenteeism, presentism, turnover, and medical error. However, a

What this paper adds

•
This review demonstrates that burnout, especially emotional exhaustion of nurses, is negatively associated with the quality and safety of care, patient satisfaction, nurses’ organizational commitment, and productivity.
•
Burnout could potentially predict patient safety and quality of care better than either demographic or organizational characteristics, but the evidence for such a conclusion is limited.

Methods

A systematic review searches, appraises, and synthesizes research evidence (Grant and Booth, 2009), aiming for an exhaustive and comprehensive inquiry. Such a review is especially important amid a vast array of scholarly literature. With more studies on occupational stress and burnout being published, a systematic review can deliver a comprehensive overview of the available evidence, identify research gaps, and offer recommendations for practice and future research (Grant and Booth, 2009;

Results

The PRISMA diagram shown in Fig. 1 demonstrates the literature search process and results. After removing duplicates, we identified 2324 articles. After applying inclusion and exclusion criteria, we reviewed the abstracts of 458 articles. Sixty-four articles met the inclusion criteria for full-text review; after evaluating the full-text versions of these articles, we included 20 in this review. Most articles omitted at this step measured burnout as an outcome, rather than as a predictor or

Discussion

This review demonstrates that burnout, especially emotional exhaustion of nurses, is associated with a range of adverse patient and organizational outcomes. The overall quality of the included studies was moderate due to their observational study design and their risks for bias. Even though burnout could potentially predict patient safety and quality of care better than either demographic or organizational characteristics, the evidence for such a conclusion is limited.

Burnout is a complex,

Conclusion

Nurse burnout is a severe occupational hazard affecting nurses, patients, organizations, and society at large. This review adds to the existing literature examining the negative associations between nurse burnout, patient safety, quality of care, patient experiences, nurses’ commitment to their organizations, and practitioner productivity. Framing burnout as an organizational phenomenon, rather than as an individual issue, affords the broader perspective necessary to assess and address this

Declaration of Competing Interest

All authors declare no conflict of interest.

Acknowledgments

We acknowledge the National Clinician Scholars Program at the University of Michigan for their support and the health librarian at the University of Michigan, Kate Saylor, for assisting with the literature search.

Ethical approval

None.

Funding sources

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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View full text

Relationship between nurse burnout, patient and organizational outcomes: Systematic review

Abstract

Background

Objective

Design and data sources

Results

Conclusions

Section snippets

What is already known

What this paper adds

Methods

Results

Discussion

Conclusion

Declaration of Competing Interest

Acknowledgments

Ethical approval

Funding sources

Int. J. Nurs. Stud.

Patient Educ. Couns.

Am. J. Infect. Control

Int. J. Nurs. Stud.

Crit. Care Nurs. Clin.

Appl. Nurs. Res.

Soc. Sci. Med.

Int. J. Nurs. Stud.

J. Vocat. Behav.

Int. J. Nurs. Stud.

Int. J. Nurs. Stud.

Lancet

J. Psychiatr. Res.

Safety climate, emotional exhaustion and job satisfaction among Brazilian paediatric professional nurses

Int. Nurs. Rev.

The ripple effect: emotional contagion and its influence on group behavior

Adm. Sci. Q.

Predictors of actual turnover in a national sample of newly licensed registered nurses employed in hospitals

J. Adv. Nurs.

Managing manifest diseases, but not health risks, saved PepsiCo money over seven years

Health Aff.

The impact of burnout on self-efficacy, outcome expectations, career interest and nurse turnover

J. Adv. Nurs.

How does burnout impact the three components of nursing professional commitment?

Scand. J. Caring Sci.

Nurse occupational burnout and patient-rated quality of care: the boundary conditions of emotional intelligence and demographic profiles

Jpn. J. Nurs. Sci.

Turnover of new graduate nurses in their first job using survival analysis

J. Nurs. Scholarsh.

Effect of effort-reward imbalance and burnout on infection control among Ecuadorian nurses

Int. Nurs. Rev.

Burnout in the intensive care unit professionals: a systematic review

Medicine (Baltimore)

Burnout in nursing: a theoretical review

Hum. Resour. Health

Association between culture of patient safety and burnout in pediatric hospitals

PLoS ONE

Prevention actions of burnout syndrome in nurses: an integrating literature review

Clin. Pract. Epidemiol. Ment. Health

The relationship between physician burnout and quality of healthcare in terms of safety and acceptability: a systematic review

BMJ Open

Nurse turnover and perceived causes and consequences: a preliminary study at private hospitals in Indonesia

BMC Nurs.

Influence of burnout on patient safety: systematic review and meta-analysis

Medicina (B. Aires).

Relationship between job burnout, psychosocial factors and health care-associated infections in critical care units

Intens. Crit. Care Nurs.

A typology of reviews: an analysis of 14 review types and associated methodologies

Health Info. Libr. J.

The relationship between workplace stressors and mortality and health costs in the United States

Manag. Sci.