Highlights
- •Less burnout was associated with more open communication among nurses.
- •Less burnout was related to being more involved in quality improvement.
- •More burnout was linked to a greater quality improvement workload.
- •Unit-level teamwork was associated with less burnout.
- •Future research is needed to identify aspects of QI involvement that reduce burnout.
Abstract
Purpose
Burnout among nurses negatively impacts patient care experiences and safety. Inpatient
pediatric nurses are high-risk for burnout due to high patient volumes, inadequate
staffing, and needing to balance the demands of patients, families and team members.
We examined the associations of inpatient pediatric nurse burnout with their perspectives
on the importance of quality at the hospital, patient experience measurement, quality
improvement (QI), unit culture, and staffing.
Methods
We conducted a cross-sectional study at an urban children's hospital. We surveyed
pediatric nurses about their perspectives including the single-item Maslach Burnout
Inventory. We fit separate regression models, controlling for role, location and unit,
predicting outcome measures from the dichotomized burnout scale.
Results
Twenty-seven percent of pediatric nurses reported burnout. Nurses who had more confidence
in patient experience measurement, received frequent patient experience performance
reports, felt included in QI, and experienced QI efforts as integrated into patient
care reported not being burned out (compared to those reporting burnout; all p-values<0.05). More open communication among nurses (e.g., about possible problems
with care) and unit-level teamwork were also associated with not being burned out,
whereas a larger QI workload was associated with burnout (p-values<0.05).
Conclusions
Open communication among nurses and nurses being more involved and valued in QI efforts
were related to not being burned out. Research is needed to further examine aspects
of QI involvement that reduce burnout.
Practice implications
Supporting open communication among pediatric nurses, engaging them in QI and integrating
QI into patient care while minimizing QI workload may decrease burnout.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Pediatric Nursing: Nursing Care of Children and FamiliesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The relationship between nurse-reported safety culture and the patient experience.The Journal of Nursing Administration. 2016; 46: 662-668
- Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction.JAMA. 2002; 288: 1987-1993
- Improving the patient experience and decreasing patient anxiety with nursing bedside report.Clinical Nurse Specialist. 2019; 33: 82-89
- Experiences of frontline healthcare workers and their views about support during COVID-19 and previous pandemics: A systematic review and qualitative meta-synthesis.BMC Health Services Research. 2021; 21: 923
- From triple to quadruple aim: Care of the patient requires care of the provider.Annals of Family Medicine. 2014; 12: 573-576
- Engaging patients to improve quality of care: A systematic review.Implementation Science. 2018; 13: 98
- Nurses’ communication skills: An evaluation of the impact of solution-focused communication training.Journal of Advanced Nursing. 2001; 36: 347-354
- Quality safety assessment/application for nurses (QSAAN).All Regis University Theses, 2012 (Retrieved September 18 from)
- Statistical power analysis for the behavioral sciences.Routledge Academic, 1988
- Patient engagement—what works?.Journal of Ambulatory Care Management. 2012; 35: 80-89
- Women, younger Clinicians’, and Caregivers’ experiences of burnout and well-being during COVID-19 in a US healthcare system.Journal of General Internal Medicine. 2022; 37: 145-153
- Dying babies and associated stress in NICU nurses.Neonatal Network. 1995; 14: 41-46
- The role of nurses in hospital quality improvement.Research Brief. 2008; : 1-8
- The quality improvement attitude survey: Development and preliminary psychometric characteristics.Journal of Clinical Nursing. 2017; 26: 5113-5120
- Exploring the nuances of nurse-patient interaction through concept analysis: Impact on patient satisfaction.Nursing Science Quarterly. 2016; 29: 62-70
- Caring for sick kids: An integrative review of the evidence about the prevalence of compassion fatigue and effects on pediatric nurse retention.Journal of Pediatric Nursing. 2022; 63: 9-19
- State of well-being.2019
- Influence of burnout on patient safety: Systematic review and meta-analysis.Medicina (Kaunas). 2019; 55
- Workplace empowerment, incivility, and burnout: Impact on staff nurse recruitment and retention outcomes.2012
- Nurse burnout and patient safety outcomes: Nurse safety perception versus reporting behavior.Western Journal of Nursing Research. 2008; 30: 560-577
- Healthcare staff wellbeing, burnout, and patient safety: A systematic review.PLoS One. 2016; 11e0159015
- Q12 Meta-analysis: The relationship between engagement at work and organizational outcomes.
- A five-item measure of socially desirable response set.Educational and Psychological Measurement. 1989; 49: 629-636
- Stress in pediatric oncology nurses.Journal of Pediatric Oncology Nursing. 2012; 29: 356-361
- Do increases in patient activation result in improved self-management behaviors?.Health Services Research. 2006; 42: 1443-1463
- Burnout syndrome in hospital nurses.in: BHAA International 2015, Chicago, IL. 2015
- Relationship between nurse burnout, patient and organizational outcomes: Systematic review.International Journal of Nursing Studies. 2021; 119103933
- Impact of nurse burnout on organizational and position turnover.Nursing Outlook. 2021; 69: 96-102
- PRC National Nursing Engagement Report.2019
- Maslach burnout toolkit for medical personnel group report.2018
- Integrating compassionate, collaborative care (the “triple C”) into health professional education to advance the triple aim of health care.Academic Medicine. 2016; 91: 310-316
- Clinician perceptions of a changing hospital environment.HERD. 2013; 6: 69-79
- Communication enhancement: Nurse and patient satisfaction outcomes in a complex continuing care facility.Journal of Advanced Nursing. 2006; 54: 35-44
- Nurses’ widespread job dissatisfaction, burnout, and frustration with health benefits signal problems for patient care.Health Aff (Millwood). 2011; 30: 202-210
- Taking action against clinician burnout: A systems approach to professional well-being, chapters 2 & 3.The National Academies Press, 2019
- Job stress and burnout in acute and nonacute pediatric nurses.American Journal of Critical Care. 1992; 1: 81-90
- Burnout, self- and supervisor-rated job performance, and absenteeism among nurses.Journal of Behavioral Medicine. 1995; 18: 581-599
- Facilitating Nurses’ engagement in hospital quality improvement: The New Jersey hospital Association’s implementation of transforming Care at the Bedside.Journal for Healthcare Quality. 2016; 38: e64-e75
- Prevalence of burnout in paediatric nurses: A systematic review and meta-analysis.PLoS One. 2018; 13e0195039
- Usefulness of child HCAHPS survey data for improving inpatient pediatric care experiences.Hospital Pediatrics. 2021; 11: e199-e209
- Improving patient satisfaction with nursing communication using bedside shift report.Clinical Nurse Specialist. 2013; 27: 19-25
- Nurses’ workplace social capital: Development and validation of a self-report questionnaire.in: Electronic thesis and dissertation repository. 2016 (Retrieved September 18 from)
- The experience of secondary traumatic stress upon care providers working within a children’s hospital.Journal of Pediatric Nursing. 2009; 24: 270-279
- Validation of a single-item measure of burnout against the Maslach burnout inventory amonh physicians.Stress and Health. 2004; 20: 75-79
- Compassion fatigue and nursing work: Can we accurately capture the consequences of caring work?.International Journal of Nursing Practice. 2006; 12: 136-142
- Prevalence of and factors associated with nurse burnout in the US.JAMA Network Open. 2021; 4e2036469
- A review of instruments to measure interprofessional team-based primary care.Journal of Interprofessional Care. 2016; 30: 423-432
- Exploring relationships between patient safety culture and patients’ assessments of hospital care.The Journal of Nursing Administration. 2014; 44: S45-S53
- Multilevel psychometric properties of the AHRQ hospital survey on patient safety culture.BMC Health Services Research. 2010; 10: 199
- The impact of nursing work environments on patient safety outcomes: The mediating role of burnout/engagement.The Journal of Nursing Administration. 2006; 36: 259-267
- Workplace engagement and workers' compensation claims as predictors for patient safety culture.Journal of Patient Safety. 2012; 8: 194-201
- Variation in family experience of pediatric inpatient care as measured by child HCAHPS.Pediatrics. 2017; 139
- The development of a pediatric inpatient experience of care measure: Child HCAHPS.Pediatrics. 2015; 136: 360-369
- Impacts of unit-level nurse practice environment and burnout on nurse-reported outcomes: A multilevel modelling approach.Journal of Clinical Nursing. 2010; 19: 1664-1674
- Improving client and nurse satisfaction through the utilization of bedside report.Journal for Nurses in Professional Development. 2014; 30 (quiz E161-162): 166-173
- Burned out by the pandemic, 3 in 10 health-care workers consider leaving the profession.The Washington Post, 2021
- Concurrent validity of single-item measures of emotional exhaustion and depersonalization in burnout assessment.Journal of General Internal Medicine. 2012; 27: 1445-1452
- Single item measures of emotional exhaustion and depersonalization are useful for assessing burnout in medical professionals.Journal of General Internal Medicine. 2009; 24: 1318-1321
- United States registered nurse workforce report card and shortage forecast: A revisit.American Journal of Medical Quality. 2018; 33: 229-236
Article info
Publication history
Published online: November 16, 2022
Accepted:
November 3,
2022
Received in revised form:
November 3,
2022
Received:
June 14,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 Elsevier Inc. All rights reserved.
