Study Identifies Interventions Physicians and Nurses Want to Address Burnout

Researchers find relatively high levels of burnout at hospitals designated as good places to work.

To address burnout, physicians and nurses prefer actions to boost nurse staffing, increase clinician control over workload, and improve work environments rather than wellness programs and resilience training, a new research article found.

Physician and nurse burnout was widespread before the coronavirus pandemic and spiked during the public health emergency. An earlier study found that from September 2019 to January 2022, overall emotional exhaustion among healthcare workers increased from 31.8% to 40.4%.

The new research article, which was published by JAMA Health Forum, is based on survey data collected from more than 15,000 nurses and more than 5,000 physicians at 60 Magnet-recognized hospitals in 2021. The Magnet Recognition Program designates hospitals as good places to work based on nursing excellence and healthcare quality.

The study features several key findings:

• Burnout rates were 32% among physicians and 47% among nurses
   
• 12% of physicians and 26% of nurses rated patient safety unfavorably at their hospitals
   
• 28% of physicians and 54% of nurses said their hospitals had inadequate nurse staffing
   
• 20% of physicians and 34% of nurses said they had a poor work environment
   
• 42% of physicians and 46% of nurses lacked confidence in management
   
• Less than 10% of physicians and nurses reported that their workplace was joyful
   
• To improve mental health and well-being of clinicians, boosting nurse staffing was ranked as the top preferred intervention, with support of 87% of nurses and 45% of physicians
   
• Other preferred interventions included taking breaks without interruptions, reducing time spent on documentation, improving the usability of electronic medical records, and control over scheduling
   
• Popular management interventions such as clinician wellness champions, resilience training, and quiet places did not rank high with most physicians and nurses
   
• 23% of physicians said they would leave their hospital within a year possible
   
• More than 40% of nurses said they would leave their hospital if possible
   
• One-third of physicians and nurses said they had poor control over their workloads
   
• A chaotic work environment was reported by 39% of physicians and 63% of nurses

The findings are notable given that the data was collected at hospitals designated as good places to work, the study's co-authors wrote. "This cross-sectional survey study of physicians and nurses practicing in U.S. Magnet hospitals found that hospitals characterized as having too few nurses and unfavorable work environments had higher rates of clinician burnout, turnover, and unfavorable patient safety ratings. Clinicians wanted action by management to address insufficient nurse staffing, insufficient clinician control over workload, and poor work environments; they were less interested in wellness programs and resilience training."

Interpreting the data

The research identified primary factors driving burnout, the study's co-authors wrote. "For physicians, whether they have control over their workload was shown to be of paramount importance regarding level of burnout. For nurses, the factors of greatest importance to burnout were sufficiency of nurse staffing and quality of the work environment."

There is a significant disconnect between clinicians and management at Magnet hospitals, the study's co-authors wrote. "Close to half of physicians and nurses were not confident that management would act to resolve problems that clinicians identify in patient care, and close to one-third of clinicians reported that their values were not well aligned with those of management. These are surprising findings in Magnet hospitals given that these issues may be even more pronounced in non-Magnet hospitals."

To boost their mental health and well-being, physicians and nurses preferred interventions aimed at improving their ability to provide effective care in a positive work environment, the study's co-authors wrote.

"Among their priority choices were improved nurse staffing (highly ranked by 45% of physicians and 87% of nurses) and improved work environments, including scheduled breaks without interruptions, not working unscheduled hours, more control over scheduling, and additional resources devoted to new-to-practice clinicians. Improving EHR usability and reducing emphasis on meeting external quality metrics were among the more highly ranked initiatives. Clinician wellness and resilience programs were ranked lowest, although they tended to be more commonly implemented than actions to improve clinicians' working conditions."

Related: Physicians Reporting at Least One Burnout Symptom Rises from 38.2% in 2020 to 62.8% in 2021