Association Between Nurse Burnout and Patient Outcomes in U.S. Hospitals

Burnout is an occupational phenomenon affecting 35% to 45% of hospital nurses. While nurses are equipped with the knowledge and skill to care for sick patients, lacking the infrastructure and support to provide high quality care (e.g. a poor work environment, inadequate staffing) strains nurses and leads to burnout. In the acute care setting, nurses provide the majority of bedside care. Research has linked burnout to higher rates of medical errors, missed care, and poor quality, thus drawing attention to the potentially life-threatening consequences of burnout for patients. The National Academy of Medicine has called for more evidence to determine the impact of clinician burnout on patient outcomes. This study addresses this call by determining the relationship between nurse burnout and objective patient outcomes including 30-day in-hospital mortality, failure to rescue, adverse events, length of stay, and readmissions (Aim 1). Our study also evaluated whether the effect of nurse burnout on patient outcomes was attenuated by the quality of the nurse work environment and nurse staffing (Aim 2). This was a secondary data analysis of 2015-2016 cross-sectional data from 4 large states. The final sample included 1,939,878 adult surgical patients across 523 U.S. hospitals. Multilevel logistic regression and zero truncated negative binomial regression were used to determine the association between hospital-level nurse burnout and patient outcomes. After adjustments for patient and hospital characteristics, patients in hospitals with higher nurse burnout scores were associated with higher odds of 30-day in-hospital mortality (OR=1.05, p=.023), failure to rescue (OR=1.05, p=.038), and longer length of stay (OR=1.01, p=.035). The nurse work environment attenuated the relationship between nurse burnout and patient outcomes, lowering the odds of 30-day in-hospital mortality (OR=0.82, p=.001) and failure to rescue (OR=0.82, p=.003). Nurse staffing was not found to attenuate the relationship between nurse burnout and 30-day in-hospital mortality or between nurse burnout and failure to rescue. For the analysis of length of stay, the nurse work environment and nurse staffing attenuated the effect of nurse burnout, although neither were significant in the final model. No significant associations were found between nurse burnout and the odds of readmissions (OR=1.01, p=.314) or adverse events (OR=0.99, p=.537). We conclude that higher nurse burnout in hospitals is a risk for preventable mortality, failure to rescue, and prolonged length of stay. Improving hospital work environments holds promise as a strategy for reducing nurse burnout and its associated adverse outcomes such as preventable mortality. Together, these findings suggest that hospitals can simultaneously effect positive change in nurse well-being and patient outcomes through systematic investments in the nurse work environment