Associations of pediatric nurse burnout with involvement in quality improvement.

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.

[1]  Kimberly A. Lewis,et al.  Caring for sick kids: An integrative review of the evidence about the prevalence of compassion fatigue and effects on pediatric nurse retention. , 2021, Journal of pediatric nursing.

[2]  D. Frosch,et al.  Women, Younger Clinicians’, and Caregivers’ Experiences of Burnout and Well-being During COVID-19 in a US Healthcare System , 2021, Journal of General Internal Medicine.

[3]  R. Hays,et al.  Usefulness of Child HCAHPS Survey Data for Improving Inpatient Pediatric Care Experiences. , 2021, Hospital pediatrics.

[4]  T. Greene,et al.  Experiences of frontline healthcare workers and their views about support during COVID-19 and previous pandemics: a systematic review and qualitative meta-synthesis , 2021, BMC Health Services Research.

[5]  Jin Jun,et al.  Relationship between nurse burnout, patient and organizational outcomes: Systematic review. , 2021, International journal of nursing studies.

[6]  Jeannie P. Cimiotti,et al.  Prevalence of and Factors Associated With Nurse Burnout in the US , 2021, JAMA network open.

[7]  P. Gee,et al.  Impact of nurse burnout on organizational and position turnover , 2020, Nursing Outlook.

[8]  L. D. de Abreu,et al.  Influence of Burnout on Patient Safety: Systematic Review and Meta-Analysis , 2019, Medicina.

[9]  K. Baldwin,et al.  Improving the Patient Experience and Decreasing Patient Anxiety With Nursing Bedside Report , 2019, Clinical nurse specialist CNS.

[10]  Y. Bombard,et al.  Engaging patients to improve quality of care: a systematic review , 2018, Implementation Science.

[11]  Xiaoming Zhang,et al.  United States Registered Nurse Workforce Report Card and Shortage Forecast: A Revisit , 2018, American journal of medical quality : the official journal of the American College of Medical Quality.

[12]  Laura Pradas-Hernández,et al.  Prevalence of burnout in paediatric nurses: A systematic review and meta-analysis , 2018, PloS one.

[13]  Pamela B Dunagan The quality improvement attitude survey: Development and preliminary psychometric characteristics , 2017, Journal of clinical nursing.

[14]  A. Zaslavsky,et al.  Variation in Family Experience of Pediatric Inpatient Care As Measured by Child HCAHPS , 2017, Pediatrics.

[15]  R. Ramanujam,et al.  The Relationship Between Nurse-Reported Safety Culture and the Patient Experience , 2016, The Journal of nursing administration.

[16]  J. Needleman,et al.  Facilitating Nurses' Engagement in Hospital Quality Improvement: The New Jersey Hospital Association's Implementation of Transforming Care at the Bedside , 2016, Journal for healthcare quality : official publication of the National Association for Healthcare Quality.

[17]  Ian Watt,et al.  Healthcare Staff Wellbeing, Burnout, and Patient Safety: A Systematic Review , 2016, PloS one.

[18]  Sarah J. Shoemaker,et al.  A review of instruments to measure interprofessional team-based primary care , 2016, Journal of interprofessional care.

[19]  B. Lown,et al.  Integrating Compassionate, Collaborative Care (the “Triple C”) Into Health Professional Education to Advance the Triple Aim of Health Care , 2016, Academic medicine : journal of the Association of American Medical Colleges.

[20]  E. Evans Exploring the Nuances of Nurse-Patient Interaction through Concept Analysis , 2016, Nursing science quarterly.

[21]  E. Read Nurses' Workplace Social Capital: Development and Validation of a Self-report Questionnaire , 2016 .

[22]  Marc N. Elliott,et al.  The Development of a Pediatric Inpatient Experience of Care Measure: Child HCAHPS® , 2015, Pediatrics.

[23]  David P. Paul,et al.  Burnout syndrome in hospital nurses , 2015 .

[24]  Christine A. Sinsky,et al.  From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider , 2014, The Annals of Family Medicine.

[25]  Alice E. Dupler,et al.  Improving Client and Nurse Satisfaction Through the Utilization of Bedside Report , 2014, Journal for nurses in professional development.

[26]  D. Maguire,et al.  Clinician Perceptions of a Changing Hospital Environment , 2013, HERD.

[27]  Kimberly Radtke Improving Patient Satisfaction With Nursing Communication Using Bedside Shift Report , 2013, Clinical nurse specialist CNS.

[28]  James K. Harter,et al.  Workplace Engagement and Workers’ Compensation Claims as Predictors for Patient Safety Culture , 2012, Journal of patient safety.

[29]  Hillary M. Hecktman Stress in Pediatric Oncology Nurses , 2012, Journal of pediatric oncology nursing : official journal of the Association of Pediatric Oncology Nurses.

[30]  Russell E. Mardon,et al.  Exploring Relationships Between Patient Safety Culture and Patients’ Assessments of Hospital Care , 2012, Journal of patient safety.

[31]  A. Coulter Patient Engagement—What Works? , 2012, The Journal of ambulatory care management.

[32]  Tait D. Shanafelt,et al.  Concurrent Validity of Single-Item Measures of Emotional Exhaustion and Depersonalization in Burnout Assessment , 2012, Journal of General Internal Medicine.

[33]  Matthew D. McHugh,et al.  Nurses' widespread job dissatisfaction, burnout, and frustration with health benefits signal problems for patient care. , 2011, Health affairs.

[34]  J. Sorra,et al.  Multilevel psychometric properties of the AHRQ hospital survey on patient safety culture , 2010, BMC health services research.

[35]  S. Clarke,et al.  Impacts of unit-level nurse practice environment and burnout on nurse-reported outcomes: a multilevel modelling approach. , 2010, Journal of clinical nursing.

[36]  L. Dyrbye,et al.  Single Item Measures of Emotional Exhaustion and Depersonalization Are Useful for Assessing Burnout in Medical Professionals , 2009, Journal of General Internal Medicine.

[37]  L. Meltzer,et al.  The experience of secondary traumatic stress upon care providers working within a children's hospital. , 2009, Journal of pediatric nursing.

[38]  Bonnie J Wakefield,et al.  Nurse Burnout and Patient Safety Outcomes , 2008, Western journal of nursing research.

[39]  L. Felland,et al.  The role of nurses in hospital quality improvement. , 2008, Research brief.

[40]  Judith H Hibbard,et al.  Do increases in patient activation result in improved self-management behaviors? , 2007, Health services research.

[41]  B. Sabo Compassion fatigue and nursing work: can we accurately capture the consequences of caring work? , 2006, International journal of nursing practice.

[42]  M. Leiter,et al.  The Impact of Nursing Work Environments on Patient Safety Outcomes: The Mediating Role of Burnout Engagement , 2006, The Journal of nursing administration.

[43]  Heather Irwin-Robinson,et al.  Communication enhancement: nurse and patient satisfaction outcomes in a complex continuing care facility. , 2006, Journal of advanced nursing.

[44]  James A. Kulik,et al.  Burnout, self- and supervisor-rated job performance, and absenteeism among nurses , 1995, Journal of Behavioral Medicine.

[45]  James E. Rohrer,et al.  Validation of a single‐item measure of burnout against the Maslach Burnout Inventory among physicians , 2004 .

[46]  L. Aiken,et al.  Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. , 2002, JAMA.

[47]  N. Bowles,et al.  Nurses' communication skills: an evaluation of the impact of solution-focused communication training. , 2001, Journal of advanced nursing.

[48]  L. Heuer,et al.  Dying babies and associated stress in NICU nurses. , 1995, Neonatal network : NN.

[49]  J. Oehler,et al.  Job stress and burnout in acute and nonacute pediatric nurses. , 1992, American Journal of Critical Care.

[50]  Ron D. Hays,et al.  A Five-Item Measure of Socially Desirable Response Set , 1989 .