Used up or energetic, frustrated or exhilarated?Associations between scope of nursing practice and burnoutGerardo Melendez-Torres1,2; Robyn Cheung, PhD, RN2 1The Wharton School, University of Pennsylvania 2Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania

Nursing specialties have differential burnout rates (Browning et al., 2007).

Nurse burnout translates to lower patient satisfaction (Vahey, et al., 2004).

Nurse burnout affects healthcare outcomes in hospitals (Sochalski, 2001).

Nurse burnout leads to nurse turnover (Lake, 1998).

Background

Table 2: Burnout rates, correlates, and p-values

1. Examine the potential relationship between burnout and scope of practice, defined as practice as an NP, CNM, or CRNA or a non-advanced practice registered nurse (RN).

2. Examine potential correlates to burnout as a function of scope of nursing practice.

Objectives

% APNs reporting

% non-APNs reporting

p-value

Emotional exhaustion 23 30 <.001

Good physician-nurse relations

87 84 .002

Good physician-nurse teamwork

73 68 <.001

Good physician-nurse collaboration

78 75 .004

Nurse contributions acknowledged

63 57 <.001

Satisfied with job 90 81 <.001

Table above displays data pooled for three states.

We ran the same analyses for the data in each state to control for differential practice environments.

Background. While burnout rates amongst nursing specialties have been studied, burnout as correlated with scope of nursing practice has not been studied.

Objective. We seek to explore the potential relationship between scope of nursing practice and burnout.

Methods. We used data from a 2006 survey of registered nurses in three states (n=58,249).

Results. Fewer advanced practice nurses (APNs) reported high levels of emotional exhaustion as compared to non-APNs.

Conclusions. APNs are less likely to suffer burnout than non-APNs. More research is necessary to see how burnout rates can be lowered across scopes of practice.

Abstract

The Maslach Burnout Inventory-Emotional Exhaustion Subscale was included as part of the 2006 Nursing Care and Patient Safety Survey, sent to RNs in CA, PA, and NJ.

A score ≥27 on the MBI-EE indicates high emotional exhaustion among health professionals.

The survey also included questions about job satisfaction and practice environment.

We used Pearson’s chi-square test to verify statistically significant differences in burnout rates and satisfaction amongst APNs and non-APNs.

Methods

APNs had significantly lower burnout rates than non-APNs, both across and within the three states.

APNs also reported significantly higher job satisfaction than non-APNs, both across and within the three states.

APNs reported significantly more positive ratings of practice environments than non-APNs across states, but not necessarily within them.

Results

These findings suggest that APNs experience less burnout than non-APNs.

These results also suggest that work environments differ between APNs and non-APNs.

Further research is necessary to determine which factors impact the differential burnout rates amongst APNs and non-APNs.

Conclusions

Lower burnout rates may attract nurses to pursue careers as APNs.

This may particularly impact nurses at the bedside. A shift towards advanced practice would further exacerbate the bedside nursing shortage.

Comparing differences in practice environments between APNs and non-APNs could help to reduce burnout rates for all nurses, in turn improving patient health outcomes.

Policy Implications

Special thanks to Jeannie Cimiotti, RN, DNSc, Tim Cheney, and Eileen Lake, RN, PhD, FAAN for their assistance.

This project was supported by the Leonard Davis Institute’s Summer Undergraduate Minority Research Program.

The 2006 Nursing Care and Patient Safety Survey, administered by the Center for Health Outcomes and Policy Research and affiliates, was funded by NIH/NINR R01-NR-04513 (Linda H. Aiken, PI).

Acknowledgements

Nurses have been providing expanded-scope primary care “unofficially” since the beginning of nursing practice. However, within the last forty years, the function and education of the advanced practice nurse—whether as a nurse practitioner, nurse-midwife, or nurse anesthetist—has been formalized through graduate degrees extending beyond initial bachelor’s level preparation. APNs can practice in all 50 states, and have primary care outcomes equal to—if not better than—physicians. Photo from the American Academy of Nurse Practitioners.

Table 1: Characteristics of nurses in the study

APNs non-APNs Total

California 1549 20707 22256

New Jersey 737 16557 17294

Pennsylvania 1005 17694 18699

Total 3291 54958 58249