Abstract
BackgroundWorldwide, rather few studies have examined the association between burnout and care quality using objectively measured quality indicators, with most of the studies have relied on perceived quality outcomes. This study aimed to examine the association between staff nurses’ burnout and selected objective quality metrics in long-term care wards in Japan.MethodsThis is a secondary analysis of a cross-sectional survey. Nurse managers and staff nurses working at randomly selected hospitals with long-term care wards—the equivalent of skilled nursing homes in Western countries— completed self-administered, anonymous questionnaires. The questionnaires collected data regarding care quality indicators, staff nurses’ burnout, and other confounders (e.g., ward size, participants’ years of experience, and patients’ conditions). All statistical analyses were conducted at the ward level. A multivariate regression analysis was used to examine associations between burnout and outcome indicators.ResultsData from 196 wards in 196 hospitals (196 nurse managers and 2473 staff nurses) across Japan were analyzed. Multivariate regression analysis showed that higher emotional exhaustion was associated with higher rates of pneumonia and pressure ulcers (p-value = .036 and .032, respectively), and that reduced personal accomplishment was associated with higher rates of tube feeding (p-value = .018). A larger ward size was also associated with low rates of pneumonia (regression coefficient = −.001, p-value = .019).ConclusionsStaff nurses’ burnout is a significant determinant of care quality in long-term care wards, implying that organizations that implement burnout reducing strategies may see greater benefits in patient outcomes. A large ward size was significantly associated with better care outcomes—specifically, low rates of pneumonia. Future research needs to determine feasible quality improvement measures in small-scale long-term care facilities, and to provide more comprehensive insights on ward-level variables that influence care quality in long-term care settings.
Highlights
Worldwide, rather few studies have examined the association between burnout and care quality using objectively measured quality indicators, with most of the studies have relied on perceived quality outcomes
Burnout is a common, multifactorial phenomenon [1,2,3,4]. It is conceptualized as a prolonged response to chronic emotional and interpersonal stressors on the job, and is defined by the three dimensions of emotional exhaustion (EE), depersonalization (DP), and diminished sense of personal accomplishment (PA) [5]
Rather few studies have examined the association between burnout and care quality using objectively measured quality indicators [19], with most of the studies have relied on perceived quality outcomes, such as nurses’ perception of patient outcome [20, 21] and nurses’ rating of patient care [22]
Summary
Rather few studies have examined the association between burnout and care quality using objectively measured quality indicators, with most of the studies have relied on perceived quality outcomes. This study aimed to examine the association between staff nurses’ burnout and selected objective quality metrics in long-term care wards in Japan. Multifactorial phenomenon [1,2,3,4] It is conceptualized as a prolonged response to chronic emotional and interpersonal stressors on the job, and is defined by the three dimensions of emotional exhaustion (EE), depersonalization (DP), and diminished sense of personal accomplishment (PA) [5]. In long-term care (LTC) settings, nurses make up the largest proportion of the workforce [14], and they are exposed to a large number of stressors, including heavy workloads, time pressure, role conflict, role ambiguity, and physical tiredness [15, 16]. Nurses in LTC settings, are highly vulnerable to emotional strains, including burnout [18]
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