Study links nurse burnout to lower patient safety, care quality

Editor's Note

A new meta-analysis of 85 studies reveals a significant association between nurse burnout and negative outcomes in patient safety, satisfaction, and care quality. The findings underscore the impact of burnout—characterized by emotional exhaustion, depersonalization, and low personal accomplishment—on healthcare performance globally, with implications for organizational and policy interventions, researchers wrote November 5 in JAMA Network.

Including data from 288,581 nurses across 32 countries, the analysis identified consistent, negative links between burnout and critical patient outcomes. Specifically, high burnout levels correlated with increased medical errors, adverse events, and nosocomial infections, as well as with lower patient safety culture ratings. Moreover, nurse burnout was linked to reduced patient satisfaction, demonstrated by lower satisfaction survey scores and more frequent complaints, although associations with patient abuse and complaint frequency were less conclusive, researchers write.

Burnout was also tied to lower overall care quality. Nurses experiencing burnout reported reduced quality of care assessments, while nursing homes with higher burnout rates saw increased reliance on tube feeding and urinary catheter use, which can be detrimental to patient well-being. However, no clear association emerged for metrics like patient length of stay, rescue failure rates, or 30-day mortality, indicating that burnout may not impact all quality metrics uniformly, researchers write.

The study found that burnout's effects on patient safety were most strongly linked to emotional exhaustion and depersonalization, rather than to feelings of low personal accomplishment. Additionally, the association between burnout and patient safety did not vary significantly by demographic factors like age, gender, or work experience, though higher education levels seemed to moderate the negative impact slightly. Nurses with college degrees showed a smaller drop in patient safety associated with burnout, suggesting educational investments may buffer some burnout effects, researchers write. Geographic comparisons revealed generally similar patterns, although associations were stronger in countries like the United States, Canada, and Belgium.  

Limitations of the study include the heterogeneity of included research and its cross-sectional design, limiting causal conclusions. Nevertheless, researchers write that the findings align with previous studies and emphasize the need for systemic, organizational-level strategies—beyond individual resilience training—to combat nurse burnout. Recommendations include enhanced staffing, reduced work hours, and supportive leadership roles aimed at fostering a healthy work environment.