Making Care Safer: Exploring Predictors and Impact of RN Burnout and Engagement

patient safety;nurse burnout;nurse engagement;work system factors;Nursing

Mossburg, Sarah ElizabethDennison Himmelfarb, Cheryl ;

Johns Hopkins University

关键词: patient safety;    nurse burnout;    nurse engagement;    work system factors;    Nursing;   

Others  :  https://jscholarship.library.jhu.edu/bitstream/handle/1774.2/60042/MOSSBURG-DISSERTATION-2018.pdf?sequence=1&isAllowed=y

瑞士|英语

来源: JOHNS HOPKINS DSpace Repository

【 摘 要 】

BackgroundDuring the last two decades of the patient safety movement, healthcare has made much progress. Yet evidence suggests that there remains a long path forward. A 2016 study ranked deaths due to medical error as the third leading cause of death in the US. As researchers seek to ways to mitigate this, they have begun to look into the complex adaptive system within which nurses provide care to patients, in attempt to understand how changes within this system impact nurse and patient outcomes. PurposeThe purpose of this study is to examine the relationships among work system factors (autonomy, time pressure, supportive nursing management) on inpatient hospital units and their effect on nurse outcomes (burnout and engagement) and measures of patient safety and quality (falls). We drew on the Systems Engineering Initiative for Patient Safety (SEIPS) model to identify potential relationships among our variables of interest.MethodsTo address this, we propose a descriptive correlational study using secondary data analysis combining five different operational cross-sectional data sources. Data was aggregated and analyzed at the unit level, using a convenience sample of inpatient nursing units in Johns Hopkins Hospital (JHH).This sample includes a diverse set of inpatient nursing units, including medical, surgical, pediatric, oncology, and intensive care among others. We used bivariate regression of each variable of interest (autonomy, time, supportive nursing management) with burnout as the outcome variable.Significant predicators using an alpha level of .10 were included in a multivariable analysis. The same set of analyses was conducted with engagement as the outcome variable. Statistical analysis for mediation followed Baron and Kenny’s approach, using a series of regression equations.Each variable of interest (autonomy, time pressure, supportive nursing management) shown to be significantly associated with burnout was evaluated. We next tested for significant association with the outcome variables (falls). Burnout was tested for significant association with the outcome variables (falls) after controlling for variables of interest. Subsequent analysis with engagement as the mediator was conducted. We used multivariable regression to evaluate the association between process improvement activities and work systems factors.All CUSP variables were included in the regression equation simultaneously as explanatory variables. Separate regression analysis was conducted with autonomy, time pressure and supportive nursing management as the outcome variable. The same set of analyses were conducted with burnout and engagement as the outcome variables to evaluate the association between CUSP implementation and employee outcomes.ResultsIn adjusted multivariable analysis, time pressure was significantly associated with burnout (ß=-5.44; 95% CI -7.02, -3.87). Supportive nursing management was significantly associated with engagement ((ß=0.19; 95% CI 0.07, 0.3). We didn’t find evidence that burnout or engagement mediated the relationship between work system factors and patient falls. We found a significant association between CUSP implementation and nurse engagement (p=0.05) and a moderate effect size (R2=0.55).ConclusionThis study illustrated several important relationships among work system factors, nurse outcomes and quality improvement activities. We observed that time pressure was associated with nurse burnout, an important finding for nurse managers and hospital administrators seeking to retain nursing staff. Additionally, we found that nursing management support and CUSP implementation were associated with nurse engagement. Hospital leaders can leverage these findings to maximize engagement of nursing staff to harness the positive outcomes that are associated with increased engagement.