National survey data suggest that, well before COVID-19, the largest healthcare workforce in the US has been challenged by understaffing and stressful situations.
Burnout is highly prevalent among US nurses who leave or are considering leaving the medical field, according to a secondary analysis of survey data.
The new findings, from investigators at Emory University, contribute to the understanding of the largest proportion of the country’s healthcare workforce at a time when greater strain is being put on the individual caregiver.
Led by Megha K. Shah, MD, MSc, of the Department of Family and Preventive Medicine at the Emory School of Medicine, the team of investigators observed that nearly one-third of nurses to leave their job in 2017 reported burnout as their reason—with factors including a stressful work environment and inadequate staffing driving others to consider a switch in professions.
“As the workloads on health care systems and clinicians have grown, so have the demands placed on nurses, negatively affecting the nursing work environment,” investigators wrote. “When combined with the ever-growing stress associated with the coronavirus disease 2019 (COVID-19) pandemic, this situation could leave the US with an unstable nurse workforce for years to come.”
Shah and colleagues sought to measure nurse burnout rates and the factors associated within those who are considering leaving the field. They did so with a secondary assessment of cross-sectional survey data collected from the National Sample Survey of Registered Nurses in the US, from April 30 – October 12, 2018.
The survey database included nearly 4 million respondents (n = 3,957,661), a strong majority of whom were female (90.4%), and White (80.7%). Mean respondent age was 48.7 years old, and primary work setting was hospitals (63.7%). Another 82% of respondents were full-time nurses, versus 18% part-time, with 40.3 mean hours worked weekly.
Regionally, most respondents were either in the South (40.3%) or Midwest (24.8%).
Because of the timing of the survey, conducted prior to the ongoing pandemic, Shah and colleagues stressed the significance of the burnout prevalence in a nursing workforce most recently measured at 6 million—or 30% of the hospital employment count in the US.
“Given their far-ranging skill set, importance in the care team, and proportion of the health care workforce, it is imperative that we better understand job-related outcomes and the factors that contribute to burnout in nurses nationwide,” they wrote.
The investigators observed 418,769 respondents (10.6%) who stated having left their job in 2017. Of them, 31.5% reported burnout as their reason for leaving. Working more than the mean 40 hours per week was associated with a 3 times greater likelihood of leaving nursing due to burnout than for those who work less than 20 hours per week (odds ratio [OR], 3.28; 95% CI, 1.61 – 6.67).
The team also observed a disparity in burnout rates among the 2 of the most nurse-populated regions of the country: just 16.6% of nurses in the West reported burnout, versus 30% in the Southeast. Such differences warrant continue discussion, Shah and colleagues wrote.
“The lower reported rates of nurse burnout in California and Massachusetts could be attributed to legislation in these states regulating nurse staffing ratios; California has the most extensive nurse staffing legislation in the US,” they wrote. “The high rates of reported burnout in the Southeast and the overlap of burnout and inadequate staffing in our findings could be driven by shortages of nurses in the states in this area, particularly South Carolina and Georgia.”
Indeed, respondents who reported either leaving or considering leaving nursing frequently reported a stressful work environment (68.6% and 59.5%, respectively) and inadequate staffing (63.0% and 60.9%, respectively) as key factors.
How COVID-19 and its unprecedented demand on the healthcare workforce affects continual rates of burnout among US caregivers remains to be seen, but these findings among the predominant care team highlight a historical issue of systemic shortcomings which can result in the most over-worked care team members seeking an out from the field—perpetuating issues of nursing shortages further.
“Legislation that supports adequate staffing ratios is a key part of a multitiered solution,” Shah and colleagues concluded. “Solutions must come through system-level efforts in which we reimagine and innovate workflow, human resources, and workplace wellness to reduce or eliminate burnout among frontline nurses and work toward healthier clinicians, better health, better care, and lower costs.”
The study, “Prevalence of and Factors Associated With Nurse Burnout in the US,” was published online in JAMA Network Open.