Factors Associated With Provider Burnout in the NICU

Abstract

Background: NICUs vary greatly in patient acuity and volume and represent a wide array of organizational structures, but the effect of these differences on NICU providers is unknown. This study sought to test the relation between provider burnout prevalence and organizational factors in California NICUs.

Methods: Provider perceptions of burnout were obtained from 1934 nurse practitioners, physicians, registered nurses, and respiratory therapists in 41 California NICUs via a validated 4-item questionnaire based on the Maslach Burnout Inventory. The relations between burnout and organizational factors of each NICU were evaluated via t-test comparison of quartiles, univariable regression, and multivariable regression.

Results: Overall burnout prevalence was 26.7% ± 9.8%. Highest burnout prevalence was found among NICUs with higher average daily admissions (32.1% ± 6.4% vs 17.2% ± 6.7%, P < .001), higher average occupancy (28.1% ± 8.1% vs 19.9% ± 8.4%, P = .02), and those with electronic health records (28% ± 11% vs 18% ± 7%, P = .03). In sensitivity analysis, nursing burnout was more sensitive to organizational differences than physician burnout in multivariable modeling, significantly associated with average daily admissions, late transfer proportion, nursing hours per patient day, and mortality per 1000 infants. Burnout prevalence showed no association with proportion of high-risk patients, teaching hospital distinction, or in-house attending presence.

Conclusions: Burnout is most prevalent in NICUs with high patient volume and electronic health records and may affect nurses disproportionately. Interventions to reduce burnout prevalence may be of greater importance in NICUs with ≥10 weekly admissions.

FIGURE 1

Relation between admission rate and burnout prevalence in 41 NICUs showed significant positive association. R = 0.53, P < .001, n = 1934 providers. Point size proportional to number of licensed NICU beds, shading proportional to questionnaire response rate.

FIGURE 2

Relation between EHR use and burnout prevalence in 41 NICUs, n = 1934 providers. Medians, interquartile ranges, and outliers shown. Burnout was significantly higher in units with EHR use ≥2 years compared with no EHR use (28.3% ± 10.1% vs 18.4% ± 6.6%, P = .015).