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Meta-Analysis
. 2024 Nov 4;7(11):e2443059.
doi: 10.1001/jamanetworkopen.2024.43059.

Nurse Burnout and Patient Safety, Satisfaction, and Quality of Care: A Systematic Review and Meta-Analysis

Lambert Zixin Li  1 , Peilin Yang  1   2 , Sara J Singer  3   4 , Jeffrey Pfeffer  1 , Maya B Mathur  3 , Tait Shanafelt  3
Affiliations
Meta-Analysis

Nurse Burnout and Patient Safety, Satisfaction, and Quality of Care: A Systematic Review and Meta-Analysis

Lambert Zixin Li et al. JAMA Netw Open. .

Abstract

Importance: Occupational burnout syndrome is characterized by emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment and is prevalent among nurses. Although previous meta-analyses have explored the correlates of nurse burnout, none have estimated their association with health care quality and safety and patient morbidity and mortality.

Objective: To evaluate the magnitude and moderators of the association between nurse burnout and patient safety, patient satisfaction, and quality of care.

Data source: The Web of Science, Scopus, MEDLINE, Embase, PsycINFO, CINAHL, and ProQuest databases were searched from January 1, 1994, to February 29, 2024.

Study selection: Two reviewers independently identified studies that reported a quantifiable association between nurse burnout and any of the outcomes of patient safety, patient satisfaction, or quality of health care.

Data extraction and synthesis: The PRISMA 2020 guideline was followed. Two reviewers independently extracted the standardized mean difference (SMD) (Cohen d) estimates for a random-effects meta-analysis. Subgroup analyses and meta-regressions were conducted using prespecified variables.

Main outcomes and measures: Any measure of patient safety, patient satisfaction, or quality of health care previously associated with nurse burnout.

Results: A total of 85 studies (81 cross-sectional and 4 longitudinal) involving 288 581 nurses from 32 countries (mean [SD] age, 33.9 (2.1) years; 82.7% female; mean [SD] burnout prevalence rate with study-specific ascertainments, 30.7% [9.7%]) were included. Nurse burnout was associated with a lower safety climate or culture (SMD, -0.68; 95% CI, -0.83 to -0.54), lower safety grade (SMD, -0.53; 95% CI, -0.72 to -0.34), and more frequent nosocomial infections (SMD, -0.20; 95% CI, -0.36 to -0.04), patient falls (SMD, -0.12; 95% CI, -0.22 to -0.03), medication errors (SMD, -0.30; 95% CI, -0.48 to -0.11), adverse events or patient safety incidents (SMD, -0.42; 95% CI, -0.76 to -0.07), and missed care or care left undone (SMD, -0.58; 95% CI, -0.91 to -0.26) but not with the frequency of pressure ulcers. Nurse burnout was also associated with lower patient satisfaction ratings (SMD, -0.51; 95% CI, -0.86 to -0.17) but not with the frequencies of patient complaints or patient abuse. Finally, nurse burnout was associated with lower nurse-assessed quality of care (SMD, -0.44; 95% CI, -0.57 to -0.30) but not with standardized mortality rate. The associations were consistent across nurses' age, sex, work experience, and geography and persistent over time. For patient safety outcomes, the association was smaller for the low personal accomplishment subcomponent of burnout than for emotional exhaustion or depersonalization, as well as for nurses with a college education.

Conclusions and relevance: In this systematic review and meta-analysis, nurse burnout was found to be associated with lower health care quality and safety and lower patient satisfaction. This association was consistent across nurse and study characteristics.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Shanafelt reported receiving patents for well-being index and leadership behavior index instruments, with royalties shared with the Mayo Clinic (the copyright holder), and speaker honoraria from Baylor Scott & White Health; UT Southwestern Medical Center; California Pacific Medical Center; Albany Medical Center; Doctors’ Health SA; Southwestern Health Resources; University of California, San Diego; All American Entertainment (on behalf of the Association of Faculties of Medicine of Canada); Samaritan Health Services; American Society of Clinical Oncology; Centra; American Medical Group Association; Inland Empire Health Plan; Cleveland Clinic; NYU Grossman School of Medicine (Emergency Medicine); Beamtree Health Roundtable; Well-Being Collaborative of Arizona Health Professionals; Corewell Health; Mercy Clinic East Community; Federation of Medical Specialists of Quebec; Sutter Health; Overlake Hospital; Gould Medical Group; Optum Massachusetts (Reliant Medical Group and Atrius Health); DAP Health; Children’s National Hospital; Georgia Heart Institute; Honor Health of Arizona; Meharry Medical College; and the University of Kentucky College of Medicine and UK HealthCare, St Jude Children’s Research Hospital outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Association of Nurse Burnout With Patient Safety Climate and Grade and Frequency of Nosocomial Infections
The size of the boxes corresponds to the weight of the study in the meta-analysis. SMD indicates standardized mean difference.
Figure 2.
Figure 2.. Association of Nurse Burnout With Patient Safety Issues
The size of the boxes corresponds to the weight of the study in the meta-analysis. SMD indicates standardized mean difference.
Figure 3.
Figure 3.. Association of Nurse Burnout With Patient Satisfaction
The size of the boxes corresponds to the weight of the study in the meta-analysis. SMD indicates standardized mean difference.
Figure 4.
Figure 4.. Association of Nurse Burnout With Quality of Health Care
The size of the boxes corresponds to the weight of the study in the meta-analysis. SMD indicates standardized mean difference.
Figure 5.
Figure 5.. Nurse Burnout and Patient Safety Stratified by Education
The circle area is proportional to the reciprocal of the variance.
See this image and copyright information in PMC

References

    1. Maslach C, Schaufeli WB, Leiter MP. Job burnout. Annu Rev Psychol. 2001;52(1):397-422. doi:10.1146/annurev.psych.52.1.397 - DOI - PubMed
    1. Woo T, Ho R, Tang A, Tam W. Global prevalence of burnout symptoms among nurses: a systematic review and meta-analysis. J Psychiatr Res. 2020;123:9-20. doi:10.1016/j.jpsychires.2019.12.015 - DOI - PubMed
    1. Zhang YY, Han WL, Qin W, et al. . Extent of compassion satisfaction, compassion fatigue and burnout in nursing: a meta-analysis. J Nurs Manag. 2018;26(7):810-819. doi:10.1111/jonm.12589 - DOI - PubMed
    1. Ge MW, Hu FH, Jia YJ, Tang W, Zhang WQ, Chen HL. Global prevalence of nursing burnout syndrome and temporal trends for the last 10 years: a meta-analysis of 94 studies covering over 30 countries. J Clin Nurs. 2023;32(17-18):5836-5854. doi:10.1111/jocn.16708 - DOI - PubMed
    1. Shah MK, Gandrakota N, Cimiotti JP, Ghose N, Moore M, Ali MK. Prevalence of and factors associated with nurse burnout in the US. JAMA Netw Open. 2021;4(2):e2036469. doi:10.1001/jamanetworkopen.2020.36469 - DOI - PMC - PubMed

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