Swamy Lakshmana, Mohr David, Blok Amanda, Anderson Ekaterina, Charns Martin, Wiener Renda Soylemez, Rinne Seppo
Lakshmana Swamy is a pulmonary and critical care fellow at Boston Medical Center and VA Boston, Boston, Massachusetts.
David Mohr is an investigator at Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, and a research assistant professor at Boston University School of Public Health, Boston, Massachusetts.
Am J Crit Care. 2020 Sep 1;29(5):380-389. doi: 10.4037/ajcc2020831.
Burnout is a maladaptive response to work-related stress that is associated with negative consequences for patients, clinicians, and the health care system. Critical care nurses are at especially high risk for burnout. Previous studies of burnout have used survey methods that simultaneously measure risk factors and outcomes of burnout, potentially introducing common method bias.
To evaluate the frequency of burnout and individual and organizational characteristics associated with burnout among critical care nurses across a national integrated health care system using data from an annual survey and methods that avoid common method bias.
A 2017 survey of 2352 critical care nurses from 94 sites. Site-level workplace climate was assessed using 2016 survey data from 2191 critical care nurses.
Overall, one-third of nurses reported burnout, which varied significantly across sites. In multilevel analysis, workplace climate was the strongest predictor of burnout (odds ratio [OR], 2.20; 95% CI, 1.50-3.22). Other significant variables were overall hospital quality (OR, 1.44; 95% CI, 1.05-1.99), urban location (OR, 1.93; 95% CI, 1.09-3.42), and nurse tenure (OR, 2.11; 95% CI, 1.44-3.10). In secondary multivariable analyses, workplace climate subthemes of perceptions of workload and staffing, supervisors and senior leadership, culture of teamwork, and patient experience were each significantly associated with burnout.
Drivers of burnout are varied, yet interventions frequently target only the individual. Results of this study suggest that in efforts to reduce burnout, emphasis should be placed on improving local workplace climate.
职业倦怠是对工作相关压力的一种适应不良反应，会给患者、临床医生和医疗保健系统带来负面后果。重症监护护士出现职业倦怠的风险尤其高。以往关于职业倦怠的研究采用的调查方法同时测量职业倦怠的风险因素和结果，可能会引入共同方法偏差。
利用年度调查数据和避免共同方法偏差的方法，评估全国综合医疗保健系统中重症监护护士职业倦怠的发生率以及与职业倦怠相关的个人和组织特征。
对来自94个地点的2352名重症监护护士进行2017年调查。使用来自2191名重症监护护士的2016年调查数据评估地点层面的工作场所氛围。
总体而言，三分之一的护士报告有职业倦怠，各地点差异显著。在多水平分析中，工作场所氛围是职业倦怠最强的预测因素（优势比[OR]，2.20；95%可信区间[CI]，1.50 - 3.22）。其他显著变量包括医院整体质量（OR，1.44；95% CI，1.05 - 1.99）、城市地点（OR，1.93；95% CI，1.09 - 3.42）和护士任期（OR，2.11；95% CI，1.44 - 3.10）。在二次多变量分析中，工作场所氛围的工作量和人员配备感知、主管和高级领导、团队合作文化以及患者体验等子主题均与职业倦怠显著相关。
职业倦怠的驱动因素多种多样，但干预措施通常只针对个人。本研究结果表明，为减少职业倦怠，应着重改善当地的工作场所氛围。
