Background: Amid a national nurse shortage, there is growing concern that high levels of nurse burnout could adversely affect patient outcomes.
Objectives: This study examines the effect of the nurse work environment on nurse burnout, and the effects of the nurse work environment and nurse burnout on patients' satisfaction with their nursing care.
Research Design/Subjects: We conducted cross-sectional surveys of nurses (N = 820) and patients (N = 621) from 40 units in 20 urban hospitals across the United States.
Measures: Nurse surveys included measures of nurses' practice environments derived from the revised Nursing Work Index (NWI-R) and nurse outcomes measured by the Maslach Burnout Inventory (MBI) and intentions to leave. Patients were interviewed about their satisfaction with nursing care using the La Monica-Oberst Patient Satisfaction Scale (LOPSS).
Results: Patients cared for on units that nurses characterized as having adequate staff, good administrative support for nursing care, and good relations between doctors and nurses were more than twice likely as other patients to report high satisfaction with their care, and their nurses reported significantly lower burnout. The overall level of nurse burnout on hospital units also affected patient satisfaction.
Conclusions: Improvements in nurses' work environments in hospitals have the potential to simultaneously reduce nurses' high levels of job burnout and risk of turnover and increase patients' satisfaction with their care.
The hospital nurse workforce is experiencing greater workloads resulting from shorter hospital stays, rising average patient acuity, fewer support resources, and a national nurse shortage. Higher nurse workloads are associated with burnout and job dissatisfaction, precursors to voluntary turnover that contribute to the understaffing of nurses in hospitals and poorer patient outcomes. 1 Indeed, more than 40% of hospital staff nurses score in the high range for job-related burnout, and more than 1 in 5 hospital staff nurses say they intend to leave their hospital jobs within 1 year. 2 The understaffing of nurses and the overwork of health professionals in hospitals are ranked by consumers as major threats to patient safety, 3 and more patients are bringing their own caregivers to the hospital with them. 4
Research on job-related burnout among human service workers, nurses in particular, suggests that organizational stressors in the work environment are important determinants of burnout and subsequent voluntary turnover. 5-9 A largely separate research literature on patient satisfaction documents the importance of patients' satisfaction with nursing care in their overall ratings of satisfaction with their hospital care. 10-13 This article examines the association between nurse burnout and patient satisfaction, and explores whether the factors that account for nurse burnout also account for patient dissatisfaction. The findings are important to understanding how to simultaneously stem the flight of nurses from hospital bedside care and improve patient satisfaction with care.