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Advanced Practice Provider Burnout in a Large Urban Medical Center

Ashooh, Meredith P. MSN; Barnette, Katherine MSN; Moran, Tim P. PhD; O'Shea, James MBBS, MA; Lall, Michelle D. MD

doi: 10.1097/TME.0000000000000255

Burnout is characterized by 3 facets: the presence of emotional exhaustion, depersonalization, and a lack of sense of personal accomplishment. It arises when stress becomes so severe relative to a person's own resources that he or she loses motivation to perform, and it is associated with many negative outcomes. Emergency medicine (EM) physicians ranked highest in a study of burnout rates among physician subspecialties. However, there is an overall lack of robust research examining the work-related psychological states in advanced practice providers (APPs). Because the utilization of APPs in emergency departments (EDs) is steadily increasing, we aimed to describe burnout in this understudied group. A sample of APPs employed in a large urban academic hospital was surveyed using 3 well-established questionnaires measuring burnout, resilience, and mindfulness. Responses were compared with a normative group of health care workers (HCWs). The respondents reported a significantly greater sense of personal accomplishment than other HCWs. This was greater with a perceived control over their work environment and if they self-identified as being nonjudgmental. The sense of accomplishment was less in the respondents of older age and for those with children. This group also reported an increased sense of depersonalization. Mindfulness traits of acting with awareness and having trust in their instincts were identified as potential protective factors against depersonalization. Although the respondents were not more emotionally exhausted than other HCWs, being more emotionally “reactive” did predict greater emotional exhaustion. This is an important finding for APPs working in affect-laden work environments such as EDs. These findings suggest that increasing control over the work environment, fostering trust of instincts, and reducing emotional reactiveness are prudent interventional targets for EM-APP leaders to prevent and reduce burnout in the workforce.

Emory University Department of Emergency Medicine at Grady Memorial Hospital, Atlanta, Georgia.

Corresponding Author: Meredith P. Ashooh, MSN, Emory University Department of Emergency Medicine at Grady Memorial Hospital, 49 Jesse Hill Jr Drive SE, Atlanta, GA 30303 (

Disclosure: The authors report no conflicts of interest.

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