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ADVANCE Perspective: Nurses

Researchers Link Nurse Burnout to Increased Rates of HAI

Published August 3, 2012 1:04 PM by Chuck Holt


Are you feeling a little rundown, like you could use a vacation or maybe a whole new career? Do you find yourself being easily distracted on the job you’re growing so tired of? Is your nursing flame flickering?

You’re certainly not alone, as many studies attest.

But have you considered they way you’re feeling might cause you to be a little less diligent than you’ve been all these years and wind up putting patients at risk for healthcare-acquired infections?

A group of nursing researchers, including three from the vaunted Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing in Philadelphia and another from the school of nursing at Rutgers, The State university of New Jersey, certainly have been giving it a lot of thought lately.

In fact, based on a careful analysis of certain data, they’ve discovered nursing burnout actually leads to higher healthcare-associated infection rates (HAIs) and costs hospitals millions of additional dollars annually.

Specifically, the researchers analyzed data previously collected by the Pennsylvania Health Care Cost Containment Council, the American Hospital Association Annual Survey, and a 2006 survey of more than 7,000 registered nurses from 161 hospitals in Pennsylvania.

They then used that data to study the effect of nurse staffing and burnout on catheter-associated urinary tract infections (CAUTI) and surgical site infections (SSI), two of the most common HAIs.

Job-related burnout was determined by analyzing the emotional exhaustion subscale from the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) that was obtained from nursing survey responses.

The MBI-HSS filters 22 items on job-related attitudes into emotional exhaustion, depersonalization, and personal accomplishment, identifying emotional exhaustion as the key component to burnout syndrome. More than one-third of survey respondents got an emotional exhaustion score of 27 or greater, the MBI-HSS definition for healthcare personnel burnout.

Comparing CAUTI rates with nurses' patient loads (5.7 patients on average), the researchers found for each additional patient assigned to a nurse, there was roughly one additional infection per 1,000 patients (or 1,351 additional infections per year, calculated across the survey population).

Additionally, each 10 percent increase in a hospital's high-burnout nurses corresponded with nearly one additional CAUTI and two additional SSIs per 1,000 patients annually (average rate of CAUTIs across hospitals was nine per 1,000 patients; for SSIs it was five per 1,000 patients).

Using the per-patient average costs associated with CAUTIs ($749 to $832 each) and SSIs ($11,087 to $29,443 each), the researchers estimate that if nursing burnout rates could be reduced to 10 percent from an average of 30 percent, Pennsylvania hospitals could prevent an estimated 4,160 infections annually with an associated savings of $41 million.

"Healthcare facilities can improve nurse staffing and other elements of the care environment and alleviate job-related burnout in nurses at a much lower cost than those associated with healthcare-associated infections," conclude the authors. "By reducing nurse burnout, we can improve the well-being of nurses while improving the quality of patient care."

So what do you think? Does nurse burnout increasing HAIs seem plausible? Do you feel the methodology used by the researchers resulted in a fair analysis? If not, here’s an opportunity to let others know why. If so, do you have any suggestions for steps nurses and facilities can take to help keep burnout to a minimum and potentially even lower rates of HAI?



Cutting cost of course need to be weighed heavily against the risk of doing harm. When we loose sight of our core mission, which I still need to believe is to do good and heal the sick is when it is all over my friends. I have worked with a few staffing firms but was the only one to take into account the burn out rate and my need to career growth to come up with a personal management plan to ensure I would not burn out.

Lee Van Michaels, onc - RN, hospital August 24, 2012 5:10 PM
Fresno CA

Go for it!Some of the best nurses I have wokerd with have had military or law enforcement experience. As for being tired of being shot at, nurses do experience workplace violence, or the risk of it. An ER patient  in a 12 bed hospital in the rural southwest I wokerd in 16 years ago did wrestle a gun from the officer we called for help. It was a tense situation, turned out Ok, thank God,It was an odd and gentle yet fast teamwork soccer game on the floor with the gun.Another time, a man turned a pointed paper spindle towards a very petite femaie new grad. doctor when she tried to keep him from stabbing himself with it. These situations are not routine, but you never know what will happen. Your experience handling crises will sometimes come in handy.  A lot of  psych nursing  happens outside of big city behavioral units.GD Star Ratingloading...

Irene Irene, jIDchozDSAlWp - arDkFSBPIzTh, hRjXInHCMw August 24, 2012 7:29 AM

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