When nonphysician health care professionals experienced burnout and declines in professional satisfaction, it led to reduced work effort over the following two years, according to a JAMA Network Open study. This is a problem for the health care system and can affect physician burnout as well. That is why a team effort is needed to set things right.
The original investigation, “Characterization of Nonphysician Health Care Workers’ Burnout and Subsequent Changes in Work Effort,” found that burnout and professional satisfaction were associated with reduced work effort over the following 24 months, as measured in full-time equivalent (FTE) units from payroll records. This longitudinal cohort study was conducted at Mayo Clinic locations in Minnesota, Arizona, Florida, and in community-based hospitals and health care facilities in the Midwest. Nearly 27,000 nonphysician health workers responded to two online surveys from 2015 to 2017.
Of those who reported burnout, 10.5% reduced their work effort compared to 6.7% who did not have burnout. Similarly, when an individual had lower satisfaction with the organization, there was a higher prevalence of reduction in work effort. Of those who reduced their work effort over the 24-month period, 42.2% were younger than 35, 89.7% were women and 42.4% had fewer than five years of employment. More than half of those who reduced their work effort were nurses, a health professional role for which there is already a significant shortage.
“We've done lots of studies showing there is high prevalence of burnout in health care workers and we've studied different drivers and explained different consequences. And a lot of that work has been in physicians,” said AMA member and Lotte Dyrbye, MD, MPHE, co-author of the study. “What we wanted to do was to really bring in more information about what the consequences of burnout are in other very important, critical members of the health care team.”
“Burnout is one of the reasons why we don't have enough nurses and why they're reducing their FTE,” said Dr. Dyrbye, a professor of medicine and medical education at Mayo Clinic and co-director of the organization’s Program on Physician Well-Being. “That adds financial strain on organizations, and it can have implications to quality, safety, patient satisfaction—all those things we care deeply about.”
Committed to making physician burnout a thing of the past, the AMA has studied, and is currently addressing, issues causing and fueling physician burnout—including time constraints, technology and regulations—to better understand and reduce the challenges physicians face. By focusing on factors causing burnout at the system level, the AMA assesses an organization’s well-being and offers guidance and targeted solutions to support physician well-being and satisfaction.
All about teamwork
“When there are not enough team members, that means the workload increases for the members who are left,” explained Dr. Dyrbye. “If the team is short-staffed, you're going to see quality metrics go down and you're going to see burnout rates go up—and then you can get into a cycle.”
Less “staff, more work, more burnout, more turnover, and the cycle repeats—it’s definitely a problem,” she said. “And it takes a long time to recruit new health care workers, to get them trained, acculturated into that work environment.”
Additionally, “we can unintentionally implement strategies to reduce burnout in physicians that then exacerbate burnout in nurses,” said Dr. Dyrbye. “Ultimately that's not going to be successful and it's not going to help us reach our goal of better patient care, so we need to have a team-oriented approach.”
System-level changes needed
The findings from this study further emphasize the need for health systems to address factors that contribute to high stress among all health professionals. The priority must to be to ensure workloads are manageable and systems are efficient.
“If we want to retain nurses and help them have a productive career, we need to address the factors that are contributing to their burnout, which includes the work environment, making sure their workloads are reasonable and their leaders are skilled and the practice is efficient,” said Dr. Dyrbye. “Promoting flexibility and work-life integration—having, even, on-site day care centers—can be helpful as most of those who leave health care are young women.”
