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Burnout in the NICU setting and its relation to safety culture
  1. Jochen Profit1,2,
  2. Paul J Sharek2,3,4,
  3. Amber B Amspoker5,6,
  4. Mark A Kowalkowski7,
  5. Courtney C Nisbet2,4,
  6. Eric J Thomas8,
  7. Whitney A Chadwick9,
  8. J Bryan Sexton10,11
  1. 1Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, USA
  2. 2California Perinatal Quality Care Collaborative, Palo Alto, USA
  3. 3Center for Quality and Clinical Effectiveness, Lucile Packard Children's Hospital, Palo Alto, USA
  4. 4Division of General Pediatrics, Department of Pediatrics, Stanford University, Palo Alto, USA
  5. 5Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, USA
  6. 6Health Policy and Quality Program, Houston Veterans Affairs (VA) Health Services Research and Development Center of Excellence, Michael E. DeBakey VA Medical Center, Houston, USA
  7. 7Levine Cancer Institute, Carolinas HealthCare System, Charlotte, North Carolina, USA
  8. 8University of Texas at Houston—Memorial Hermann Center for Healthcare Quality and Safety, University of Texas Medical School, Houston, USA
  9. 9Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, USA
  10. 10Department of Psychiatry, Duke University School of Medicine, Duke University Health System, Durham, USA
  11. 11Duke Patient Safety Center, Duke University Health System, Durham, USA
  1. Correspondence to Dr Jochen Profit, Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, MSOB Rm x115, 1265 Welch Road, Stanford, CA 94305, USA; profit{at}stanford.edu

Abstract

Background Burnout is widespread among healthcare providers and is associated with adverse safety behaviours, operational and clinical outcomes. Little is known with regard to the explanatory links between burnout and these adverse outcomes.

Objectives (1) Test the psychometric properties of a brief four-item burnout scale, (2) Provide neonatal intensive care unit (NICU) burnout and resilience benchmarking data across different units and caregiver types, (3) Examine the relationships between caregiver burnout and patient safety culture.

Research design Cross-sectional survey study.

Subjects Nurses, nurse practitioners, respiratory care providers and physicians in 44 NICUs.

Measures Caregiver assessments of burnout and safety culture.

Results Of 3294 administered surveys, 2073 were returned for an overall response rate of 62.9%. The percentage of respondents in each NICU reporting burnout ranged from 7.5% to 54.4% (mean=25.9%, SD=10.8). The four-item burnout scale was reliable (α=0.85) and appropriate for aggregation (intra-class correlation coefficient-2=0.95). Burnout varied significantly between NICUs, p<0.0001, but was less prevalent in physicians (mean=15.1%, SD=19.6) compared with non-physicians (mean=26.9%, SD=11.4, p=0.0004). NICUs with more burnout had lower teamwork climate (r=−0.48, p=0.001), safety climate (r=−0.40, p=0.01), job satisfaction (r=−0.64, p<0.0001), perceptions of management (r=−0.50, p=0.0006) and working conditions (r=−0.45, p=0.002).

Conclusions NICU caregiver burnout appears to have ‘climate-like’ features, is prevalent, and associated with lower perceptions of patient safety culture.

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