Organizational Changes to Reduce Nurse Burnout

About This Grant

This study evaluates multi-level interventions—ranging from state-level policy action to healthcare organizational strategy and frontline care delivery innovations—to effectively prevent nurse burnout and mitigate the severity of burnout among the roughly half of hospital-based nurses already burned-out. Study objectives will be accomplished by leveraging unique data from thousands of nurses in approximately 535 hospitals in multiple states (CA, FL, NJ, PA) across 4 time-points spanning 20 years. We will generate repeated samples of these hospitals at multiple time-points (already collected: 2006, 2016, 2024, to be collected 2026). Using a repeated cross-sectional design with changing organizational and policy influences overtime, we are uniquely positioned to evaluate potentially causal relationships of modifiable organizational factors and state-level policy interventions on nurse burnout. Each time-period of data includes repeated measures of nurse outcomes (e.g., burnout, job dissatisfaction, intent to leave employment), and hospital factors and models of care (e.g., staffing levels, work environment, Magnet). These cross-sections of data will be linked with contemporaneous American Hospital Association data for considering structural features of hospitals (e.g. teaching status). In combination, we will have 4 cross-sections of data from 535 hospitals (with fluctuating nurse populations), with changing organizational, policy, and other intervening influences (e.g. CA staffing policy relative to non-policy states, 2008 Great Recession, 2020 Covid-19 pandemic). Our quantitative analytic approach uses hierarchical models with time-varying covariates to capture the multilevel structure of the data, as well as difference-in-difference models with propensity score weighting for rigorous causal inferences of changes in organizational factors on changes in outcomes. Using data collected in 2026, we will empirically identify typologies of hospitals with respect to their proportions of nurses with high burnout and average tenure and conduct in-depth interviews with key nurse leaders (hospital nurse executives, nurse managers) in hospitals representative of each of the typologies to elucidate the facilitators and barriers to reducing hospital nurse burnout and turnover. This multi-modal study has novel potential for sustained impact since it will (1) evaluate the impact of modifiable organizational and policy changes on hospital nursing and models of care on nurse burnout; (2) leverage 20 years of repeated cross-sections of data to evaluate potentially causal mechanisms between modifiable hospital factors and external policy interventions on nurse burnout; (3) evaluate currently employed nurses and those who recently left employment to understand whether the reasons nurses say they would leave hospital employment are the same as the reasons they actually leave; (4) integrate quantitative findings with qualitative frontline hospital leadership perspectives to move from evidence to action. The cumulative evidence will inform targeted recommendations for policy and hospital interventions for reducing the unprecedented high rates of nurse burnout and low retention.