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Cited by 501Healthcare professionals’ stress and burnoutOccupational Health and BurnoutStress and Burnout Research

Nurse Burnout and Patient Safety, Satisfaction, and Quality of Care: A Systematic Review and Meta-Analysis

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Li, Lambert Zixin, Yang, Peilin, Singer, Sara J., Pfeffer, Jeffrey, Mathur, Maya B., Shanafelt, Tait·2024·JAMA Network Open
DOI 10.1001/jamanetworkopen.2024.43059PMC PMC11539016
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Abstract

Importance: Occupational burnout syndrome is characterized by emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment and is prevalent among nurses. Although previous meta-analyses have explored the correlates of nurse burnout, none have estimated their association with health care quality and safety and patient morbidity and mortality. Objective: To evaluate the magnitude and moderators of the association between nurse burnout and patient safety, patient satisfaction, and quality of care. Data Source: The Web of Science, Scopus, MEDLINE, Embase, PsycINFO, CINAHL, and ProQuest databases were searched from January 1, 1994, to February 29, 2024. Study Selection: Two reviewers independently identified studies that reported a quantifiable association between nurse burnout and any of the outcomes of patient safety, patient satisfaction, or quality of health care. Data Extraction and Synthesis: The PRISMA 2020 guideline was followed. Two reviewers independently extracted the standardized mean difference (SMD) (Cohen d ) estimates for a random-effects meta-analysis. Subgroup analyses and meta-regressions were conducted using prespecified variables. Main Outcomes and Measures: Any measure of patient safety, patient satisfaction, or quality of health care previously associated with nurse burnout. Results: A total of 85 studies (81 cross-sectional and 4 longitudinal) involving 288 581 nurses from 32 countries (mean [SD] age, 33.9 (2.1) years; 82.7% female; mean [SD] burnout prevalence rate with study-specific ascertainments, 30.7% [9.7%]) were included. Nurse burnout was associated with a lower safety climate or culture (SMD, −0.68; 95% CI, −0.83 to −0.54), lower safety grade (SMD, −0.53; 95% CI, −0.72 to −0.34), and more frequent nosocomial infections (SMD, −0.20; 95% CI, −0.36 to −0.04), patient falls (SMD, −0.12; 95% CI, −0.22 to −0.03), medication errors (SMD, −0.30; 95% CI, −0.48 to −0.11), adverse events or patient safety incidents (SMD, −0.42; 95% CI, −0.76 to −0.07), and missed care or care left undone (SMD, −0.58; 95% CI, −0.91 to −0.26) but not with the frequency of pressure ulcers. Nurse burnout was also associated with lower patient satisfaction ratings (SMD, −0.51; 95% CI, −0.86 to −0.17) but not with the frequencies of patient complaints or patient abuse. Finally, nurse burnout was associated with lower nurse-assessed quality of care (SMD, −0.44; 95% CI, −0.57 to −0.30) but not with standardized mortality rate. The associations were consistent across nurses’ age, sex, work experience, and geography and persistent over time. For patient safety outcomes, the association was smaller for the low personal accomplishment subcomponent of burnout than for emotional exhaustion or depersonalization, as well as for nurses with a college education. Conclusions and Relevance: In this systematic review and meta-analysis, nurse burnout was found to be associated with lower health care quality and safety and lower patient satisfaction. This association was consistent across nurse and study characteristics.

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  • Burnout has consequences including poor patient outcomes, low patient satisfaction, and increased employee turnover.

    “Many studies point to consequences such as poor patient outcomes, low patient satisfaction, and increased employee turnover—factors that may further exacerbate healthcare delivery conditions and stressors for those workers who remain.8”

    From What do we really know about addressing burnout among healthcare workers? Maybe less than we think (2026) · cites this paper as [8]

    The Discussion (page not available in our copy) reports that nurse burnout is negatively associated with patient safety, patient satisfaction, and quality of care. The Introduction mentions an association with turnover intention, but not increased actual employee turnover. The paper reports associations rather than establishing that burnout causes these outcomes. (LLM, conf=0.86)

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Cited by

Sorted by citations

Authors
Li, L. Z., Yang, P., Singer, S. J., Pfeffer, J., Mathur, M. B., & Shanafelt, T.
Affiliations
  • Stanford University (US)
  • Barcelona School of Economics (ES)
  • Harvard University (US)
  • Stanford Medicine (US)
Corresponding author
Yang, Peilin
ORCID
Venue
JAMA Network Open
Publisher
American Medical Association (AMA)
Published
2024-11-05
Volume
7
Issue
11
Pages
e2443059
ISSN
2574-3805 (ISSN-L)
DOI
10.1001/jamanetworkopen.2024.43059
PMC
PMC11539016
OpenAlex
W4404061202
Cited by
501
References
13
Citations by year
2026: 341 · 2025: 157 · 2024: 3
FWCI
45.02
Type
journal article
Language
en
Open access
Licence
cc-by-nc-nd
Locations
  • JAMA Network Open (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
Topics
  • Health Sciences › Health Professions › General Health Professions › Healthcare professionals’ stress and burnout
  • Health Sciences › Health Professions › Occupational Therapy › Occupational Health and Burnout
  • Social Sciences › Psychology › Social Psychology › Stress and Burnout Research
Keywords
nurse burnout, patient safety, patient satisfaction, quality of care, emotional exhaustion, depersonalization, personal accomplishment, safety climate, safety culture, nosocomial infections, patient falls, medication errors, adverse events, nurse staffing, nurse turnover, nurse retention, nurse-patient relationship, nurse-patient communication, nurse-patient trust, nurse-patient rapport
MeSH terms
Adult, Burnout, Professional, Female, Humans, Job Satisfaction, Male, Nurses, Nursing Staff, Hospital, Quality of Health Care, Patient Satisfaction, Patient Safety

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