Burnout in the NICU setting and its relation to safety culture
Open accessAbstract
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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The burnout primary outcome has an intra-class correlation of roughly 0.1.
“the primary outcome measure of burnout has a relatively large ICC of about 0.1 [35].”
From The Work-life Check-ins randomized controlled trial: a leader-based adaptive, semi-structured burnout intervention in primary care clinics (2024) · cites this paper as [35]
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Cites
Tabachnick, B. G., & Fidell, L. S. (1983) · Cited by 79,888 · see citing works
Alternative Ways of Assessing Model Fit
Browne, M. W., & Cudeck, R. (1992) · Sociological Methods & Research · doi:10.1177/0049124192021002005 · Cited by 27,200 · see citing works
Comparative fit indexes in structural models.
Bentler, P. M. (1990) · Psychological Bulletin · doi:10.1037/0033-2909.107.2.238 · Cited by 25,266 · see citing works
The measurement of experienced burnout
Maslach, C., & Jackson, S. E. (1981) · Journal of Organizational Behavior · doi:10.1002/job.4030020205 · Cited by 14,496 · see citing works
Maslach, C., Schaufeli, W. B., & Leiter, M. P. (2001) · Annual Review of Psychology · doi:10.1146/annurev.psych.52.1.397 · Cited by 12,852 · see citing works
Testing Structural Equation Models.
Clogg, C. C., Bollen, K. A., & Long, J. S. (1995) · Social Forces · doi:10.2307/2580595 · Cited by 8,244 · see citing works
Shanafelt, T. D., Boone, S., Tan, L., Dyrbye, L. N., Sotile, W., Satele, D., West, C. P., Sloan, J., & Oreskovich, M. R. (2012) · Archives of Internal Medicine · doi:10.1001/archinternmed.2012.3199 · Cited by 3,439 · see citing works
Maslach, C., & Jackson, S. E. (1979) · PsycTESTS Dataset · doi:10.1037/t55656-000 · Cited by 2,360 · see citing works
Burnout and self-reported patient care in an internal medicine residency program
Shanafelt, T. D., Bradley, K. A., Wipf, J. E., & Back, A. L. (2002) · Annals of Internal Medicine · doi:10.7326/0003-4819-136-5-200203050-00008 · Cited by 2,165 · see citing works
Burnout and Medical Errors Among American Surgeons
Shanafelt, T. D., Balch, C. M., Bechamps, G., Russell, T., Dyrbye, L., Satele, D., Collicott, P., Novotny, P. J., Sloan, J., & Freischlag, J. (2010) · Annals of Surgery · doi:10.1097/sla.0b013e3181bfdab3 · Cited by 2,099 · see citing works
Comparative Fit Indices in Structural Models
Bentler, P. M. (1990) · eScholarship (California Digital Library) · Cited by 2,044 · see citing works
Sexton, J. B., Helmreich, R. L., Neilands, T. B., Rowan, K., Vella, K., Boyden, J., Roberts, P. R., & Thomas, E. J. (2006) · BMC Health Services Research · doi:10.1186/1472-6963-6-44 · Cited by 1,787 · see citing works
Self-citationWest, C. P., Huschka, M. M., Novotny, P. J., Sloan, J. A., Kolars, J. C., Habermann, T. M., & Shanafelt, T. D. (2006) · JAMA · doi:10.1001/jama.296.9.1071 · Cited by 1,454 · see citing works
Rates of medication errors among depressed and burnt out residents: prospective cohort study
Fahrenkopf, A. M., Sectish, T. C., Barger, L. K., Sharek, P. J., Lewin, D., Chiang, V. W., Edwards, S., Wiedermann, B. L., & Landrigan, C. P. (2008) · BMJ · doi:10.1136/bmj.39469.763218.be · Cited by 1,175 · see citing works
Self-citationCOMMITTEE ON FETUS AND NEWBORN, Barfield, W. D., Papile, L.-A., Baley, J. E., Benitz, W., Cummings, J., Carlo, W. A., Kumar, P., Polin, R. A., Tan, R. C., et al. (2012) · Pediatrics · doi:10.1542/peds.2012-1999 · Cited by 959 · see citing works
Staff Burnout: Job Stress in the Human Services
Cherniss, C. (1980) · Cited by 817 · see citing works
Discrepant attitudes about teamwork among critical care nurses and physicians*
Thomas, E. J., Sexton, J. B., & Helmreich, R. L. (2003) · Critical Care Medicine · doi:10.1097/01.ccm.0000056183.89175.76 · Cited by 775 · see citing works
Self-citationNurse staffing, burnout, and health care-associated infection.
Cimiotti, J. P., Aiken, L. H., Sloane, D. M., & Wu, E. S. (2012) · American Journal of Infection Control · doi:10.1016/j.ajic.2012.02.029 · Cited by 763 · see citing works
Hospital staffing, organization, and quality of care: cross-national findings
Aiken, L. H. (2002) · International Journal for Quality in Health Care · doi:10.1093/intqhc/14.1.5 · Cited by 728 · see citing works
Career Fit and Burnout Among Academic Faculty
Shanafelt, T. D., West, C. P., Sloan, J. A., Novotny, P. J., Poland, G. A., Menaker, R., Rummans, T. A., & Dyrbye, L. N. (2009) · Archives of Internal Medicine · doi:10.1001/archinternmed.2009.70 · Cited by 619 · see citing works
Applying multilevel confirmatory factor analysis techniques to the study of leadership
Dyer, N., Hanges, P. J., & Hall, R. J. (2005) · The Leadership Quarterly · doi:10.1016/j.leaqua.2004.09.009 · Cited by 538 · see citing works
Burnout among American surgeons
Campbell, D. A., Sonnad, S. S., Eckhäuser, F. E., Campbell, K. K., & Greenfield, L. J. (2001) · Surgery · doi:10.1067/msy.2001.116676 · Cited by 434 · see citing works
The prevalence and impact of post traumatic stress disorder and burnout syndrome in nurses
Mealer, M. L., Burnham, E. L., Goode, C. J., ROTHBAUM, B. O., & Moss, M. M. (2009) · Depression and Anxiety · doi:10.1002/da.20631 · Cited by 427 · see citing works
The work lives of women physicians
the SGIM Career Satisfaction Study Group, McMurray, J. E., Linzer, M., Konrad, T. R., Douglas, J. A., Shugerman, R. P., & Nelson, K. G. (2000) · Journal of General Internal Medicine · doi:10.1046/j.1525-1497.2000.9908009.x · Cited by 393 · see citing works
Vogus, T. J., & Sutcliffe, K. M. (2006) · Medical Care · doi:10.1097/01.mlr.0000244635.61178.7a · Cited by 389 · see citing works
(2000) · Cited by 375 · see citing works
Maslach Burnout Inventory--ES Form
Maslach, C., & Jackson, S. E. (1981) · PsycTESTS Dataset · doi:10.1037/t05190-000 · Cited by 368 · see citing works
McMurray, J. E., Linzer, M., Konrad, T. R., Douglas, J., Shugerman, R. P., & Nelson, K. (2000) · PubMed · Cited by 354 · see citing works
Antecedents and consequences of work-home interference among medical residents
Geurts, S., Rutte, C., & Peeters, M. (1999) · Social Science & Medicine · doi:10.1016/s0277-9536(98)00425-0 · Cited by 303 · see citing works
Zhang, Y., & Feng, X. (2011) · BMC Health Services Research · doi:10.1186/1472-6963-11-235 · Cited by 270 · see citing works
Vogus, T. J., & Sutcliffe, K. M. (2007) · Medical Care · doi:10.1097/mlr.0b013e318053674f · Cited by 259 · see citing works
Burnout, engagement and resident physicians' self-reported errors
Prins, J., der Heijden, F. M. M. A. V., Hoekstra‐Weebers, J. E. H. M., Bakker, A. B., van de Wiel, H. B. M., Jacobs, B., & Gazendam-Donofrio, S. M. (2009) · Psychology Health & Medicine · doi:10.1080/13548500903311554 · Cited by 257 · see citing works
Burnout in the working population: relations to psychosocial work factors
Lindblom, K. M., Linton, S. J., Fedeli, C., & Bryngelsson, I. (2006) · International Journal of Behavioral Medicine · doi:10.1207/s15327558ijbm1301_7 · Cited by 252 · see citing works
Ahola, K., Väänänen, A., Koskinen, A., Kouvonen, A., & Shirom, A. (2010) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2010.01.002 · Cited by 241 · see citing works
Modak, I., Sexton, J. B., Lux, T. R., Helmreich, R. L., & Thomas, E. J. (2007) · Journal of General Internal Medicine · doi:10.1007/s11606-007-0114-7 · Cited by 210 · see citing works
Self-citationNurses’ work environments, care rationing, job outcomes, and quality of care on neonatal units
Rochefort, C. M., & Clarke, S. P. (2010) · Journal of Advanced Nursing · doi:10.1111/j.1365-2648.2010.05376.x · Cited by 202 · see citing works
Assessing and improving safety climate in a large cohort of intensive care units*
Sexton, J. B., Berenholtz, S. M., Goeschel, C. A., Watson, S. R., Holzmueller, C. G., Thompson, D. A., Hyzy, R. C., Marsteller, J. A., Schumacher, K., & Pronovost, P. J. (2011) · Critical Care Medicine · doi:10.1097/ccm.0b013e318206d26c · Cited by 200 · see citing works
Self-citationVariation in caregiver perceptions of teamwork climate in labor and delivery units
Sexton, J. B., Holzmueller, C. G., Pronovost, P. J., Thomas, E. J., McFerran, S., Nunes, J., Thompson, D. A., Knight, A. P., Penning, D. H., & Fox, H. E. (2006) · Journal of Perinatology · doi:10.1038/sj.jp.7211556 · Cited by 175 · see citing works
Self-citationNurse Burnout and Stress in the NICU
Braithwaite, M. (2008) · Advances in Neonatal Care · doi:10.1097/01.anc.0000342767.17606.d1 · Cited by 174 · see citing works
The Work Lives of Women Physicians. Results from the Physician Work Life Study
McMurray, J. E., Linzer, M., Konrad, T. R., Douglas, J. A., Shugerman, R. P., Nelson, K. G., & for the SGIM Career Satisfaction Study Group* (2000) · Journal of General Internal Medicine · doi:10.1111/j.1525-1497.2000.im9908009.x · Cited by 165 · see citing works
Working Together in the Neonatal Intensive Care Unit: Provider Perspectives
Thomas, E. J., Sherwood, G. D., Mulhollem, J. L., Sexton, J. B., & Helmreich, R. L. (2004) · Journal of Perinatology · doi:10.1038/sj.jp.7211136 · Cited by 114 · see citing works
Self-citationSafety Climate Survey: reliability of results from a multicenter ICU survey
Kho, M. E. (2005) · BMJ Quality & Safety · doi:10.1136/qshc.2005.014316 · Cited by 104 · see citing works
The Role of Regional Collaboratives: The California Perinatal Quality Care Collaborative Model
Gould, J. B. (2010) · Clinics in Perinatology · doi:10.1016/j.clp.2010.01.004 · Cited by 93 · see citing works
Burnout and Risk Factors for Arteriosclerotic Disease: Follow‐up Study
Kitaoka‐Higashiguchi, K., Morikawa, Y., Miura, K., Sakurai, M., Ishizaki, M., Kido, T., Naruse, Y., & Nakagawa, H. (2009) · Journal of Occupational Health · doi:10.1539/joh.l8104 · Cited by 83 · see citing works
The Safety Attitudes Questionnaire as a tool for benchmarking safety culture in the NICU
Profit, J., Etchegaray, J. M., Petersen, L. A., et al. (2011) · Archives of Disease in Childhood Fetal & Neonatal · doi:10.1136/archdischild-2011-300612 · Cited by 74 · see citing works
Self-citationUnderstanding nurse anesthetists' intention to leave their job
Meeusen, V., van Dam, K., Brown-Mahoney, C., van Zundert, A. A. J., & Knape, H. (2011) · Health Care Management Review · doi:10.1097/hmr.0b013e3181fb0f41 · Cited by 73 · see citing works
Demir Zencirci, A., & Arslan, S. (2011) · Croatian Medical Journal · doi:10.3325/cmj.2011.52.527 · Cited by 69 · see citing works
Neonatal intensive care unit safety culture varies widely
Profit, J., Etchegaray, J. M., Petersen, L. A., et al. (2011) · Archives of Disease in Childhood Fetal & Neonatal · doi:10.1136/archdischild-2011-300635 · Cited by 65 · see citing works
Self-citationGuest, R. S., Baser, R., Li, Y., Scardino, P. T., Brown, A. E., & Kissane, D. W. (2011) · Annals of Surgical Oncology · doi:10.1245/s10434-011-1623-5 · Cited by 59 · see citing works
Assessing burnout among neonatologists
Bellieni, C. V., Righetti, P., Rosanna, C., Iacoponi, F., Coviello, C., & Buonocore, G. (2012) · The Journal of Maternal-Fetal & Neonatal Medicine · doi:10.3109/14767058.2012.666590 · Cited by 44 · see citing works
Safety Culture and Hand Hygiene: Linking Attitudes to Behavior
Daugherty, E. L., Paine, L. A., Maragakis, L. L., et al. (2012) · Infection Control and Hospital Epidemiology · doi:10.1086/668432 · Cited by 36 · see citing works
Shelledy, D. C., Mikles, S. P., May, D., et al. (1992) · Respiratory Care · doi:10.1177/194336549203700105 · Cited by 32 · see citing works
Block, M. S., Ehrenworth, J. F., Cuce, V. M., Ng’ang’a, N., Weinbach, J., Saber, S. B., Milic, M., Urgo, J. A., Sokoli, D., Schlesinger, M. D., et al. (2013) · The Joint Commission Journal on Quality and Patient Safety · doi:10.1016/s1553-7250(13)39028-x · Cited by 26 · see citing works
Self-citationAbtracts from the 30th Annual Meeting of the Society of General Internal Medicine
Guthrie, B., Grant, S., Davies, H. T., & Huby, G. (2007) · Journal of General Internal Medicine · doi:10.1007/s11606-007-0176-6 · Cited by 22 · see citing works
Flagged first, then by citations
Research works printed but not linked: 1
- [30]Kline RB Principals and Practice of Structural Equation Modelling 1998 New York, NY Gulford Press
Cited by
Sorted by citations
Healthcare staff wellbeing, burnout, and patient safety: a systematic review
Hall, L. H., Johnson, J., Watt, I., Tsipa, A., & O’Connor, D. B. (2016) · PLOS ONE · doi:10.1371/journal.pone.0159015 · Cited by 1,683 · see citing works
Cross-Disciplinary Care: A Systematic Review on Teamwork Processes in Health Care
Dinh, J. V., Traylor, A. M., Kilcullen, M. P., Perez, J. A., Schweissing, E. J., Venkatesh, A., & Salas, E. (2020) · Small Group Research · doi:10.1177/1046496419872002 · Cited by 73 · see citing works
On the relationship between safety climate and occupational burnout in healthcare organizations
Zarei, E., Khakzad, N., Reniers, G., & Akbari, R. (2016) · Safety Science · doi:10.1016/j.ssci.2016.05.011 · Cited by 59 · see citing works
Barr, P. (2017) · Traumatology · doi:10.1037/trm0000115 · Cited by 54 · see citing works
Safety organizing, emotional exhaustion, and turnover in hospital nursing units
Vogus, T. J., Cooil, B., Sitterding, M., & Everett, L. Q. (2014) · Medical Care · doi:10.1097/mlr.0000000000000169 · Cited by 50 · see citing works
Challenges of Mental Health in Medical Staffs during COVID-19 Outbreak: A Systematic Review
Rakhshan, M., Hakimi, H., Mousazadeh, N., & Dorri, S. (2023) · Medicina Clínica Práctica · doi:10.1016/j.mcpsp.2022.100361 · Cited by 4 · see citing works
Hurtado, D. A., Boyd, J., Madjlesi, R., Greenspan, S. A., Ezekiel-Herrera, D., Potgieter, G., Hammer, L. B., Everson, T., & Lenhart, A. (2024) · Contemporary Clinical Trials · doi:10.1016/j.cct.2024.107609 · Cited by 3 · see citing works
- Authors
- Profit, J., Sharek, P. J., Amspoker, A. B., Kowalkowski, M. A., Nisbet, C. C., Thomas, E. J., Chadwick, W. A., & Sexton, J. B.
- Affiliations
- Lucile Packard Children's Hospital (US)
- Michael E. DeBakey VA Medical Center (US)
- Levine Cancer Institute, Carolinas HealthCare System, Charlotte, North Carolina, USA
- Stanford Medicine (US)
- Memorial Hermann (US)
- Duke University (US)
- Corresponding author
- Profit, Jochen
- Venue
- BMJ Quality & Safety
- Publisher
- BMJ
- Published
- 2014-04-17
- Volume
- 23
- Issue
- 10
- Pages
- 806-813
- ISSN
- 1475-3898 (ISSN-L)
- 2044-5415
- 2044-5423
- PMC
- PMC4167972
- OpenAlex
- W2132520610
- Cited by
- 246
- References
- 54
- Citations by year
- 2026: 14 · 2025: 12 · 2024: 19 · 2023: 13 · 2022: 36 · 2021: 30 · 2020: 25 · 2019: 23 · 2018: 16 · 2017: 25 · 2016: 14 · 2015: 13 · 2014: 5
- FWCI
- 34.32
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- BMJ Quality & Safety (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- Agency for Healthcare Research and Quality (UC1 HS014246, 1UC1HS014246)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (K24HD053771, K23HD056298)
- 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
- burnout, neonatal intensive care unit, patient safety culture, safety climate, teamwork climate, job satisfaction, working conditions, healthcare workers, nurses, physicians, caregiver resilience
- MeSH terms
- Workforce, Adult, Burnout, Professional, California, Cross-Sectional Studies, Female, Humans, Intensive Care Units, Neonatal, Male, Psychometrics, Surveys and Questionnaires, Organizational Culture, Prevalence, Safety Management, Patient Safety
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