Preventing Inpatient NP Burnout: The Power of Adequate Staffing and Leadership

Rebecca John; Melisa Hill; Lauren Kanamori; Robyn Lao; Lois Sayrs; Rachael L Stottlemyre; Tricia Morphew

doi:10.1016/j.pedhc.2024.02.005

Preventing Inpatient NP Burnout: The Power of Adequate Staffing and Leadership

J Pediatr Health Care. 2024 May 2:S0891-5245(24)00046-4. doi: 10.1016/j.pedhc.2024.02.005. Online ahead of print.

Authors

Rebecca John¹, Melisa Hill², Lauren Kanamori², Robyn Lao³, Lois Sayrs⁴, Rachael L Stottlemyre⁵, Tricia Morphew⁶

Affiliations

¹ Rebecca John, Melisa Hill, Lauren Kanamori, General and Thoracic Surgery Nurse Practitioner, Division of Pediatric General & Thoracic Surgery, Children's Hospital of Orange County, Orange, CA. Electronic address: rjohn@choc.org.
² Rebecca John, Melisa Hill, Lauren Kanamori, General and Thoracic Surgery Nurse Practitioner, Division of Pediatric General & Thoracic Surgery, Children's Hospital of Orange County, Orange, CA.
³ Robyn Lao, General and Thoracic Surgery Nurse Practitioner, Department of Pediatric Surgery, University of California Davis Medical Center, Sacramento, CA.
⁴ Lois Sayrs, Director, Research Institute, Biostatistics, Children's Hospital of Orange County Research Institute, Orange, CA.
⁵ Rachael L. Stottlemyre, University of Miami Miller, School of Medicine Student, Miami, FL.
⁶ Tricia Morphew, Senior Biostatistician, Children's Hospital of Orange County Research Institute, Orange, CA.

PMID: 38703177
DOI: 10.1016/j.pedhc.2024.02.005

Abstract

Background: Nurse practitioner (NP) burnout related to high patient-to-NP ratios needs to be addressed.

Objectives: To survey inpatient pediatric NPs, assess burnout and characterize associated workload and support.

Design: Online cross-sectional survey conducted in three phases from March 2022 to August 2023.

Subjects and setting: Inpatient specialty NPs from 32 hospitals.

Results: Fisher's exact test and logistic regression were implemented. A patient-to-provider (NP or resident) ratio of more than 5:1 was associated with NP burnout (OR = 3.5, 95% CI 1.0, 12.0 and OR = 4.1, 95% CI 1.1, 16.2, respectively, p < .05). Among NPs without burnout, 100% had organizational NP leadership (p = .012).

Interpretation: Though limited by a small convenience sample, a patient-to-provider ratio over 5:1 was associated with NP burnout, and NP leadership was protective. Further research of cost analysis, retention, and patient quality and safety measures are needed.

Conclusion: Lower patient-to-NP ratios and NP leadership play a pivotal role in preventing burnout.

Keywords: CROSS survey reporting; Nurse practitioner; burnout; inpatient; patient-to-NP ratio; patient-to-provider ratio.