Workplace Climate Key Target for Strategies Aimed at Reducing Nurse Burnout

By Lisette Hilton   The reflection of employees' emotional and psychological response to the overall work environment is often referred to as workplace climate and plays a key role in intensive care unit nurse wellbeing. Workplace climate should be a prime target when trying to reduce nurse burnout, according to a study published September in the American Journal of Critical Care.   The research emphasizes the importance of working with frontline nurses to assess workload, perceptions of the patient experience, teamwork, and relationships with leadership.   "Interventions at these points will likely result in improvements in the experience of working in the ICU with potentially dramatic reductions in burnout that may extend beyond nurses to the entire ICU staff," said study author, Lakshmana Swamy, MD, MBA, and Pulmonary and Critical Care Fellow at Boston Medical Center and VA Boston Healthcare System.   Swamy and coauthors reported on a 2017 survey of 2352 critical care nurses from 94 Veterans Administration (VA) sites, as well as data from a 2016 survey of nearly 2,200 critical care VA nurses on workplace climate.   While there was marked variation across sites, more than one-third of nurses reported burnout. Nurses' perceptions of local workplace climate most strongly predicted burnout -- more so than individual and other organization-level factors.   As a result of these findings, hospitals and health systems that focus on burnout reduction interventions aimed at building resilience at the individual level, should turn at least equal attention to addressing work environment issues.   "While I'm not a critical care nurse, our study results ring true with nursing experience. Whether working in the inpatient or outpatient setting, the impact of workplace culture and leadership certainly contributes to our feelings of burnout," said study author Amanda Blok, PhD, MSN, PHCNS-BC, Research Health Scientist at the VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, and Research Assistant Professor, Department of Systems, Populations and Leadership, School of Nursing, University of Michigan, Ann Arbor. "Nurses everywhere are busy and feel the pressures of workload and staffing issues, yet it's also how these are dealt with by management and the feeling of working together -- like we're all in this together -- that makes or breaks our resilience."   Burnout among nurses, even prior to the COVID-19 pandemic, is not a new finding. This study confirms the significance of nurse burnout on a large scale, according to Swamy.   "The importance of workplace climate is a novel finding, and it was surprising that workplace climate had a stronger role than characteristics of the working environment such as where the hospital is, or demographics of the individual nurse," Swamy said. "In retrospect, this certainly makes sense. Burnout is not a problem in the individual, it is a problem in the workplace."   And while this study focuses on nurses in the VA system, the findings likely are relevant across critical care settings, according to Swamy.   A closer look at workplace climate   In a secondary data analysis, researchers studied these aspects of workplace climate: perceptions of teamwork, patient experience, workload, supervisors, and senior leadership. All were individually significant, representing potentially important contributing factors to burnout, according to a press release by the American Association of Critical-Care Nurses (AACN).   "Front-line ICU clinicians know how important these characteristics are. If you have a strong team, manageable workload which of course relates to staffing, and you feel like you are delivering the best possible patient experience, well, it isn't surprising to me that each of those components stands on its own merit for your wellbeing at work," Swamy said. "The same goes for your relationship with leadership at the local level but also at the hospital or executive level. Without the sense of leadership support - feeling like you're constantly short-staffed and managing more work than is reasonable - you can't rely on your teammates. And when you feel like patients are suffering because of it all, I'd expect a high proportion of burned out nurses in a setting like that."   The concept of workplace climate is complex because it incorporates how everyone on the unit perceives the unit environment. Nurses might form their perceptions from answers to questions such as: Is this a place that we feel safe to speak up? Is it a place where we can rely on each other? Do we have the staffing and management support to care for our patients well? Is leadership fair, and are we satisfied with the leadership at the highest levels of the organization?   It is difficult to boil those concepts down to a number that can be compared between facilities, according to Swamy.   "The survey we used asks 52 questions related to workplace climate along these dimensions. Using survey responses from 2016, we performed a factor analysis to extract the common variance from these questions and distill it into a single score for each site," Swamy said.   These findings do not exclude the need to build individual resilience to fight burnout.   "Of course, individual nurse wellbeing should be supported, including both physical and mental health, but the more salient drivers of burnout are likely to be found and improved upon in the workplace itself," Swamy concluded.