Aiken, L. H., Lasater, K. B., Sloane, D. M., Pogue, C. A., Fitzpatrick Rosenbaum, K. E., Muir, K. J., McHugh, M. D., US Clinician Wellbeing Study Consortium, (2023). Physician and nurse well-being and preferred interventions to address burnout in hospital practice: Factors associated with turnover, outcomes, and patient safety. JAMA Health Forum, 4(7), e231809. https://doi.org/10.1001/jamahealthforum.2023.1809
Using data from a comprehensive national survey, this study establishes a strong and statistically significant connection between high levels of nurse burnout and factors such as inadequate staffing, increased workloads, and unsupportive work environments. It goes beyond identifying the problem by incorporating the voices of nurses themselves, who propose targeted, evidence-based interventions like increasing staffing ratios, improving management support, and fostering collaborative team dynamics. The study's findings underscore that burnout is not simply an individual issue, but a systemic problem that contributes directly to high turnover rates and job dissatisfaction across healthcare settings. This resource is particularly valuable for healthcare administrators and unit leaders seeking to design meaningful improvement plans, as it provides empirical support for organizational-level changes rather than placing responsibility solely on individual resilience or coping strategies.
For example, one intervention that could be implemented based on this research is the establishment of a staffing acuity tool that dynamically adjusts nurse-patient ratios based on patient needs rather than fixed numbers. By ensuring that nurse workloads are appropriate to the complexity and volume of care required, units can reduce stress and physical exhaustion among staff, leading to better job satisfaction and lower turnover. This example directly reflects the article’s findings and offers a practical application for real-life setting impact.
Bruyneel, A., Dauvergne, J. E., Bouckaert, N., Caillet, A., Sermeus, W., Poiroux, L., & Van den Heede, K. (2025). Association of Burnout and Intention-To-Leave the Job With Objective Nursing Workload and Nursing Working Environment: A Cross-Sectional Study Among Intensive Care Nurses. Journal of Clinical Nursing. https://doi.org/10.1111/jocn.17650
The researchers used a cross-sectional study to examine burnout prevalence and intention-to-leave among 1,271 ICU nurses across 61 hospitals. Using the Nursing Activities Score (NAS) to quantify workload, the Maslach Burnout Inventory (MBI) to measure burnout, and a direct question to assess turnover intention, the study offered a comprehensive analysis of the relationship between nurse workload, emotional well-being, and retention. Results showed a high average burnout prevalence of 64.7% and a 20.7% intention-to-leave rate, with most nurses reporting workloads that exceeded safe and sustainable levels. Crucially, the study identified as the quality of the work environment increases, levels of burnout and turnover intention tend to decrease significantly. ICU nurses who reported working in supportive, well-structured environments experienced significantly lower rates of emotional exhaustion and were less likely to consider leaving their positions. These findings reinforce that burnout is not simply an individual issue but a reflection of broader systemic problems, including chronic understaffing, and inadequate organizational support. This study adds meaningful value to current workforce improvement efforts by highlighting evidence-based, modifiable factors that nursing leadership can address. It supports prioritizing staffing improvements, and investments in workplace culture as core components of any safety and quality improvement plan. In addition, the validated use of NAS and MBI provides a replicable framework that healthcare settings can adopt to routinely monitor workload and burnout, track trends over time, and assess the effectiveness of implemented interventions. The evidence presented in this study offers clear guidance for hospital administrators and nursing leadership: addressing burnout requires a strategic investment in workplace redesign, including balanced staffing, and improved nurse-to-patient ratios. This article is a critical resource for healthcare systems designing safety and retention improvement plans, as it provides empirical validation that workforce well-being is directly tied to workload and patient outcomes. It reinforces the need for ongoing monitoring, leadership accountability, and system-wide change to build resilient, sustainable nursing teams, especially in high-pressure clinical environments.
For example, a unit in the hospital experiencing high turnover might implement an acuity-based staffing model influenced by NAS data, and pair it with regular burnout assessments using the MBI, and then create action plans focused on reducing workload during peak stress periods. An intervention supporting nurses with healthy workload coupled with leadership training could significantly reduce burnout rates and improve both nurse retention and patient care quality.
Choudhary, M., Kumar, A., Pandey, V., Choudhary, V., & Patidar, N. (2022). Burnout Syndrome Assessment Scale for Nurses Working in Intensive Care Units: Development and Validation. International Journal of Applied & Basic Medical Research, 12(2), 82–86. doi.org/10.4103/ijabmr.ijabmr_547_21
This study details the development and validation of the Burnout Syndrome Assessment Scale (BOSAS), a tool specifically designed to assess burnout in nursing professionals. Unlike more generalized instruments such as the Maslach Burnout Inventory (MBI), BOSAS is tailored to reflect the unique emotional, physical, and psychological demands experienced by nurses in diverse clinical environments. The researchers conducted a comparative analysis of existing burnout tools and found that BOSAS demonstrated better reliability, consistency, and validity in capturing nurse-specific indicators of burnout.The development process involved a thorough review of burnout literature, expert panel validation, and pilot testing among nurses from various healthcare settings, including acute care, critical care, and community-based facilities. Key topics assessed by BOSAS include emotional exhaustion, depersonalization, reduced personal accomplishment, work environment stressors, and coping capacity. Unlike one-size-fits-all tools, BOSAS provides actionable insights that can assist with targeted interventions and policy decisions. This study provides a valuable resource for healthcare administrators, occupational health teams, and researchers seeking to monitor, understand, and address burnout with greater precision. The BOSAS tool enhances the ability of healthcare organizations to move toward data-driven workforce wellness strategies, ultimately contributing to better staff retention, mental health, and patient care outcomes.
For example, a nurse manager could use BOSAS as part of quarterly wellness assessments to identify early warning signs of burnout within their unit. Collected and measured data could then guide department-wide interventions such as modifying shift schedules, improving staff-to-patient ratios, or launching peer support initiatives tailored to the most affected domains.
Clark, R. S., & Lake, E. (2020). Burnout, job dissatisfaction and missed care among maternity nurses. Journal of Nursing Management, 28(8), 2001–2006. doi.org/10.1111/jonm.13037
This cross-sectional study investigates the relationship between job dissatisfaction, nurse burnout, and missed nursing care among maternity nurses, a patient population where continuity and accuracy of care are critical. The findings are significant: 25% of maternity nurses reported experiencing burnout, while 20% expressed job dissatisfaction. More strikingly, the analysis revealed a strong association between these conditions and missed care, with 84.5% of burned-out nurses and 72.6% of dissatisfied nurses reporting instances of missed care. The study highlights how emotional exhaustion and workplace dissatisfaction do not just impact nurse well-being but directly threaten the quality and safety of patient care. Missed nursing care, which can include delayed medications, incomplete assessments, or overlooked patient education, has serious implications for maternal and neonatal outcomes. Thus, this study underscores burnout as a clinical risk factor, not just a workforce issue. Beyond identifying the problem, this study advocates for organizational-level changes to improve the work environment, such as increasing staffing adequacy, enhancing leadership responsiveness, fostering supportive team dynamics, and ensuring manageable workloads. These interventions are not only essential for improving nurse satisfaction but are also crucial for ensuring safe, reliable patient care. This study is particularly valuable for nurse managers, quality improvement teams, and healthcare administrators as it provides quantifiable evidence linking staff well-being to care delivery performance. It supports the growing recognition that patient safety and nurse wellness are interdependent, and that investing in a positive work environment is both a clinical and operational imperative.
For example, a maternity unit, or any unit experiencing high levels of missed care could use these findings to conduct an internal burnout and satisfaction assessment. If high emotional exhaustion levels are detected, leadership could implement strategies such as improving nurse-to-patient ratios during high-acuity periods, introducing flexible scheduling, or offering structured debriefing sessions after complex deliveries. Such interventions may improve not only nurse morale but also patient outcomes.
Meyer, K. R., Fraser, P. B., & Emeny, R. T. (2020). Development of a Nursing Assignment Tool Using Workload Acuity Scores. The Journal of Nursing Administration, 50(6), 322–327. doi.org/10.1097/NNA.0000000000000892
This study introduces a data-driven model for developing fair and consistent nurse-to-patient assignments, addressing a long-standing challenge in clinical settings: the imbalance in nursing workloads caused by traditional assignment methods that rely solely on patient counts rather than acuity. Using electronic health record (EHR) data, researchers calculated individualized nurse workload scores by aggregating patient-specific care needs and integrating unit-specific nurse-to-patient ratios. This quantitative approach revealed significant disparities in workloads across units and shifts, illustrating the inadequacy of assigning nurses based only on headcount. One of the study's key findings is the development of unit-specific thresholds for low, medium, and high workload categories. By stratifying workload intensity, the model allows nurse managers to make more equitable and transparent staffing decisions in real-time. This approach not only promotes fairness but also improves the alignment between staff capacity and patient care needs. Most importantly, the study highlights how acuity-based assignment systems contribute to improved patient safety, enhanced staff satisfaction, and more efficient resource utilization. When nurses are assigned workloads that match their capacity, both physically and cognitively, care quality improves, and the risk of burnout decreases. This study is a valuable resource for nurse leaders, informatics teams, and charge nurses committed to implementing fair, data-informed staffing strategies. It supports the shift toward acuity-based assignment systems as a critical component of safe staffing practices and long-term workforce sustainability.
For example, a unit with high acuity patients might adopt this model by using real-time EHR data to generate acuity scores high, medium, low, which are then recorded for each nurse's assignment. If one nurse is regularly being assigned a high-acuity patient while another is not, assignments can be adjusted proactively to maintain balance. This ensures more equitable workloads across the team, supports nurse well-being, and supports positive work environment.