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With care worker weariness impossible to ignore in the long-term care sector, researchers have increasingly tried to learn whether burnout has led to lower care quality in nursing homes. 

A new study, however, has found no link between worker burnout and several common negative patient outcomes — including use of antipsychotics without indication, depressive symptoms and responsive behaviors. 

Burnout and these negative outcomes were both common in the approximately 90 nursing homes studied, but struggling care workers still had confidence in their abilities and were able to provide competent care in these areas, investigators said.

“Using a large sample of care aides working in [nursing homes], we found that over one-third reported emotional exhaustion and one-half reported high cynicism but that very few reported diminished professional efficacy,” study authors noted.

Care workers’ resilience and self-confidence were significant factors in maintaining stability in patient outcomes even while experiencing burnout, the authors wrote.

“Despite the high frequency of emotional exhaustion and cynicism, care aides reported very low levels of diminished professional efficacy,” they explained. “Self-efficacy is an individual’s belief about their abilities to manage their work and it is a key personal resource.”

While burnout has been well-documented in academia, the Dec. 30 study — published in Medical Care Research and Review — is among the first to look for direct links between burnout and resident outcomes. 

A developing picture

This research is evidence of long-term care workers’ flexibility, but it’s neither the first nor the final word on the effects of workplace stress. 

High burnout, for example, is linked to greater employee turnover. Maintaining a stable workforce is consistently linked with higher nursing home star ratings over time.

Care workers are also likely to prioritize their time and resources when under stress more toward vital tasks and less toward secondary tasks. The Dec. 30 study noted that it might have focused on the elements of care that workers are likely to prioritize most. 

“We used routinely measured and widely reported outcomes, which may represent care tasks where care aides continue to invest effort even as their resources dwindle,” the researchers explained. “It is possible that outcomes that are not included in routine reporting, for example, quality of life, would have been more sensitive to differences in care aide behavior.”

Future studies should focus on the differences in work between those care workers who are experiencing burnout and those who are not, the researchers noted. 

“It is still unclear,” they wrote, “how care aides experiencing burnout carry out their jobs compared to those without burnout and whether this would have been better captured with different resident outcomes. Despite our null findings, understanding the impact of the quality of work-life on care aides and residents is critical to identifying strategies to improve [nursing home] care and experience.”