Joseph Ouslander, M.D.
Joseph Ouslander, M.D.

Burnout victims are five times more likely to finish a shift without completing necessary care. That’s a bad sign for nursing homes, which report higher levels of burnout and job dissatisfaction than any other US healthcare setting. 

That’s the message from University of Pennsylvania School of Nursing researchers who on Thursday revealed results of a study involving 540 nursing homes in four large states.

Thirty percent of the nearly 700 direct-care registered nurses involved exhibited high levels of burnout, while 31% said they were dissatisfied with their job. Nearly three in four (72%) reported missing one or more necessary care tasks on their last shift due to lack of time or resources. 

RNs who were dissatisfied are 2.6 times more likely to leave necessary care undone, said researchers from Penn’s Center for Health Outcomes and Policy Research.

“The data should raise a clarion call to health policy makers and those who own and manage nursing homes,” said Joseph Ouslander, M.D., the editor of the Journal of the American Geriatrics Society, which published study results online Tuesday and released comments Thursday.

The most frequent care gaps of 14 topics were comforting/talking with patients, adequately observing patients, teaching patients and family members and care planning.

In addition, 33% of respondents with burnout and 25% with job dissatisfaction said they were “unable to administer medications on time, a key aspect of medication safety.”

“Improved work environments with sufficient staff hold promise for improving care and nurse retention,” wrote study author, who were led by Brown University postdoctoral fellow Elizabeth White, Ph.D., APRN.

While acknowledging nursing homes’ “real financial constraints due to heavy reliance on Medicaid,” researchers emphasized “evidenced-based” interventions, and other investments that would offset “additional labor costs for training, recruitment, and productivity loss generated by high turnover.”

Recommended steps include: 1) creating a culture that emphasizes root-cause analysis of systemic problems rather than punishing nurses for individual mistakes, 2) Involving RNs in quality improvement committees, 3) having administrators consult with direct care staff on solutions to organizational problems, and 4) having formal processes for responding to employee concerns.

They also recommended offering career ladders, preceptor programs for new hires, leadership training and continuing education. 

They said that a direct causal effect could not be concluded between them and poor care, however, due to limitations in the data set, even though hospital-focused studies had established such a connection.

Study subjects were drawn from random samples of RNs in non-supervisory capacities at nursing homes in Pennsylvania, Florida, Texas and California.