While nurse burnout and patient satisfaction have been studied separately, few studies have linked the two. Now, research shows that hospital units with adequate nurse staffing, good administrative support for nurses, and good doctor-nurse relationships had more patients who were satisfied with their care, compared with units that did not have these characteristics. Nurses on these units also reported significantly less burnout.

The study detailing the research, "Nurse Burnout and Patient Satisfaction," was published in the February 2004 issue of Medical Care. Linda H. Aiken, Ph.D., R.N., is director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing. Aiken is the principal investigator and second author on the work, and the recipient of an RWJF Investigator Award in Health Policy Research. She spoke with RWJF about this study.

Q: What are the main findings of this study?

A: An original contribution of this analysis is to link nurse burnout and patient satisfaction. There are two separate groups of literature. There is research on nurse burnout and the factors that lead to burnout and nurse dissatisfaction, and there's a whole body of research on patient satisfaction. However, until now, the two haven't been brought together to suggest there's a link.

We found there were three very important aspects of the work environment that predict high burnout: inadequate numbers of nurses, poor administrative support for nursing care, and poor doctor-nurse relationships.

The paper suggests that the factors that lead nurses to burn out also lead to patients being dissatisfied with their care. The overall conclusion is that we should improve the work environment of nurses in hospitals. This will not only reduce burnout and turnover, but also will increase patient satisfaction.

Q: Is there anything that can be done today, based on your results?

A: I think this is an important paper in terms of practical implications. It suggests that hospitals should be concerned about nurse burnout whether or not there's a shortage of nurses, simply because of the implications for patient satisfaction, which we think is a proxy for other sorts of outcomes.

It's imperative that we improve the practice environment in hospitals so nurses can provide the level of care that patients need. All of the issues are very "fixable," so it's a positive. It is possible to improve the environment of care.

Q: These data are from 1991. Do you think these findings have changed as the supply of nurses has changed?

A: Unfortunately, the problems in the nurse work environment have existed for many decades. Nursing shortages in the United States have been cyclical. During peak shortages, we see an institutional response to improving the nurse work environment, but as soon as the pressure lets up, institutions revert to business as usual.

Q: Only AIDS patients were followed in this study. Do you think you can extend the findings to other types of patients?

A: There is every reason to think these findings would translate to all seriously ill hospitalized patients. The patients we studied were very sick and were comparable to the average person in a hospital.

Q: What other research is the center doing in this area?

A: We're looking at the relationships between certain nurse-related factors and outcomes for nurses and patients. We published a paper fairly recently (JAMA 2002 Oct 23-30; 288(16):1987-93) that showed that nurse staffing ratios predicted both job dissatisfaction among nurses and patient mortality. All hospitals in Pennsylvania were studied. We found that the higher the nurse dissatisfaction, the higher the patient mortality.

Q: What about the stress of caring for extremely sick patients versus caring for patients who, say, just had routine surgery? Is there a difference in nurse burnout there?

A: You might assume that one of the reasons nurses burn out in AIDS care is because they have to handle all these people dying. However, we've found that the inherent stressors in nursing don't burn out nurses. They can cope with individual stresses, but the factors leading to burnout are institutional issues that are beyond the capacity of a single individual to solve. Problems on the job—when nurses are thwarted in their abilities to sufficiently care for patients—lead to burnout.

This is actually a good thing, because we can't do much about very sick patients dying, but we can do things about institutional management issues.