Elizabeth M. White, Linda H. Aiken, and Matthew D. McHugh
Abstract
Objective
To examine the relationship between registered nurse (RN) burnout, job dissatisfaction, and missed care in nursing homes.
Design
Cross‐sectional secondary analysis of linked data from the 2015 RN4CAST‐US nurse survey and LTCfocus.
Setting
A total of 540 Medicare‐ and Medicaid‐certified nursing homes in California, Florida, New Jersey, and Pennsylvania.
Results
Among states that provided facility-level data and had outbreaks, more than 60 percent of nursing homes where at least a quarter of the residents were black or Latino reported double the rate of coronavirus cases than those where black and Latino people made up less than 5 percent of the population. A racial disparity remained even after accounting for a variety of factors, including the size of a nursing home, the infection rate in the surrounding county, the population density of the neighborhood, and how many residents had Medicaid or Medicare.
Participants
A total of 687 direct care RNs.
Measurements
Emotional Exhaustion subscale of the Maslach Burnout Inventory, job dissatisfaction, and missed care.
Results
Across all RNs, 30% exhibited high levels of burnout, 31% were dissatisfied with their job, and 72% reported missing one or more necessary care tasks on their last shift due to lack of time or resources. One in five RNs reported frequently being unable to complete necessary patient care. Controlling for RN and nursing home characteristics, RNs with burnout were five times more likely to leave necessary care undone (odds ratio [OR] = 4.97; 95% confidence interval [CI] = 2.56‐9.66) than RNs without burnout. RNs who were dissatisfied were 2.6 times more likely to leave necessary care undone (OR = 2.56; 95% CI = 1.68‐3.91) than RNs who were satisfied. Tasks most often left undone were comforting/talking with patients, providing adequate patient surveillance, patient/family teaching, and care planning.
Conclusion
Missed nursing care due to inadequate time or resources is common in nursing homes and is associated with RN burnout and job dissatisfaction. Improved work environments with sufficient staff hold promise for improving care and nurse retention.