To Understand Nurse Burnout, Listen to the Nurses

Research into Nurse Burnout analyzes over 15,000 online responses to better understand the pressure points and issues

There’s a deep fissure in our global healthcare systems: nurse burnout. The shortage has hit 5.9 million nurses, and accelerating turnover costs about $4.7 billion in the US alone. As the majority of nurses say they want to quit their jobs, all stakeholders must take critical steps to mitigate an ongoing crisis.

To understand the causes of nurse burnout and explore the ways design might help, HKS created a research coalition alongside CADRE and MillerKnoll. We sought to understand what nurses are dealing with—the good, the bad, and the complicated—and listen to as many nurses as possible.

Beginning in 2022, we cataloged and analyzed existing evidence on nurse burnout—and importantly, the tools used to measure it.

Here are the questions that led our work:

• What contributes to nurse burnout?
• What components of the physical environment contribute to nurse burnout?
• How can the design of the physical environment help mitigate nurse burnout?

Most studies rely on the Maslach Burnout Inventory (MBI), which is considered the “gold standard” for measuring burnout. However, while the tool focuses on the emotional aspects related to exhaustion and depersonalization, it may also overlook other crucial factors like physical and cognitive stressors in its application.

We also discovered that while many articles examine nurse burnout, few focus on physical environment factors such as the layout of patient rooms, the availability of natural light, noise levels, and the ergonomic design of workstations. Our research explored this gap, too.

While our approach reflects methods used within academia, we wanted an approach that reaches more nurses. We used natural language processing, a powerful social listening tool that enables machine learning algorithms to track and identify key topics defined by our research team.

This methodology enabled us to research over 15,000 comments from the Reddit Community, r/Nursing.

In doing so, we collected data unobtrusively, creating an environment of increased openness, to get authentic view into nurses’ experiences and opinions.

As lead researcher Dr. Deborah Wingler says, “I’ve been researching burnout for over five years—and these results are provocative. What nurses are saying challenges the dominant narratives around nurse burnout.” 

The results were jarring at times. Examples of nurse feedback include:

• “My average day is 10km on my feet while being screamed at with the constant anxiety of knowing I can’t do all I have to do…”
• “I feel my mental health deteriorating…”
• “I want a job where I come to work and come home. I don’t even care if it's meaningless at this point. I just know there is no way I can do this long term.”
• “Positive affirmations during a staffing huddle always pissed me off.”
• “My hospital just opened a new wing with 125 beds but they can’t staff the beds we already have.”

The Results

Results from the data were clear with the top five types of fatigue that contribute to nurse burnout being:

1. Hierarchy (17%) requirement to explain capabilities and relevance in the clinical decision-making process 
2. Affinity (12%) reduced emotional connections to others and the profession in response to repeated exposure to negative or adverse working conditions and interactions
3. Mental (11%) difficulty with focus and decision-making related to constant anxiety and stress
4. Distance (9%) excessive walking during the course of a shift
5. Barrier (7%) asymmetry between what could or should be done for patients, and the resources or authority to deliver

The big surprise here is the prominence of affinity. Affinity is not prevalent in the research on nurse burnout, and in this study, it is the second-highest contributor.  

“The first step to developing effective solutions is to listen. The data made clear that nurses’ decision-making is hampered by constant stress and anxiety. In each of our own practice areas, we can take this insight to better design environments that support nurses to ensure better care, and better overall wellness, for all involved.” — Dr. Michelle Ossmann, MillerKnoll

Next Steps

We will publish a full report on our findings in the upcoming months. Additionally, we will be exploring ways to design healthcare environments to alleviate burnout, based upon the findings of our research.

To learn more about our healthcare offerings, connect with us here.