| dc.description.abstract | NP burnout is on the rise, with factors in the work environment including lack of autonomy, inequities in practice support, and hierarchical leadership to blame. A framework, the Social Ecology of Burnout is presented to examine NP burnout and psychological safety within the context of the practice environment. The purpose of this study was to explore NP experiences with burnout, psychological safety, and the work environment, using both interview and survey data, from a sample of NPs licensed and active in the 2022 public database of the California Board of Registered Nursing. A cross-sectional survey was fielded to a random sample of 3,600 NPs stratified by geographic region; this study included participants currently employed in positions requiring a NP license and with complete data for outcome measures. The primary study variables were assessed using Edmonson’s Psychological Safety Scale, the NP Primary Care Organizational Climate Questionnaire, and the Maslach Burnout Inventory. Those who indicated willingness for interview were interviewed using a semi-structured interview guide.
17 NPs living and working in California were interviewed. Data were analyzed using a qualitative descriptive approach, yielding six-themes: (i) Burnout is dread, (ii) Illusion of autonomy, (iii) No voice. No value. (iv) Lacking psychological safety, (v) Lost vocation, (vi) Finding solution. The survey sample consisted of 621 NPs, over half (56%) experienced high burnout. All work environment factors were positively correlated with psychological safety (beta=0.35 to 0.44, p< .001). Psychological safety was inversely associated with burnout (p < .001). Significant mediation effects of psychological safety were observed on the relationship between work environment factors and burnout. In this mixed-method analysis of NPs in California, qualitative themes are supported by our survey data. Low burnout is associated with improved perceptions of psychological safety and the work environment and participants describe psychological safety in the context of feeling valued at work, having autonomy, and more control over their practice. This study provides insight into NP experiences with burnout considering contextual factors in the work environment. The results highlight the role of psychological safety as a protective factor in the work environment and may offer an avenue for burnout prevention. The findings lay the groundwork for future practice, policy, and research that can help promote a culture of empowerment and equity in health worker wellbeing. | |
