title: Burnout in the NICU setting and its relation to safety culture.
abstract: BACKGROUND
  Burnout is widespread among healthcare providers and is associated with adverse safety behaviours, operational and clinical outcomes. Little is known with regard to the explanatory links between burnout and these adverse outcomes.
  
  
  OBJECTIVE
  (1) Test the psychometric properties of a brief four-item burnout scale, (2) Provide neonatal intensive care unit (NICU) burnout and resilience benchmarking data across different units and caregiver types, (3) Examine the relationships between caregiver burnout and patient safety culture.
  
  
  METHODS
  Cross-sectional survey study.
  
  
  METHODS
  Nurses, nurse practitioners, respiratory care providers and physicians in 44 NICUs.
  
  
  METHODS
  Caregiver assessments of burnout and safety culture.
  
  
  RESULTS
  Of 3294 administered surveys, 2073 were returned for an overall response rate of 62.9%. The percentage of respondents in each NICU reporting burnout ranged from 7.5% to 54.4% (mean=25.9%, SD=10.8). The four-item burnout scale was reliable (α=0.85) and appropriate for aggregation (intra-class correlation coefficient-2=0.95). Burnout varied significantly between NICUs, p<0.0001, but was less prevalent in physicians (mean=15.1%, SD=19.6) compared with non-physicians (mean=26.9%, SD=11.4, p=0.0004). NICUs with more burnout had lower teamwork climate (r=-0.48, p=0.001), safety climate (r=-0.40, p=0.01), job satisfaction (r=-0.64, p<0.0001), perceptions of management (r=-0.50, p=0.0006) and working conditions (r=-0.45, p=0.002).
  
  
  CONCLUSIONS
  NICU caregiver burnout appears to have 'climate-like' features, is prevalent, and associated with lower perceptions of patient safety culture.
authors.affiliation: Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, USA California Perinatal Quality Care Collaborative, Palo Alto, USA.
authors.forename: Jochen
authors.initials: J
authors.lastname: Profit
authors.affiliation: California Perinatal Quality Care Collaborative, Palo Alto, USA Center for Quality and Clinical Effectiveness, Lucile Packard Children's Hospital, Palo Alto, USA Division of General Pediatrics, Department of Pediatrics, Stanford University, Palo Alto, USA.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Sharek
authors.affiliation: Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, USA Health Policy and Quality Program, Houston Veterans Affairs (VA) Health Services Research and Development Center of Excellence, Michael E. DeBakey VA Medical Center, Houston, USA.
authors.forename: Amber B
authors.initials: AB
authors.lastname: Amspoker
authors.affiliation: Levine Cancer Institute, Carolinas HealthCare System, Charlotte, North Carolina, USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Kowalkowski
authors.affiliation: California Perinatal Quality Care Collaborative, Palo Alto, USA Division of General Pediatrics, Department of Pediatrics, Stanford University, Palo Alto, USA.
authors.forename: Courtney C
authors.initials: CC
authors.lastname: Nisbet
authors.affiliation: University of Texas at Houston-Memorial Hermann Center for Healthcare Quality and Safety, University of Texas Medical School, Houston, USA.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Thomas
authors.affiliation: Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, USA.
authors.forename: Whitney A
authors.initials: WA
authors.lastname: Chadwick
authors.affiliation: Department of Psychiatry, Duke University School of Medicine, Duke University Health System, Durham, USA Duke Patient Safety Center, Duke University Health System, Durham, USA.
authors.forename: J Bryan
authors.initials: JB
authors.lastname: Sexton
mesh_terms: D000328:Adult; D002055:Burnout, Professional / Q000175:diagnosis* / Q000453:epidemiology; D002140:California / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007363:Intensive Care Units, Neonatal; D008297:Male; D015279:Organizational Culture; D061214:Patient Safety; D015995:Prevalence; D011594:Psychometrics; D017751:Safety Management; D011795:Surveys and Questionnaires; D000078329:Workforce
keywords: Health services research; Healthcare quality improvement; Safety culture
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