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Applied Nursing Research
journal homepage: www.elsevier.com/locate/apnr
Original article
Estimating the association between burnout and electronic health record-related stress among advanced practice registered nurses
Daniel A. Harris, MPHa,c, Jacqueline Haskell, MSc, Emily Cooper, MPHc,⁎, Nancy Crouse, CNSd,Rebekah Gardner, MDb,c
a Department of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, CanadabWarren Alpert Medical School, Brown University, Providence, RI, United States of AmericacHealthcentric Advisors, Providence, RI, United States of Americad Boston Medical Center, Boston, MA, United States of America
A R T I C L E I N F O
Keywords:APRNBurnoutElectronic health recordHealth information technology
A B S T R A C T
Background: Health information technology (HIT), such as electronic health records (EHRs), is a growing part ofthe clinical landscape. Recent studies among physicians suggest that HIT is associated with a higher prevalenceof burnout. Few studies have investigated the workflow and practice-level predictors of burnout among ad-vanced practice registered nurses (APRNs).Aim: Characterize HIT use and measure associations between EHR-related stress and burnout among APRNs.Methods: An electronic survey was administered to all APRNs licensed in Rhode Island, United States(N= 1197) in May–June 2017. The dependent variable was burnout, measured with the validated Mini zburnout survey. The main independent variables were three EHR-related stress measures: time spent on the EHRat home, daily frustration with the EHR, and time for documentation. Logistic regression was used to measurethe association between EHR-related stress and burnout before and after adjusting for demographics, practice-level characteristics, and the other EHR-related stress measures.Results: Of the 371 participants, 73 (19.8%) reported at least one symptom of burnout. Among participants withan EHR (N=333), 165 (50.3%) agreed or strongly agreed that the EHR added to their daily frustration and 97(32.8%) reported an insufficient amount of time for documentation. After adjustment, insufficient time fordocumentation (AOR=3.72 (1.78–7.80)) and the EHR adding to daily frustration (AOR=2.17 (1.02–4.65))rem
ained predictors of burnout.Conclusions: Results from the present study revealed several EHR-related environmental factors are associatedwith burnout among APRNs. Future studies may explore the impact of addressing these EHR-related factors tomitigate burnout among this population.
1. Introduction
Resulting from chronic job-related stress, burnout is characterizedby emotional exhaustion, depersonalization, and decreased job sa-tisfaction (Maslach, Schaufeli, & Leiter, 2001). Given the high-stressnature of clinical environments, burnout among healthcare workers hasbeen shown to exceed that of the general population (Shanafelt, Boone,Tan, et al., 2012). Among physicians, the first published report of“burnout” emerged in 1981 (Pines, 1981). A nationally representativesurvey of United States physicians revealed that nearly half (45.8%)experienced at least one symptom of burnout (Shanafelt et al., 2012;Shanafelt, Hasan, Dyrbye, et al., 2015). Moreover, results indicated thatover 50% of physicians in “front line” specialties (e.g., emergency
medicine and general internal medicine) reported one or more symp-toms of burnout (Shanafelt et al., 2012). Several studies have identifiedassociations between physician burnout and poorer quality of care(Melville, 1980; Yuguero, Marsal, Esquerda, & Soler-Gonzalez, 2017),reduced patient satisfaction (Haas et al., 2000), and increased risk ofturnover (Williams, Konrad, Scheckler, et al., 2001). However, despitethe breadth of literature investigating burnout among physicians, sig-nificantly fewer studies have explored burnout among advanced prac-tice registered nurses (APRNs) (Hoff, Carabetta, & Collinson, 2017).
In 2010, the Agency for Healthcare Research and Quality estimatedthat over 100,000 APRNs practice in the United States, with over half(52.0%) working in primary care (Agency for Research Health andQuality, 2012). As of 2017, the number of APRNs has grown to 234,000
londonessays.com 4 March 2018; Received in revised form 19 June 2018; Accepted 23 June 2018
⁎ Corresponding author at: 235 Promenade Street, Suite 500, Providence, RI, United States of America.E-mail address: [email protected] (E. Cooper).
Applied Nursing Research 43 (2018) 36–41
0897-1897/ © 2018 Elsevier Inc. All rights reserved.
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