1) What type of research study is this? (Qualitative vs…. 1) What type of research study

1) What type of research study is this? (Qualitative vs…. 1) What type of research study is this? (Qualitative vs. Quantitative). If you can identify what type of qualitative (ie. phenomenology, grounded theory, etc.) or quantitative study (ie. RCT, cohort, longitudinal, etc), please include that as well.2) Besides a similar statement that this is a “randomized controlled trial” or an exact description of the type of study, how do you know this is “that” type of study?3) What is the “problem” or the “what” identified in the study? (Ex: catheter-associated urinary tract infections [CAUTI]) What is the PURPOSE or “why” of the study? (Ex: The purpose of this study is to reduce the rates of CAUTIs)4) What is the population or sample under study? (Who or maybe what, is being studied)5) If this is a quantitative study, what is the hypothesis? (It may be explicitly stated or implied). If this is a qualitative study, what is (are) the research question(s)?6) Provide one example of how you might explore this same topic and similar problem using the opposite type of research. (If your study is quantitative, describe a qualitative example).7) Do you prefer qualitative research or quantitative research? Explain.article to use: Burnout and Turnover among NICU Nurses Thomas, Anisa O. PhD, RN; Bakas, Tamilyn PhD, RN, FAHA, FAAN; Miller, Elaine PhD, RN, CRRN, FAHA, FAAN; Johnson, Kimberly PhD, RN, CEN, FAEN; Cooley, Heather L. Tubbs PhD, RN, FAANAuthor Abstract  Introduction: In 2019, the national average turnover rate of registered nurses in the United States was approximately 17.8%. Each percentage increase in turnover costs a hospital, on average, $270,800. Although burnout is a known contributor to nurses’ turnover intention, few studies have examined the relationship between nurse burnout and turnover, and there is little data on this relationship in neonatal intensive care environments. The purpose of this study was to examine the relationship between nurse burnout and turnover among neonatal intensive care unit (NICU) nurses.Study Design: A secondary analysis of data collected from an observational study involving 136 nurses in a 52-bed NICU from 2013 to 2014.Methods: Multivariate logistic regression models were used to test for associations between measures of burnout and turnover.Results: 16.9% of nurses turned over during the 11 months of the original study. Most nurses reported high (46%) to moderate (37%) levels of emotional exhaustion. Final models did not indicate a relationship between burnout and turnover.Clinical Nursing Implications: Although burnout has been associated with turnover intent among nurses, we did not observe an association between burnout and turnover among NICU nurses. Despite no direct relationship between burnout and turnover in the NICU, burnout may have other negative consequences. Nurse leaders should continue to prioritize reducing burnout among nursing staff to improve the well-being of the NICU nurse workforce. Nurse turnover, the voluntary or involuntary release of a budgeted position, challenges productivity and stability of health care organizations each year (O’Brien-Pallas et al., 2006). Turnover among health care employees, including nurses, can cause a single organization to lose $3.6 to 6.5 million annually (NSI Nursing Solutions Inc., 2021). Nurses who leave their positions often do so because of poor unit management (Mazurenko et al., 2015), verbal and lateral violence (Zhao et al., 2018), or other issues within their working environment. Burnout, a syndrome that occurs in the context of a social setting in response to chronic interpersonal stressors (Maslach & Leiter, 2016), is a known correlate of a nurse’s intention to leave a job (Boamah & Laschinger, 2016; Lee et al., 2019; Pienaar & Coenraad, 2011; Spence Laschinger et al., 2009). Figure. No caption a…Opens a popup windowOpens a popup windowOpens a popup windowCritical care nurses often experience a great deal of stress related to intensive monitoring of patients, emotional and physical demands, and increased need for quick decision making under pressure (Vahedian-Azimi et al., 2019). These circumstances can contribute to adverse nurse outcomes, including burnout (Myhren et al., 2013; Poncet et al., 2007). Burnout is prevalent among intensive care nurses and critical care professionals across multiple studies (Chuang et al., 2016; Daouda et al., 2021). The experience of burnout has been documented in neonatal intensive care and pediatric nurses; a review of 78 studies on burnout among pediatric and neonatal intensive care nurses described moderate levels of burnout among nurses with scores of burnout being higher in high-acuity pediatric and neonatal intensive care environments (Buckley et al., 2020).Neonatal intensive care unit (NICU) nurses, a subset of critical care nurses, care for medically unstable neonates and infants and support parents through the process of “normal” parenting in a high-tech and intimidating environment (Reis et al., 2010). Neonates and infants in the NICU are often at risk of developing conditions that may threaten their quality or quantity of life. The quality of nursing care in NICUs can influence short- and long-term infant neurodevelopmental and physiological outcomes (Altimer & Phillips, 2016). Thus, retaining experienced nurses is an important strategy for ensuring high-quality care in the NICU.Most studies investigating nurse burnout and turnover focus on turnover intention, and the vast majority of evidence generated to date is from non-NICU environments. After an extensive review of the literature, only one study to date was found to have examined NICU nurse burnout in the context of turnover outcomes, finding a positive correlation between higher burnout levels and intention to leave a position (Barr, 2020). Considering the importance of nursing care to neonatal outcomes, we endeavored to examine the relationship between NICU nurse burnout and job turnover (Tubbs-Cooley et al., 2019; Tubbs-Cooley et al., 2015). We hypothesized that higher burnout scores, measured at study outset using the Maslach Burnout Inventory, would be associated with increased odds of nurse turnover during the 11 active months of the original study.Back to TopTheoretical Framework  We conceptualized the study using Maslach’s Multidimensional Theory of Burnout (Maslach, 1998), which identifies three core dimensions of burnout: emotional exhaustion, depersonalization, and reduced personal accomplishment. These three dimensions are conceptualized in a completely social or structural context, where relationships are the source of strain that manifest in burnout. The emotional exhaustion dimension, often referred to as being most descriptive of burnout, is the feeling of being emotionally drained and unable to give emotional resources to others. Emotional exhaustion is a representation of stress but alone is not definitive of burnout (Maslach, 2003). Emotional exhaustion leads to the experience of the other two dimensions of burnout, and the combination of the three dimensions define the syndrome. Depersonalization, or cynicism, describes disconnectedness from reality or from other people. The last dimension, reduced personal accomplishment, includes feelings of ineffectiveness or incompetence on the job. These feelings may develop consequently because of emotional exhaustion and depersonalization or simultaneously with the two dimensions (Maslach, 2003). In this study, turnover was hypothesized as an outcome of any of the three individual dimensions or of the combined syndrome of emotion exhaustion, depersonalization, and reduced personal accomplishment.Back to TopMethods  Back to TopDesign  We conducted a secondary analysis of data from the Neonatal Nursing Care Quality Study, a longitudinal observational study conducted from 2013 to 2015 (Tubbs-Cooley et al., 2015). The study was designed to explore relationships between workload, missed nursing care, and neonatal patient outcomes. Measures of burnout and turnover were collected in the course of the primary study and were the focus of the current analysis.Back to TopSetting and Sample  The original study was conducted in a 52-bed level IV NICU in the Midwestern region of the United States. Registered Nurses were eligible to participate if they were permanently employed in the NICU, had completed unit orientation, and provided direct patient care for at least 24 hours biweekly. Data from the full sample of 136 registered NICU nurses were used.Back to TopPrimary Study Procedures  Data collection occurred over an 11-month period from 2013 to 2014 and recruitment measures for the original study have been published previously (Tubbs-Cooley et al., 2015). At enrollment, participants completed paper-based questionnaires related to personal and professional characteristics as well as the Maslach Burnout Inventory. Participant withdrawal was systemically documented along with reason for withdrawal; all instances of study withdrawal were due to noneligibility because of nurses leaving their position in the unit. Specific reasons for attrition (e.g., transfer to another unit, returning to school, involuntary dismissal) were not available.Back to TopMeasures  Burnout. The Maslach-Burnout Inventory Human Services Survey (Maslach et al., 1996) was used to assess burnout among NICU nurses in the sample at the time of study enrollment. The scale is comprised of 22 items divided into three subscales measuring the individual dimensions of burnout: emotional exhaustion (9 items), depersonalization (5 items), and personal accomplishment (8 items). Respondents indicate the frequency with which they experience particular feelings on a 7-point Likert-type scale. Ratings are scaled from 0 (never) to 6 (everyday). Each subscale is totaled and scored separately, and can be coded as low, average, or high (Maslach et al.). Based on norms established in prior studies of health care workers, emotional exhaustion scores 27 and greater are considered high, moderate scores range from 19 to 26, and low scores are 18 and less. Depersonalization scores greater than 10 represent high scores, moderate scores range from 6 to 9, and low scores are 5 and less. The personal accomplishment subscale scores of 40 and above are considered high, moderate scores range from 34 to 39, and low scores range from 0 to 33. The scale has good reliability with Cronbach’s alphas for all three scales exceeding 0.70 in samples of hospital nurses (Maslach & Jackson, 1981; Poghosyan et al., 2009; Vanheule et al., 2007).Turnover. Nurse participants who voluntarily or involuntary left their position during the 11-month period of data collection from 2013 to 2014 were considered to have turned over from their job. Turnover status was determined based on study withdrawal due to loss of eligibility and was confirmed by review of administrative records.Nurse Characteristics. At enrollment, nurses reported on demographic and personal characteristics including highest nursing degree attained, professional certification status, years of nursing experience, weekly hours worked in the NICU, and primary shift worked. Several nurse characteristics were included as control variables in the analysis given their potential relevance to burnout and turnover.Back to TopEthical Considerations  Written informed consent for the original study was obtained from nurse participants and a Certificate of Confidentiality was obtained from the U.S. Department of Health & Human Services. All data were permanently de-identified at the conclusion of the original study and the site’s Institutional Review Board determined the current secondary analysis to be exempt from human subjects research review.Back to TopData Analysis  Descriptive statistics were used to describe the sample and explore distributions of data. A series of multivariable logistic regression models were used to examine associations between individual dimensions of burnout (emotional exhaustion, depersonalization, and personal accomplishment) and nurse turnover. A model examining effects of all burnout dimensions and NICU nurse turnover was tested. Nurse experience, certification status, educational degree, and weekly hours worked were included as control variables in all models.Back to TopResults  Back to TopSample Characteristics  Descriptive characteristics of the sample are shown in Table 1. Average years of experience for all nurses was 9.02 and ranged from 0 to 41 years. Ninety-four percent were white, non-Hispanic and 84% held a Bachelor’s or Master’s degree. Only 32% of nurses possessed NICU RN certification (RNC-NIC). Weekly hours worked ranged from 12 to 48, with a mean of 32 hours. There was an approximately even distribution of nurses working day shift and night shift. Table 1Opens a popup windowOpens a popup windowOpens a popup windowBack to TopNurse Burnout Levels and Turnover Status  The proportion of nurses who turned over versus did not turn over are presented for the three types of burnout in Table 2. A total of 16.9% of nurses (n = 23) were classified as having turned over in their position. Although most nurses in this sample had high-to-moderate emotional exhaustion, nurses who turned over had a higher percentage of high and moderate emotional exhaustion than nurses who did not turn over. Approximately 50% of all nurses had moderate levels of depersonalization, although percentages were similar for those who turned over versus those who did not. The vast majority of the sample reported high levels of personal accomplishment. Table 2Opens a popup windowOpens a popup windowOpens a popup windowBack to TopAssociation of Nurse Burnout and Turnover  Table 3 shows results from logistic regression models testing associations between individual and combined burnout dimensions and turnover while controlling for nurse characteristics. There were no significant differences in individual or combined models of burnout and turnover. Table 3Opens a popup windowOpens a popup windowOpens a popup windowBack to TopDiscussion  The purpose of this study was to examine the relationship between nurse burnout and turnover in a sample of NICU nurses participating in a broader research study on nursing care quality. Most participants had moderate and high levels of emotional exhaustion and moderate depersonalization but, contrary to our hypothesis, we did not observe an association between burnout and turnover.Our findings contradict existing literature that demonstrate an association between burnout and turnover in various nursing workforce samples. In a 2008 national sample of RNs in the United States, nurses who experienced burnout were more likely to leave their organization (Mazurenko et al., 2015). A total of 14% of nurses in that study left their organization within a 1-year period. Turnover in this particular study was not measured using an instrument but was assessed through unit-based administrative record review and therefore lacks key contextual information that would indicate why a particular nurse decided to leave. In more dated literature, associations of burnout and turnover were found in samples of nurses from Japan (Shimizu et al., 2005) and the United Kingdom (Firth & Britton, 1989). Both studies used different forms of the Maslach Burnout Inventory as measures of burnout and measured turnover over a period of 1 year or more. It is noted that key differences that exist across settings, samples, and time (decades when studies reported) may account for the differences between findings.Our findings highlight the possibility of other factors that may more directly contribute to nurse turnover, particularly in NICUs where burnout has been associated with turnover intent (Barr, 2020) but not actual turnover. Although speculative, it is possible that the nearly 17% of NICU nurses in our sample who left their position did so for reasons other than burnout; some may have made lateral or upward moves in the hospital, retired, or left to pursue educational goals. It is important to consider other factors that may deter a nurse from leaving their job; job security, familiarity, location, finances, and ethical obligations may prevent job turnover even while nurses experience burnout and distress.Neonatal intensive care nurse burnout may have implications for nurses and patients even if it does not directly lead to turnover. Findings from a recent study of NICU nurses’ work-related mental health risks and protective factors that buffer these risks showed a positive association between depressive symptoms and burnout (Moore & Schellinger, 2018). It is possible that burnout among NICU nurses has increased during the recent COVID-19 pandemic at the same time nurses experienced numerous other social and clinical stressors impacting mental health and emotional wellbeing. Emerging literature indicates that front-line nurses working during the pandemic experienced high levels of stress and burnout along with moderate depression (Murat et al., 2021). Further study is needed to understand relationships between nurse burnout and mental health both broadly and in NICU settings.Our results have several limitations. Generalizability is limited due to a relatively small homogenous sample that was obtained from one unit in a Magnet(R)-recognized hospital. Magnet hospitals tend to report better nurse outcomes because of better working environments associated with key Magnet characteristics such as higher standards of patient care and the promotion of nurse empowerment (Kelly et al., 2011). Although consistent with the national average of annual nurse turnover (NSI Nursing Solutions Inc., 2021), the low number of nurses who turned over in our sample may have limited our ability to detect an association between burnout and turnover. Study strengths include measurement of turnover over an 11-month period using both our own research enrollment data as well as verifiable nursing administration data, use of existing data from a broader study on NICU nursing care quality, and pursuit of an evidence gap particularly related to nursing workforce issues in neonatal intensive care.Back to TopClinical Nursing Implications  Nurse leaders play an important role in retention of nurses and should be aware of varying factors that may influence a nurse’s decision to leave a unit. Although burnout may not be directly associated with turnover, nurses experiencing high-to-moderate emotional exhaustion and depersonalization may be experiencing psychological distress and other negative mental health effects. Managers should encourage nurses to be aware of burnout symptoms and explore evidence-based interventions to support nurses’ well-being. Future nurse turnover research should examine concordance between turnover intentions and turnover and explore other factors that may contribute to turnover, including potential relationships between burnout and mental health.Back to TopAcknowledgment  This study was a portion of the first author’s dissertation work which was supported in part by the Jonas Philanthropies and the University of Cincinnati, College of Nursing. Support for the original study, the Neonatal Nursing Care Quality Study (PI: Tubbs-Cooley) was provided by Cincinnati Children’s Hospital Medical Center.Back to TopCLINICAL NURSING IMPLICATIONS  * Nurse leaders and unit managers play an important role in the retention of nurses and must recognize that organizational, financial, and unit losses occur when a nurse leaves their clinical unit. * Although burnout may not be directly associated with turnover, nurses experiencing high-to-moderate emotional exhaustion and depersonalization may also be experiencing negative mental health effects such as depression. * Nurse leaders should encourage nurses to be aware of burnout symptoms and explore evidence-based interventions to support nurses who may be experiencing work-related burnout. * Nurse leaders can recognize that there may be multiple factors that affect nurses’ decisions to leave the unit such as job security, familiarity, location, finances, and ethical obligations. * Creating a supportive working environment in the midst of stressful situations may prove helpful to nurses experiencing burnout.                                Health Science Science Nursing NRSE 4550 Share QuestionEmailCopy link Comments (0)

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