Physician-Nurse Collaboration in a Tertiary Care Academic Medical Center: The Effect of Burnout

Background: Interprofessional collaboration (IPC) between nurses and physicians can be defined as shared responsibility and decision making in working towards the common goal of quality patient care. The positive effect of greater IPC on patient outcomes and job satisfaction has been described.  Studies have shown discrepancies between nurses’ and physicians’ assessment of their own collaboration. Which individual factors predict these differences has not been as well defined. One concept we hypothesized might be correlated with IPC scores was burnout. We sought to describe the relationship between IPC scores and self-reported burnout.

Methods: In our 1,125 bed academic medical center, we electronically surveyed nurses, housestaff and hospitalists on a 14 item IPC scale by Kenaszchuk, a valid measure of interprofessional perceptions of the level of collaboration.  Each item is scaled from 1-5 (strongly disagree – strongly agree) and the sum scores were calculated as the outcome variable (range 14-70).  Information on provider experience, mental workload, and demographic background were collected. We also used questions adapted from the Maslach Burnout Inventory, a validated instrument assessing job-related burnout, ranging from 0-4  (no symptoms – completely burned out).  Generalized linear models were used to examine the Interprofessional Collaboration sum scores using SAS (version 9.4). Pairwise comparisons were examined using Tukey’s Honestly Significant Difference test (HSD). A Chi-square test (X²) was used to explore the association between burnout and professions. 

Results: Overall, 47 nurses, 29 housestaff and 17 hospitalists completed the survey. Levels of burnout did not change with regard to profession (X²₍₈₎=7.94, p=0.43). Most respondents (78.26%) scored 2 or 3 on current burnout level.  One nurse responded at level 4.  Different levels of burnout were correlated with IPC score. Results of a generalized linear regression showed that with every one level increment of burnout, the IPC sum score decreased 3.8 points (F _(1,90)=11.5, p=0.001). 

Conclusions: With the ultimate goal of quality patient care, establishing the components of the ideal system is essential.  One aspect is provider satisfaction, which is linked to provider turnover. Burnout predicts both satisfaction and turnover. Several determinants of burnout have been noted in the literature, including workload, unit-based care, and provider autonomy. Good nurse-physician relationships have been shown to contribute to lower provider reports of burnout, while lack of collaboration has been linked to adverse patient outcomes, reduced patient satisfaction, and increased provider turnover.  Our study showed a significant relationship between burnout and the perception of IPC, noted across all professions. This inverse relationship between burnout and IPC emphasizes the need to define the relationships between these concepts more clearly if we are to have the interprofessional teams that deliver the highest quality care.