nursing journal thesis

Writing a Thesis for Nursing School

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Writing a thesis presents an opportunity for graduate students to conduct scholarly inquiry, with the potential of publishing their finished paper. A thesis requires nursing students to identify a problem in nursing, and review academic literature while developing advanced research skills. Thesis advisors and committees guide students from the proposal phase to the final oral defense, a process that spans about two semesters.

Not every nursing student is required to complete a thesis. Some nursing programs offer a non-thesis option, in which candidates complete a final capstone project or oral examination on topics such as nursing theories and clinical practices.

The thesis process and requirements vary by school. Ohio State University’s master of science in nursing program’s final examination includes oral and written portions.

Want to know what to expect during the thesis process? Read on to learn how you can choose a thesis topic and orally defend your paper.

Choosing Your Nursing Thesis Topic

Nursing students must choose a thesis topic before they begin the research and writing process, typically within the first two terms of nursing school. A solid thesis must present an original argument, manageable research scope, and worthy academic pursuit. A thesis advisor or research professor will help to guide each student through the process of choosing a topic.

In the conceptual phase, candidates research potential thesis topics based on their interests within their nursing specialty. Students may start with a broad topic such as obesity and weight management, depression, or cardiovascular disease. To narrow their thesis argument, graduate students might focus on racial or ethnic groups, socio-economic issues, or current events.

After settling on a topic, students draft and submit a thesis proposal to an advisor or committee chair. Once this proposal has been approved, students can begin the formal work on his or her approved thesis topic.

While graduate students must complete a thesis to fulfill the requirements of a master’s degree in nursing, the thesis process also offers a chance for future nurses to immerse themselves in current academic literature and collaborate with fellow graduate students, faculty, and professors. A thesis can also serve as the foundation for doctoral studies. A thesis at the doctoral (PhD) level is called a dissertation.

Completing Your Nursing Thesis

Brainstorming a thesis topic begins as early as the first semester of a master’s in nursing program. The formal thesis process, which typically spans multiple terms, does not take place until the student’s final year, usually during the last term.

Thesis requirements vary by school, and students must meet specific deadlines and take prerequisite courses beforehand. At the University of Texas-Houston’s School of Nursing , candidates take a public health class before they submit a thesis proposal.

Future nurses work under the guidance of a thesis committee and advisor. The experience of writing a thesis trains students in original investigation, data collection, implementing research design, and public speaking. Candidates also learn to flex their analytical thinking skills and master a specific area of nursing as they develop the ability to analyze and draw conclusions through data.

At a program’s conclusion, students submit their thesis as a bound manuscript or electronic file. In addition to submitting a written report, students orally defend their final thesis in front of the committee. Many graduates also submit their manuscripts for publication.

Presenting Your Nursing Thesis

Graduate students generally orally defend their proposal and present their completed thesis in front of their committee. This committee also includes the thesis mentor, a faculty member specializing in the nursing discipline of their scholarly inquiry. There are generally 3 total committee members on a thesis committee.

Fellow graduate students or consultants outside of the college may attend presentations, if the process is open to the public. Otherwise, the thesis defense remains a private session, with students presenting their findings. The oral examination of the thesis takes up to one hour, but can last longer depending on how many questions the committee has for the student.

During that time, the committee evaluates the thesis based on how the research experience has shaped the student’s graduate education and the findings’ significance to the nursing field. When the exam concludes, the committee either accepts or rejects the thesis defense.

How is a Nursing Thesis Graded?

Nursing schools rely on each committee to formally grade each product in the thesis process. Some graduate nursing students may receive a letter grade, while other nursing schools adhere to a “pass” or “fail” policy.

To determine a grade, the committee assesses the thesis based on set criteria. Committee members look at the project’s key components, including the statement of purpose, literature review, research methodology, analysis, findings, and implications. The process and grading criteria for the thesis process can be found in the school’s graduate handbook. Most of these handbooks are published online for student review.

The thesis must identify significant issues or service gaps in nursing and present them in a concise and coherent fashion. Candidates must support all findings and analysis by research and explain the implications for healthcare.

The oral defense also factors into the grade. The committee grades the defense based on the quality of the student’s presentation, taking into consideration if the student spoke clearly and presented a logical and well-organized argument.

What is the Difference Between a Nursing Thesis and a Capstone?

A nursing thesis and a capstone demonstrate the student’s comprehensive knowledge and educational journey. Graduate students in a non-research track may have the choice of completing a clinical project. Doctoral of Nursing ( DNP ) students complete a capstone project.

Graduate-level nursing students work on an original scholarly inquiry during their thesis, while undergraduates recap their cumulative learning experience. The thesis process, which includes completing nursing courses and writing a proposal, takes place over the entire program.

Learn more about the difference between a thesis and capstone project on this page .

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Digital Commons @ USF > College of Nursing > Theses and Dissertations

Nursing Theses and Dissertations

Theses/dissertations from 2023 2023.

Psychological Distress, Resilience, and the Impact on Quality of Life in Breast Cancer Survivors With Taxane-Induced Peripheral Neuropathy , Lauren Schwab

Theses/Dissertations from 2022 2022

Medication-Assisted Treatment Versus 12-Step Group Therapy: A Comparative Analysis of Adherence and Abstinence In Patients With Opioid Use Disorder , Derrick C. Glymph

Theses/Dissertations from 2021 2021

Quality of Life of Older Adults with Complicated Grief Receiving Accelerated Resolution Therapy: A Mixed Methods Study , Tina M. Mason

Theses/Dissertations from 2020 2020

In Post-Extubated Patients What are the Preferred Methods of Communication During Their Experience of Endotracheal Intubation with Mechanical Ventilation , Lanette Dumas

The Effect of Hope on the Relationship between Personal and Disease Characteristics and Anxiety and Depression in Adolescents and Young Adults with Cancer , Sharon B. McNeil

Predictors of Nonadherence to Radiation Therapy Schedules Among Head and Neck Cancer Patients , Jennifer Lynn Miller

Theses/Dissertations from 2019 2019

Perceived Discrimination and Cardiovascular Outcomes in Blacks: A Secondary Data Analysis of the Heart SCORE Study , Marilyn Aluoch

Exploration of Gratitude in Cardiovascular Health: Mediators, Medication Adherence and Psychometrics , Lakeshia A. Cousin

Theses/Dissertations from 2018 2018

Fatigue-related Symptom Clusters and their Relationship with Depression, and Functional Status in Older Adults Hospice Patients with Cancer. , Suzan Fouad Abduljawad

Genetic Moderation of Pain and Fatigue Symptoms Resulting from the Mindfulness-Based Stress Reduction for Breast Cancer Program , Carissa Bea Alinat

The Moderating Effect of Religion on Death Distress and Quality of Life between Christian Cancer patients in the United States with Muslim cancer patients in Saudi Arabia , Doaa Almostadi

Prevention of Post Intensive Care Syndrome-Family with Sensation Awareness Focused Training Intervention: A Randomized Controlled Trial Pilot Study , Paula L. Cairns

Assessing Abstinence in Infants Greater Than 28 Days Old , Genieveve J. Cline

The Relationship Between Sleep Quality and Motor Function in Hospitalized Older Adult Survivors of Critical Illness , Maya N. Elías

The Role of Migration-Related Stress in Depression Among Haitian Immigrants in Florida: A Mixed Method Sequential Explanatory Approach , Dany Amanda C. Fanfan

The Effect of Depression, Inflammation and Sleep Quality on Risk for Cardiovascular Disease , Catherine L. O'Neil

Adapting SafeMedicate (Medication Dosage Calculation Skills software) For Use In Brazil , Samia Valeria Ozorio Dutra

Theses/Dissertations from 2017 2017

The Relationship Between Total Neuropathy Score-reduced, Neuropathy Symptoms and Function. , Ashraf Abulhaija

Validation of the Electronic Kids Dietary Index (E-KINDEX) Screening Tool for Early Identification of Risk for Overweight/Obesity (OW/OB) in a Pediatric Population: Associations with Quality of Life Perceptions , Patricia A. Hall

Theses/Dissertations from 2016 2016

The Effectiveness of an Intervention Designed to Improve Chlorhexidine (CHG) Bathing Technique in Adults Hospitalized in Medical Surgical Units , Janette Echemendia Denny

Levels of Distress Among Women Veterans Attending a Women’s Health Specialty Clinic in the VA Healthcare System , Debbie T. Devine

Examination of the Use of Accelerated Resolution Therapy (ART) in the Treatment of Symptoms of PTSD and Sleep Dysfunction in Veterans and Civilians , Marian Jevone Hardwick

Investigating the Mutual Effects of Depression and Spiritual Well-being on Quality of Life in Hospice Patients with Cancer and Family Caregivers Using the Actor-Partner Interdependence Model , Li-Ting Huang

The Change in Nutritional Status in Traumatic Brain Injury Patients: A Retrospective Descriptive A Retrospective Descriptive Study , Dina A. Masha'al

Exploring the Relationship Between Severity of Illness and Human Milk Volume in Very Low Birth Weight and Extremely Low Birth Weight Infants Over Six Weeks , Shannon Leigh Morse

Cardiovascular Disease Risk Scores and Novel Risk Factors in Relation to Race and Gender , Johanna Wilson

Theses/Dissertations from 2015 2015

A Comparative Evaluation of the Learner Centered Grading Debriefing Method in Nursing Education , Marisa J. Belote

Sleep, Depressive Symptoms and Cognition in Older Adults and Caregivers of Persons with Dementia , Glenna Shemida Brewster

The Relationship between Hearing Status and Cognitive Performance and the Influence of Depressive Symptoms in the Older Adult , Julie A. Daugherty

Basal Salivary Oxytocin and Skin to Skin Contact among Lactating Mothers of Premature Infants , Jessica Marie Gordon

The Relationship Between Nurses' Emotional Intelligence and Patient Outcomes , Mary Kutash

Sexual Functioning and Body Image in Younger Breast Cancer Survivors , Carly Lynn Paterson

Cognitive Load of Registered Nurses During Medication Administration , Sarah Faith Perron

A Comparison of Quality of Life between Intense and Non-Intense Treatment for Patients with Acute Myeloid Leukemia and High-Risk Myelodysplastic Syndrome , Sara Marie Tinsley

Theses/Dissertations from 2014 2014

Acculturation, Self-Efficacy and Breastfeeding Behavior in a Sample of Hispanic Women , Ivonne F. Hernandez

Knowledge and Acceptance of HPV and the HPV Vaccine in Young Men and Their Intention to be Vaccinated , Brenda Renee Jasper

The Relationships Between Sleep Disturbances, Depression, Inflammatory Markers, and Sexual Trauma in Female Veterans , Ellen Marcolongo

Examination of Possible Protective Effect of Rhesus D Positive Blood Factor on Toxoplasma-related Depressive Symptoms in Pregnancy , Lisa Lynn Parnell

Knowledge, Attitudes, and Practice of Primary Care Nurse Practitioners Regarding Skin Cancer Assessmnets: Validity and Reliability of a New Instrument , Debra Michelle Shelby

Theses/Dissertations from 2013 2013

Knowledge and Practice of Reproductive Health among Mothers and their Impact on Fetal Birth Outcomes: A Case of Eritrea , Winta Negusse Araya

Race/Ethnicity, Subjective and Objective Sleep Quality, Physical and Psychological Symptoms in Breast Cancer Survivors , Pinky H. Budhrani

Factors Predicting Pap Smear Adherence in HIV-infected Women: Using the Health Belief Model , Crystal L. Chapman Lambert

The Relationship Between Socioeconomic Status and Body Mass Index on Vitamin D Levels in African American Women with and without Diabetes Living in Areas with Abundant Sunshine , Shani Vann Davis

Predictors of Quality of Life in Patients with Cutaneous T cell Lymphoma , Darcie Marie Deaver

Relationship between dysphoric moods, risk-taking behaviors, and Toxoplasma gondii antibody titers in female veterans , Allyson Radford Duffy

Prenatal Stress, Depression, and Herpes Viral Titers , Pao-Chu Hsu

Factors Associated with Fear of Breast Cancer Recurrence Among Survivors , Jean Marie Lucas

Sickle Cell Disease: The Role of Self-Care Management , Nadine Matthie

Factors Influencing Vaccination Decisions in African American Mothers of Preschool Age Children , Chauntel Mckenzie Mcnair

The Strong Black Woman, Depression, and Emotional Eating , Michelle Renee Offutt

Development of an Investigator-designed Questionnaire Concerning Childbirth Delivery Options based on the Theory of Planned Behavior , Chun-Yi Tai

Theses/Dissertations from 2012 2012

The Mediating Effect of Distress Caused by Constipation on Predictors of Quality of Life of Hospice Patients with Cancer. , Abdel Alkhalouf

Testing a Model of Bacterial Vaginosis among Black Women , Jessica Brumley

The Effect of Tight Glycemic Control on Surgical Site Infection Rates in Patients Undergoing Open Heart Surgery , Sierra Gower

Development of a Tool for Pressure Ulcer Risk Assessment and Preventive Interventions in Ancillary Services Patients , Monica Shutts Messer

Hospice Nurses- Attitudes and Knowledge about Pain Management , Amie Jacqueline Miller

Theses/Dissertations from 2011 2011

Literacy and Hazard Communication Comprehension of Employees Presenting to an Occupational Health Clinic , Christine Bouchard

A Meta-Analysis of Cultural Competence Education in Professional Nurses and Nursing Students , Ruth Wilmer Gallagher

Relationship Between Cancer-Related Fatigue and Depression: A Pilot Study , Gloria Michelle Guess

A Comparison of Oncology and Non-Oncology Nurses in Their Knowledge of Cancer Pain Management , Nicole Houle

Evaluating Knowledge and Attitudes of Graduate Nursing Students Regarding Pain , Eric Bartholomew Jackson

Bone Marrow Transplant Nurses' Attitudes about Caring for Patients Who are Near the End of Life: A Quality Improvement Project , Leslie Lauersdorf

Translation and Adaptation of the Center for Epidemiologic Studies-Depression (CES-D) Scale Into Tigrigna Language for Tigrigna Speaking Eritrean Immigrants in the United States , Mulubrhan Fisseha Mogos

Nurse Manager Emotional Intelligence as a Predictor to Registered Nurse Job Satisfaction and RN Perceptions of the Practice Environment and the Relationship to Patient, Nursing and Hospital Outcomes , Jacqueline Cecilia Munro

The Relationship of Mid-Pregnancy Levels of Cytokines, Stress, and Depression with Gestational Age at Delivery , Melissa Molinari Shelton

Prophylactic, Risk-Reducing Surgery in Unaffected BRCA-Positive Women: Quality Of Life, Sexual Functioning and Psychological Well-Being , Sharon Tollin

Theses/Dissertations from 2010 2010

The Relationship Between FAM5C SNP (rs10920501) Variability, Metabolic Syndrome, and Inflammation, in Women with Coronary Heart Disease , Jennifer L. Cline

Women’s Perceptions of Postpartum Stress: A Narrative Analysis , Nancy Gilbert Crist

Lived Experience: Near-Fatal Adolescent Suicide Attempt , Phyllis Ann Dougherty

Exploring the Relationships among Work-Related Stress, Quality of Life, Job Satisfaction, and Anticipated Turnover on Nursing Units with Clinical Nurse Leaders , Mary Kohler

A Comparative Study of Knowledge of Pain Management in Certified and Non-Certified Oncology Nurses , Sherrie A. LaLande

Evaluating Knowledge and Attitudes of Undergraduate Nursing Students Regarding Pain Management , Jessica Latchman

Evaluation of Oncology Nurses' Knowledge, Practice Behaviors, and Confidence Specific to Chemotherapy Induced Peripheral Neuropathy , Rebecca Denise McAllister

Moderating the Effectiveness of Messages to Promote Physical Activity in Type 2 Diabetes , Rachel E. Myers

Factors Affecting the Process of Clinical Decision-Making in Pediatric Pain Management by Emergency Department Nurses , Teresa A. Russo

The Correlation Between Neuropathy Limitations and Depression in Chemotherapy Patients , Melissa Thebeau

Theses/Dissertations from 2009 2009

Fatigue Symptom Distress and Its Relationship with Quality Of Life in Adult Stem Cell Transplant Survivors , Suzan Fouad Abduljawad R.N., B.S.N.

Nursing Advocacy and the Accuracy of Intravenous to Oral Opioid Conversion at Discharge in the Cancer Patient , Maria L. Gallo R.N., O.C.N.

Transitional Care for Adolescents with HIV: Characteristics and Current Practices of the Adolescent Trials Network Systems of Care , Patricia Gilliam

The Effect of Ethical Ideology and Professional Values on Registered Nurses’ Intentions to Act Accountably , Susan R. Hartranft

Falls in Bone Marrow Transplant Patients: A Retrospective Study , Lura Henderson R.N., B.S.N.

Predictors of cancer caregiver depression symptomatology , Henry R. Rivera

Psychosocial outcomes of weight stigma among college students , Sabrina Joann Robinson

The Experience of Fatigue and Quality of Life in Patients with Advanced Lung Cancer , Andrea Shaffer

The Relationship Between Uncertainty in Illness and Anxiety in Patients With Cancer , Naima Vera

Shifting Paradigms: The Development of Nursing Identity in Foreign-Educated Physicians Retrained as Nurses Practicing in the United States , Liwliwa Reyes Villagomeza

Theses/Dissertations from 2008 2008

Prostate Cancer Screening Intention Among African American Men: An Instrument Development Study , Susan Anita Baker

The Geriatric Cancer Experience in End of Life: Model Adaptation and Testing , Harleah G. Buck

Communication Systems and HIV/AIDS Sexual Decision Making in Older Adolescent and Young Adult Females , Rasheeta D. Chandler MS, ARNP, FNP-BC

Relationship of Anger Trait and Anger Expression to C-Reactive Protein in Post-Menopausal Women , Rosalyn Gross

Identifying Patients with Cancer at Risk of Experiencing a Fall While Hospitalized , Joann M. Heaton

Modulation of Monocyte-Derived Dendritic Cell Maturation and Function by Cigarette Smoke Condensate in a Bronchial Epithelial Cell Co-Culture Model , Alison J. Montpetit

Cancer Patients with Pain: Examination of the Role of the Spouse/Partner Relationship In Mediating Quality of Life Outcomes for the Couple , Mary Ann Morgan

Development of an Ecological Model to Predict Risk for Acquisition of Clostridium difficile -Associated Diarrhea During Acute Care Hospitalization , Susan Elaine Steele

Development and Psychometric Evaluation of the Chemotherapy Induced Peripheral Neuropathy Assessment Tool , Cindy S. Tofthagen

Health Decision Behaviors: Appropriateness of Dietary Choice , Daryle Hermelin Wane

Theses/Dissertations from 2007 2007

The Relationship Between Sleep-Wake Disturbance and Pain in Cancer Patients Admitted to Hospice Home Care , Marjorie Acierno

Wheelchair Positioning and Pulmonary Function in Children with Cerebral Palsy , Lee Barks

Structural Equation Model of Exercise in Women Utilizing the Theory of Unpleasant Symptoms and Social Cognitive Variables , Sarah Elizabeth Cobb

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Home > USC Columbia > Nursing, College of > Nursing Theses and Dissertations

Nursing Theses and Dissertations

Theses/dissertations from 2023 2023.

Is There a Relationship Between Direct Patient Care Registered Nurses Emotional Intelligence and Patient Satisfaction? , James J. Leach

The Impact of Shift Work on Women’s Neurological Health , Kathy Nelson

Nurse Perceptions of Caring and Professional Governance , Lan Angela Nguyen

Unlocking Population-Specific Treatments to Render Equitable Approaches and Management in Cardiovascular Disease (UPSTREAM CVD): African American Emerging Adults , Shannon Bright Smith

Substance Use Disorder Treatment Among African American Men Living in the Rural South of the United States , Serge Raoul Wandji

Theses/Dissertations from 2022 2022

Unintended Consequences of the Electronic Health Record And Cognitive Load in Emergency Department Nurses , Carolyn S. Harmon

Physical Activity and Breast Cancer Prevention Among Asian American Women , Jingxi Sheng

Theses/Dissertations from 2021 2021

Early Premature Infant Physiologic and Behavioral Indicators of ANS Instability , Karen Popp Becker

Nurses’ and Patients’ Perceptions of the Availability of Post-hospital Instrumental Support as a Predictor of 30- And 60-Day Acute Care Utilization , Beth E. Schultz

Race Is Not a Risk Factor: Examining the Influence of Models Of Care, Race, and Discrimination on Racial Disparities in Maternal Outcomes , Curisa Mae Tucker

Advancing Knowledge of Exercise as a Therapeutic Management Strategy for Women with Polycystic Ovary Syndrome , Pamela J. Wright

Theses/Dissertations from 2019 2019

Examining Caregiver Vigilance for Child Sexual Abuse , Kate K. Chappell

Exploring Turnover Among Nurse Managers, Directors, and Executives in Acute Care Hospitals , Deborah Hughes Warden

Psychometric Evaluation of Lung Cancer Stigma Among Lung Cancer Survivors in South Carolina , Lisa A. Webb

Theses/Dissertations from 2018 2018

Utilization Of The USDA Supertracker System In High Schools: A Quality Improvement Project , Twanda D. Addison

Online Risks, Sexual Behaviors, And Mobile Technology Use In Early Adolescent Children: Parental Awareness, Protective Practices, And Mediation , Kendra Allison

Implementation of a Depression Screening Tool for Cardiovascular Patients in the Primary Care Setting , Amber Nicole Ballentine

Forensic Patient Flow: An Imbalance Between Capacity And Demand , Versie J. Bellamy

An Evidence-Based Evaluation Tool To Assist Healthcare Providers In Their Assessment Of Effective mhealth Applications For The Management Of Chronic Health Conditions , Sara Belle Donevant

The Effect of a Compassion Fatigue Awareness and Self-Care Skills Educational Program on Retention Among Certified Nursing Assistants Working in a Veterans Nursing Home , Michele M. Dreher

Efficiency Of Ambulatory Blood Pressure Monitoring Vs. 5-Day Serial Monitoring In A Military Treatment Facility , Kadijatu Kakay

Initiating the Loeb Criteria in Long-term Care , Janice Khauslender

High Fidelity Simulation Experience and Development of Clinical Judgment: Recent Graduate Nurses’ Reflections , Martha Kay Lawrence

Implementing a Surgical Pathway to Reduce Operating Room Cancellation Rates , Demerise Ott Minor

Home Exercise Therapy For The Treatment Of Knee Osteoarthritis , Kezia Nixon

Assessment Of An Educational Intervention To Increase Knowledge And Intention To Take HPV Vaccine And Cervical Cancer Screening In Nigeria , Chigozie Anastacia Nkwonta

Chemotherapy Knowledge And Health Literacy Among Women With Breast Cancer , Pearman deTreville Parker

Using Ultrasound Guided Peripheral Intravenous Catheters In Difficult Access Patients , Courtney Prince

Initiating a Peer Support Program for Parents of Children With Autism Spectrum Disorder in Richland and Lexington Counties , Danielle P. Simmons

Implementation Of Provider And Workflow Strategies To Increase Adherence To Tqip Guidelines In Traumatic Brain Injury , Regina Thompson

Theses/Dissertations from 2017 2017

Best Practice for Screening Adult Patients with Psoriasis for Polyautoimmunity: Celiac Disease, Rheumatoid Arthritis and Crohn’s Disease , Susan Danielle Ashbaugh

Adherence of Nurse Practitioners to JNC 8 Guidelines , Stephanie E. Averette

Losing Weight with Five A’s (5 A’s): Assess, Advise, Agree, Assist, Arrange framework and Motivational Interviewing (MI) for health behavior change counseling , Jacqueline Baer

A Quality Improvement Project to Reduce the Incidence of Clostridium difficile Infection through Implementation of Evidence-Based Terminal Clean Procedures , Tamara Cook

Tuberculosis Screening in New Healthcare Employees: A Comparison of QuantiFERON®-TB Gold In-Tube Test and Tuberculin Skin Test , Mary C. Giovannetti

Utility of the Modified Early Warning System Score in Early Sepsis Identification , Lisa E. Hart

Picturing Rest: A Photovoice Study Of African American Women’s Perceptions And Practices Of Rest , Eboni T. Herbert Harris

Developing And Implementing A Quality Assurance Strategy For Electroconvulsive Therapy , Jessa Hollingsworth

Improving Leadership Communication In Nurse-Physician Dyad Teams , Lisa James

Assessment of Providers’ Perception and Knowledge of Overactive Bladder in Women: A Quality Improvement Project , Helen Wambui Ngigi

Simulation-Based Interprofessional Education in a Rural Setting , Ann D. Scott

An Evidence-Based Process Change to Improve Mammography Adherence , Tara E. Smalls

Evaluation, Treatment, and Education In The Hospice Setting By Initiating a Formalized Pain Card , Alyssa M. Soprano

Scribes Impact On Patient And Provider Experience In The Outpatient Setting , Kimberly A. Taylor

Barriers to the Use of Guardrails On IV Smart Pumps , Ivory Williams

Theses/Dissertations from 2016 2016

Nursing Attitudes towards Suicidal Patients in the Emergency Department: Assessment Interview Training , Belinda Beaver

MySleep101©: An Educational Mobile Medical Application for Sleep Health in Primary Care , Sonya Cook

Effects Of Sepsis Protocols On Health Outcomes Of Adult Patients With Sepsis , Monika U. Mróz

Multi-Symptom Management in Hospice Patients during End-of-Life Transition , Ashley N. B. Sirianni

Theses/Dissertations from 2015 2015

Best Practice for a Standardized and Safe Registered Nurse Shift Handoff , Nancy Rankin Ewing

An Evidence-Based Approach to Prepare Interdisciplinary Team Members for Implementation of the ABCDE Bundle , Jessica Murner Hamilton

Nurses Utilizing the V.O.I.C.E.S. HIV Prevention Intervention in the Black Church Community , Jason Richard

Unexpected and Interrupted Transitions Among Newly Licensed Registered Nurses: Perspectives of Nurse Managers and Preceptors , Sheri S. Webster

Theses/Dissertations from 2014 2014

Best Practice for Antipsychotic Medication Management in Community Dwelling Older Adults with Schizophrenia , Estelle Marie Brown

The Effects of Multiple Gratitude Interventions Among Informal Caregivers of Persons with Dementia and Alzheimer's Disease , Cristy DeGregory

An Analysis of Interpreter-Mediated Healthcare Interactions , Robin Dawson Estrada

Quality Improvement Project: A Comparison of Daily Routine Chest Radiography Versus Clinically-Indicated Chest Radiography in Preventing Ventilator-Associated Pneumonia in Adult ICU Patients on Ventilators: An Evidenced Based Practice Project , Kimberly McKenney

Best Practices in High Fidelity Patient Simulation to Enhance Higher Order Thinking Skills , Kathryn S. Mock

Best Practices in the Management of Pediatric Obesity in Primary Care Clinics , Lori Moseley

Early Screening and Identification of Preschool Children Affected by Serious Emotional Disorders , Cathy Renee Robey-Williams

Theses/Dissertations from 2013 2013

Improving the Diagnostic Accuracy of Failure-to-Rescue , Amelia Marie Joseph

Best Practice Guideline For Managing Interstitial Cystitis In Adult Women , Amanda Thomas Langford

The Use of Ultrasound as an Adjunct to X-Ray For the Localization and Removal of Soft Tissue Foreign Bodies in an Urgent Care Setting , Stacy Lane Merritt

Prevention of Skin Breakdown In the Pediatric Intensive Care Unit , Lydia H. Palmer

A Pilot Intervention To Engage Nurses To Lead Transformation of The Workplace , Molly Patton

Foot Assessment In the Dialysis Unit , Karen Robertson

Emergency Department Triage Acuity Ratings: Embedding Esi Into the Electronic Medical Record , Candace Whitfield

Theses/Dissertations from 2012 2012

Best Practice to Promote Bone Health in Post-menopausal Women through Adequate Intake of Calcium and Vitamin D , Ellen Soley Adkins

Developing A Facilitated Pathway For Associate Degree Nursing Graduates to Enroll In An Rn-Bsn Program , Christy Vansant Cimineri

Pursuing Improved Quality of Life In the Atrial Fibrillation Population: Evidence-Based Practice , Jamie Hayes Cunningham

Continuous Subcutaneous Insulin Infusion in Comparison to Subcutaneous Insulin Injections in the Preschooler with Type 1 Diabetes Mellitus , Meredith D'Agostino

Transition to Motherhood-A Qualitative Study of Low Income Women's First Term Pregnancy Experiences , Lisa Bennett Duggan

Vitamin D and Calcium Supplementation For Prevention of Falls and Fractures In Older Adults , Cynthia Hartman

The Best Practice Guideline for Early Detection and Treatment of Heart Disease In Asymptomatic Adults with a Family History of Premature Coronary Artery Disease , Stephanie Brooke Huston

Best Practice Protocol for Patients with Schizophrenia and Co-Occurring Substance Use Disorders , Shauna Rae Jones

Transcultural Nursing Clinical Education: A Systematic Review of the Literature Since 2005 With Recommendations for International Immersion Clinical Courses , Deborah J. McQuilkin

Using a Consensus Process to Develop an Evidence-Based Practice Guideline for School Exclusion For Head Lice (Pediculosis Capitis) , Michelle Lorraine Myer

Using Therapeutic Writing to Deconstruct Recovery from Posttraumatic Stress Disorder (PTSD) , Pamela Phillips

Improving Outcomes by Improving Practice: Evidence-Based Assessment, Prevention and Documentation of Pressure Ulcers In the ICU. , Kristy Fry Speronis

Increasing Awareness of Fertility Preservation Options in Cancer Patients & Survivors , Norma Sweet

Identification, Prevention and Treatment of Children with Decreased Bone Density , Laura Lee Szadek

Assessment and Strategic Planning to Determine the Growth Feasibility of a Distance-Based Rural Baccalaureate Nursing Program , Amber Proctor Williams

Theses/Dissertations from 2011 2011

A Research Utilization Project: Implementation of an Evidence-Based Behavioral Treatment for Students At-Risk of Dropout at Richland Northeast High School , Kathrene Carter Berger

The Impact of the Patient Protection and Affordable Care Act of 2010 On the Evidence Based Practice of Distributive Justice Via Comfort Care In Elderly Burn Trauma Victims , Christina Pacileo Blottner

Parenting Interventions For Children Exposed to Intimate Partner Violence , Christie Michelle Furr-Roeske

Nurse State Legislators: The Journey to State Capitols , Debbie Whitman Herman

Autonomous Nurse Practitioner Practice: A Position Paper and Action Plan for Change , Patricia Susan Noser

Best Practices in The Use of Vena Cava Filters oo Prevent Pulmonary Emboli in Trauma Patients , Dennis Absher Taylor

Theses/Dissertations from 2010 2010

Assessment and Identification of Deliberate Self-Harm in the Adolescent and Young Adult Patient in the Primary Care Population , Courtney Brooks Catledge

A Best Practice Guideline for Screening and Treating Vitamin D Deficiency in a Primary Care Setting: Moving Beyond the Bones , Amy Jeanette Clark

Best Faculty Practice Plan Model for a Small College of Nursing , Sharyn Neiman Conrad

Impact of A Primary Care-Based Organ Donation Practice Initiative On Individual Willingness to Donate , Cyndi B. Faudree

Substance Abuse Treatment Avoidance, Length of Stay, and Criminal Justice Referral For Women of Reproductive Age In South Carolina Prior to and After theWhitner Decision (1993 to 2007) , Sarah J. Gareau

Childhood Obesity and School-Based Interventions: An Evidence-Based Best Practice Guideline , Jessica Guyton

The Best Practice Guideline For theTreatment of Pediatric Diaper Dermatitis , Kate Hansson Mack

A Church-Based Health Promotion Program for Older Adults: Impacts on Participants' Religiosity, Spirituality, and Social Support , Katherine Holland Pope

Dedicated Education Units: Dothey Improve Student Satisfaction? , Eileene Elizabeth Shake

Recommendation For A Best Practice Model of Hiv Management by Advanced Practice Registered Nurses In Primary Care Settings , Sabra Smith

Exploration of the Evidence to Support Clinical Practice to Decrease Hospital Readmission Rates For Patients With Chronic Pancreatitis , Shannon Bright Smith

Best Practices: Retaining Registered Nurses , Jessica Epps Wilkes

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Yale School of Nursing Digital Theses

Theses/dissertations from 2023 2023.

Reduction Of Unnecessary Emergency Department Visits Through An Ed-Initiated Advanced Care Program For Vulnerable Patients , Dr. M. Dustin Bass

Implementing Prediabetes Screening During Hospitalization In An Internal Medicine Unit , Roxana Bustamante

Harnessing Family Empowerment To Promote Healthcare Transition For Youth With Special Healthcare Needs: The F.a.m.e. Project , Vanessa Coppola

Implementing A Workload Tool To Increase Float Nurses' Job Satisfaction And Reduce Intent To Leave The Workplace , Lisa Czaplinski

Shifting The Paradigm Toward Intent To Stay: Creating A Nurse Career Crafting Program To Increase Nurse Engagement In An Urban Teaching Hospital , Jaclyn Davis

Achieving Success[ion] In Healthcare Leadership: Building An Immersive Nurse Manager Residency Program , Natalie Marie Fucito

Enhancing Self-Efficacy Of Novice And Emerging Nurse Leaders Through A Virtual Emotional Intelligence Education Program , Josephine C. C. Garcesa-Duque

A Project To Improve Advanced Practice Provider Financial Metrics Through A Practice Management Program , Stefanie Anne Generao

Increasing Transplant Medication Knowledge Through Implementation Of A Medication Education Intervention Algorithm , Colleen Chime Karkhang

Multimodal Opioid-Sparing Analgesia: Increasing Regimen Adherence In Minimally Invasive Abdominal Surgery , Panicha F. Kittipha

Evaluating The Use Of Reflective Practice Principles To Support Nurse Manager Well-Being During A Period Of Chronic Distress , Amy A. Martone

Implementing A Prediabetes Screening Algorithm To Improve Identification And Referrals In Primary Care , Katherine Masoud

Addressing Social Needs And Creating Community Linkage Pathways For Vulnerable Populations In Primary Care Practice Settings , Mindy Marie Matthews

Improving Treatment Outcomes For American Indians With Posttraumatic Stress Disorder Through The Use Of Telepsychaitry , Shaylice Meserole

Obstructive Sleep Apnea Screening And Sleep Specialist Referral In Outpatient Psychiatric Populations , Jeremy Michael Mills

A Mixed Methods Exploration Of Stigma, Discrimination, And Sleep Among Those On Medication For Opioid Use Disorder , Uzoji Nwanaji-Enwerem

Reducing 30-Day Readmission Rates For Copd Patients: A Care Standardization & Quality Improvement Project , Oana Raluca Randolph

The Adaptation And Implementation Of A Comprehensive Retirement Transition Program For Members Of Law Enforcement , Renee White

Development Of An Educational Program To Elevate The Financial Cumen Of Nurse Managers , Quyen Wong

Theses/Dissertations from 2022 2022

Nurses, Politics And Policy: Moving A Critical Initiative Forward Through Education, Inspiration And Motivation For Political Activity , Elizabeth Clark

Assessing Risk For Right Heart Failure After Left Ventricular Assist Device Implantation , Mary-Ann Lombardi Cyr

A Nurse-Driven Protocol To Increase Metabolic Screening And Interventions For Inpatients On Antipsychotic Medications , James Thomas Demarco

Creating A Welcoming, Inclusive, And Affirming Primary Care Environment For Lesbian, Gay, Bisexual, Transgender, Queer, Questioning, Intersex And Asexual Patients , Samantha Korbey

Retention Of The Newly Licensed Registered Nursing Workforce Post-Coronavirus (covid-19): Establishing A Trauma-Informed Wellness Program, The Registered Nurse Residency Script For The Future (rnrx) (© Maryellen Hope Kosturko, 2022) , Maryellen Hope Kosturko

Sepsis Discharge Program: An Interdisciplinary Approach To Reduce Sepsis Readmissions , Rex Daniel Demetria Lomboy

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Home > FACULTIES > Nursing > NURSING-ETD

Nursing Theses and Dissertations

This collection contains theses and dissertations from the Department of Nursing, collected from the Scholarship@Western Electronic Thesis and Dissertation Repository

Theses/Dissertations from 2024 2024

Sex Differences in Coping Strategies, Infertility-Related Stress, and Predictors of Infertility-Related Stress among Saudi Men and Women Attending Infertility Clinics , Hayat Abdullah Algamadi

The Experience of Postpartum Care Practices among Parent and Healthcare Providers in Canada: A Qualitative Evidence Synthesis , Andrea Atkinson

Theses/Dissertations from 2023 2023

Nurse-Hero Discussion on Twitter: A Social Network Analysis and Qualitative Content Analysis , Amna Ali

The impact of Authentic Leadership, Structural Empowerment, Psychological Empowerment, Interpersonal Conflict, and Job Satisfaction on Turnover Intention among Early Career Nurses in Saudi Arabia. , Ohood Ali Alkaabi miss

The Process of Art Creation Among Mothers from Ontario Who Have Experienced Gender-Based Violence , Madison L. Broadbent

Exploring How Mothers With A History Of Intimate Partner Violence Experienced The COVID-19 Pandemic , Emma Jane Butler

Nurse-Assisted Injection: Perceptions of Dependent Injectors in Ontario, Canada , Emelia C. Cormack

Exploring the Role of the Nurse in Supporting Breastfeeding among Indigenous Women in Canada: A Scoping Review of the Literature , Lindsey Corrigan

The Experiences of Clinical Placement Belonging Among Nursing Students with Racially and Ethnically Minoritized Identities: An Interpretive Descriptive Study , Connor J. Gould

Nurses’ and Midwives’ Lived Experiences as Mentees in a Clinical Mentorship Program in Rwanda: An Interpretive Phenomenological Study , Yvonne Kasine 2399948

Uncovering the Experience of Determining Readiness to Increase Self-Management Responsibility in Canadian Adolescents Living with Type 1 Diabetes , Kelly A. Kennedy

Exploring Clinical Reasoning in Nursing Through A Serious Gaming-Enabled Digital Simulation , Stephanie Kennedy Miss

The Development, Refinement, Implementation, and Impact of a Nurse-Led Health Coaching Self-Care Management Intervention for Heart Failure , Maureen Leyser

Relational Variables Impacting the Healthcare Team , Linda J. MacDougall Ms

Exploring Family Members’ Beliefs and Experiences of Supporting Relatives with Substance Use and Misuse within Black Communities , Esther N. Monari

An Exploration of the Culturally-Rooted Meaning and Consequences of Unintended Adolescent Pregnancy in Rwanda: A Multi-Dimensional Perspective , Jean Pierre Ndayisenga

Exploring how the Perinatal Services of Primary Health Care Settings in Rwanda Support Adolescent Mothers to Inform the Delivery of Trauma- and Violence-Informed Care: An Interpretive Description , Aimable NKURUNZIZA

Bridging the Gap: Canadian Health Care Providers Perspectives' of Harm Reduction and Substance Use Education in Hospital , Leanne Scott

Intimate Partner Violence, Social Support, Mastery, and Mental Health , Alice Pearl Sedziafa

A Picture of Spirituality in Youth Living with Bipolar Disorder , Michelle S. Solomon

Decentering Whiteness in Nursing Education: The Pitfalls, Tensions, and Opportunities , Ivy Tran

Theses/Dissertations from 2022 2022

Exploring Health Inequities: Head Injuries in People Experiencing Homelessness , Emily M. Angus

Women’s Priorities and Actions Mothering in the Context of Intimate Partner Violence , Sharon Broughton

Toward Understanding Culturally Safe Health Care for Transgender People: A Scoping Review of Health Care Provider Knowledge , Terrie Butler-Foster

Forming Authentic and Purposeful Relationships with Racialized Communities from an Anti-Oppressive Lens: A Framework for African, Caribbean, and Black Communities , Jaimeson R. Canie

Clinical Virtual Simulation: A Qualitative Usability Study , Samantha Beatrice Cooke

Predictors and Outcomes of Patient Stigma Perception Appraisal: Developing and Testing of a Dynamic Stigma Model of Mental Illness , Sebastian Kwadwo Gyamfi

Women’s Experiences of Accessing Breastfeeding and Perinatal Health Support in the Context of Intimate Partner Violence: An Interpretive Description Study , Samantha Larose

"Pain is What the Patient Says it is": A Secondary Analysis of Nurses’ Reflections on the Term Pain Catastrophizing , Riana Longo

An Exploration of Non-Urgent Emergency Department Use from the Patient and Health Care Professional Perspective , Amanda McIntyre

Self-management Experience of Nurses Living with Migraine: A Qualitative Study , Marionette Ngole Dione

Host Organizations' Perspectives of Partnered Global Study-Abroad Programs , Jessica C. Pop

The Effect of Interprofessional Conflict Resolution on Interprofessional Collaborative Practice among Health Care Provider Teams in Hospitals , Sibylle Ugirase

Teaching Family Planning in Nursing and Midwifery Schools: A Constructivist Grounded Theory Study , Pauline Uwajeneza

Theses/Dissertations from 2021 2021

Syrian Refugee Women's Experiences with the Ontario Health Care System: A Critical Ethnography Study , Areej Al-Hamad

The Influence of Authentic Leadership on Nurses’ Turnover Intentions and Satisfaction with Quality of Care in Saudi Arabia: A Cross-Sectional Study , Bayan Alilyyani

Understanding the Current State of Health Information Exchange in Long-Term Care Homes , Kendra R. Cotton

Relationships among Interactional and Organizational Factors with Healthcare Provider Outcomes Post-Implementation of an Interprofessional Model of Patient Care , Wendy L. Ellis

Chronic Disease Management in a Nurse Practitioner Led Clinic: An Interpretive Description Study , Natalie Floriancic

Understanding the Lived Experience of Health Through the Exploration of Well-being of Women with Multiple Sclerosis in Southwestern Ontario , Jennifer Howard

"Healthcare Heroes" - The Change in Perceptions of Nurses' Roles During the COVID-19 Pandemic: A Critical Discourse Analysis , Stephanie Jones

The Discursive Construction of Substance Use and Harm Reduction in Canadian Health Policy , Sibel Kusdemir

Nurses' and Nurse Educators' Experiences of a Pediatric Nursing Continuing Professional Development program in Rwanda , Amy K. Olson

Health Providers Perspectives on the Access and Use of Formal Health and Social Services by Stroke Caregivers , Hannah Pollock

The Effect of Authentic Leadership and New Graduate Support on New Graduate Nurses' Job Satisfaction , Stephanie H. Prtenjaca

Reddit and Nursing During Covid-19: A Summative Content Analysis , Julia C. Savin

Being a Child Bride in Nigeria: A Feminist Narrative Inquiry , Olubukola Foluke Sonibare

New Graduate Nurses’ Experiences of Engaging in a Leadership Role in Hospital Settings During the COVID-19 Pandemic , Justine Jeanelle Ting

Theses/Dissertations from 2020 2020

Interprofessional Role Clarification Among Licensed Health Care Practitioners in Rural and Smaller Community Hospitals , Dianne E. Allen

Exploring Nursing Student Use of Instagram: Selfies and Soliloquies and #becominganurse with Evolving Digital Footprints , Kingsley KS Au

The Association Between Intimate Partner Violence and Functional Gastrointestinal Disorders and Symptoms Among Adult Women: Systematic Review , Ohud Shawqi Banjar

Exploring the Relationships Among New Graduate Nurses’ Structural Empowerment, Psychological Empowerment, Work Engagement, and Clinical Nurse Educator Leadership in Acute Care Settings , Carly Blair

Caring Revisited: A Foucauldian Discourse Analysis on the Association of Caring with the Profession of Nursing , Margot Boulton

Optimization of Simulated Electronic Medication Administration for Safe Management During Nursing Education , Laura Brennan

Leader Empowering Behaviour as a Predictor of Nurse and Patient Outcomes , Karen Cziraki

The Effect of Authentic Leadership on New Graduate Nurses’ Organizational Identification, Trust in the Manager, Patient Safety Climate, and Willingness to Report Errors , Fatmah Fallatah

Unit Managers’ Authentic Leadership, Staff Nurses’ Work Attitudes and Behaviours, and Outcomes of Care: A Structural Equation Model , Lisa M. Giallonardo

Developing and Evaluating the Integrated Addiction Recovery Model for the Persons' Engagement and Retention in the Recovery Process Among Clinical Populations from Rwanda , Boniface Harerimana

Developing Competencies for Public Policy Advocacy: A Comparative Case Analysis , Amy L. Lewis

Prematurity, Socioeconomic Status, And Childhood Asthma: A Canadian Cohort Study , Crystal P. McLeod

Patient Roles within Interprofessional Collaborative Patient-Centred Care Teams: The Patient and Health Care Provider Perspectives , Kateryna Metersky

Nurses' and Midwives' Experiences as Mentors in a Clinical Mentorship Program in Rwanda , Marie Chantal Murekatete

Examining the Impact of Social Media on Youth Self-Perceived Mental Health , Chantal Singh

Exploring Mental Health, Physical Health, and Affective Commitment in Acute Care Oncology Nurses in Ontario , Lesley M. Smith

Women’s Experience of Obtaining Health and Social Services following Intimate Partner Violence: Lesbian, Gay, Bisexual, Transgender, and Queer Relationships in Rural Communities , Emily E. Soares

Values, Assumptions, Behaviours, and Practices Influencing the Professional Development of Nursing Students Within Acute Care Practice Environments in Rwanda: A Focused Ethnographic Study , Benoite Umubyeyi

A study of job satisfaction and turnover intention among acute care nurses working in rural and urban settings , Yasin Yasin

Theses/Dissertations from 2019 2019

Understanding the Lived Experiences of Saudi Students Enrolled in Canadian Graduate Nursing Programs , Aisha Namshan Aldawsari

Pathways to Homelessness: Exploring the Mental Health Experiences of Refugees Experiencing Homelessness in Canada , Bridget Annor

Breastfeeding Experiences of African Migrant Women in Developed Countries: A Qualitative Systematic Review. , Odinaka Ogoegbunam Anunike

Sociocultural Factors Affecting Mental Health Service Utilization by African Newcomer Women Following Childbirth in Canada , Deborah Baiden

Registered Nurses’ Perceptions of the Electronic Canadian Triage and Acuity Scale in a Community Hospital , Andrea de Jong

New Graduate Nurses: Relationships among Sex, Empowerment, Workplace Bullying, and Job Turnover Intention , Aaron L. Favaro

Women’s Experiences Receiving Humanitarian Aid , Aden M. Hamza

Registered Nurses' Intention To Use Electronic Documentation Systems: A Mixed Methods Study , Sarah Ibrahim

Exploring the Mental Health Care Experiences of Youth Transitioning from Paediatric to Adult Psychiatric Services Using the Photovoice Method: A Participatory Analysis of the PhotoSTREAM Project , Brianna Jackson

An exploration of how persons requiring hemodialysis treatment explain the ways in which access to transportation for such treatment influences their overall health. , Navpreet Kamboj

Exploring the Characteristics and Behaviours of Nurses Who Have Attained Microcelebrity Status on Instagram , Hanna Kerr

Collaborative Self-Management and Chronic Obstructive Pulmonary Disease: Integrating Patient Needs into an Educational Program for Nurses , Loretta G. McCormick RN (EC)

Assessing the Impact of Mentorship on Rwandan Nurses’ and Midwives’ Knowledge and Self-Efficacy in Managing Postpartum Hemorrhage , Marie Grace Sandra Musabwasoni

Nurse and Midwife Educators' Experiences of Translating Teaching Methodology Knowledge into Practice in Rwanda , Jean Pierre Ndayisenga

Exploration of Knowledge and Skills Development among Community Health Workers in Rwanda , Schadrack Ngabonziza

Assessing Changes in Knowledge about and Self-efficacy for Neonatal Resuscitation Among Rwandan Nurses and Midwives after a Mentorship Process , Gerard Nyiringango

Theses/Dissertations from 2018 2018

Lived Experience of Gestational Diabetes Mellitus among Saudi Women: Interpretive Phenomenological Study , Hayat Abdullah Algamadi

Relationships Among Authentic Leadership, Manager Incivility and Trust in the Manager , Ohood Ali Alkaabi

Gender and Experiences of Family Homelessness , Fawziah Almalki

The Influence of Authentic Leadership on Fourth-Year Nursing Students' Experience of Workplace Bullying and Withdrawal Intentions , Lindsay Anderson

Exploring Social Cohesion Among Syrian Refugees in Canada: A Secondary Analysis , Sara Calvert

An Exploration of Medication Errors Generated by Baccalaureate Nursing Students Using Electronic Medication Administration Record (eMAR) Technology in Clinical Simulation , Ryan Chan

An Exploration of the Nursing Leaders’ Experiences Addressing Indigenous Health in University Undergraduate Nursing Programs in Ontario , Danae Coggins

It's About Time! GDM: A Transformative Postpartum Process. A Constructivist Grounded Theory Study , Natalie Giannotti

Women's Quality of Life After Leaving an Abusive Relationship: The Effects of Past and Ongoing Intimate Partner Violence, Mastery and Social Support , Diana Jaradat

Exploring unmet healthcare needs, healthcare access, and the use of complementary and alternative medicine by chronic pain sufferers- An analysis of the National Population Health Survey , Jessica LaChance

Exploring Harm Reduction Among Canadian Veterans Experiencing Homelessness , Olivia Marsella

Explaining Collaboration in Nursing Education Programs , Jason Powell

Social inclusion for women experiencing homelessness , Jenna Richards

Examining the Relationships among Authentic Leadership, Interprofessional Collaboration, and Nurse Assessed Adverse Events: A Mediation Model , Vanessa Safian

The Effects of Authentic Leadership and Organizational Commitment on Job Turnover Intentions of Experienced Nurses , Alexis E. Smith

Supporting Indigenous Students: A Critical Analysis of the Sociocultural Context of Nursing Education , Kay E. Vallee

Authentic Leadership and Workplace Bullying Among Experienced Registered Nurses: Testing a Double Mediation Model , Edmund J. Walsh

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Dissertations and Theses in Top Nursing Publications: A Bibliometric Study Stephen Woods

• University Libraries - University Park
• University Libraries

Research output : Contribution to journal › Article › peer-review

Objective - To investigate the overall prevalence of citations to theses and dissertations, as well as their prevalence in feature articles, editorials, and review articles in top research nursing journals. To evaluate differences between journals and to determine whether there was a change in use over time. Methods - Journals were selected from the Medical Library Association’s Nursing and Allied Health Resource Section’s 2012 Selected List of Nursing Journals. An evaluation was conducted of citations from 3,711 articles published in 2011 and 2018 in 7 top nursing journals. Thesis and dissertation citations were identified and categorized by type of scholarly communication: feature articles, reviews, and editorials. Analysis was conducted for the prevalence of citations for theses and dissertations based on percentage of overall citations and the percentage of articles with a thesis and dissertation citation. Results - Thesis and dissertation citations accounted for 0.41% of all citations. However, 9.43% of the articles contained at least one thesis and dissertation citation. Feature articles contained more thesis and dissertation citations than review articles and editorials. The Journal of Advanced Nursing, Journal of Clinical Nursing, and the Scandinavian Journal of Caring Sciences published a higher percentage of articles with at least one thesis and dissertation citation. Conclusion - The overall use of theses and dissertations in nursing scholarship is comparatively low compared to other forms of scholarly communication. However, this unique form of scholarship viewed from its impact on the percentage of scholarly articles in nursing demonstrates that theses and dissertations have made more of a contribution than previously reported. Our research provides libraries and the nursing academy with empirical evidence for the value of theses and dissertations. It provides librarians and the nursing academy justification for continuing efforts to preserve, enhance access through digital repositories, and to continue to explore strategies to promote the use of theses and dissertations in research.

All Science Journal Classification (ASJC) codes

• Library and Information Sciences

Access to Document

• 10.18438/eblip29764

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• Link to publication in Scopus
• Link to the citations in Scopus

Fingerprint

• earning a doctorate Social Sciences 100%
• nursing Social Sciences 74%
• academy Social Sciences 14%
• communication Social Sciences 8%
• librarian Social Sciences 6%
• health Social Sciences 3%
• evaluation Social Sciences 3%
• resources Social Sciences 3%

T1 - Dissertations and Theses in Top Nursing Publications

T2 - A Bibliometric Study Stephen Woods

AU - Woods, Stephen W.

AU - Phillips, Kathleen P.

AU - Dudash, Andrew D.

N2 - Objective - To investigate the overall prevalence of citations to theses and dissertations, as well as their prevalence in feature articles, editorials, and review articles in top research nursing journals. To evaluate differences between journals and to determine whether there was a change in use over time. Methods - Journals were selected from the Medical Library Association’s Nursing and Allied Health Resource Section’s 2012 Selected List of Nursing Journals. An evaluation was conducted of citations from 3,711 articles published in 2011 and 2018 in 7 top nursing journals. Thesis and dissertation citations were identified and categorized by type of scholarly communication: feature articles, reviews, and editorials. Analysis was conducted for the prevalence of citations for theses and dissertations based on percentage of overall citations and the percentage of articles with a thesis and dissertation citation. Results - Thesis and dissertation citations accounted for 0.41% of all citations. However, 9.43% of the articles contained at least one thesis and dissertation citation. Feature articles contained more thesis and dissertation citations than review articles and editorials. The Journal of Advanced Nursing, Journal of Clinical Nursing, and the Scandinavian Journal of Caring Sciences published a higher percentage of articles with at least one thesis and dissertation citation. Conclusion - The overall use of theses and dissertations in nursing scholarship is comparatively low compared to other forms of scholarly communication. However, this unique form of scholarship viewed from its impact on the percentage of scholarly articles in nursing demonstrates that theses and dissertations have made more of a contribution than previously reported. Our research provides libraries and the nursing academy with empirical evidence for the value of theses and dissertations. It provides librarians and the nursing academy justification for continuing efforts to preserve, enhance access through digital repositories, and to continue to explore strategies to promote the use of theses and dissertations in research.

AB - Objective - To investigate the overall prevalence of citations to theses and dissertations, as well as their prevalence in feature articles, editorials, and review articles in top research nursing journals. To evaluate differences between journals and to determine whether there was a change in use over time. Methods - Journals were selected from the Medical Library Association’s Nursing and Allied Health Resource Section’s 2012 Selected List of Nursing Journals. An evaluation was conducted of citations from 3,711 articles published in 2011 and 2018 in 7 top nursing journals. Thesis and dissertation citations were identified and categorized by type of scholarly communication: feature articles, reviews, and editorials. Analysis was conducted for the prevalence of citations for theses and dissertations based on percentage of overall citations and the percentage of articles with a thesis and dissertation citation. Results - Thesis and dissertation citations accounted for 0.41% of all citations. However, 9.43% of the articles contained at least one thesis and dissertation citation. Feature articles contained more thesis and dissertation citations than review articles and editorials. The Journal of Advanced Nursing, Journal of Clinical Nursing, and the Scandinavian Journal of Caring Sciences published a higher percentage of articles with at least one thesis and dissertation citation. Conclusion - The overall use of theses and dissertations in nursing scholarship is comparatively low compared to other forms of scholarly communication. However, this unique form of scholarship viewed from its impact on the percentage of scholarly articles in nursing demonstrates that theses and dissertations have made more of a contribution than previously reported. Our research provides libraries and the nursing academy with empirical evidence for the value of theses and dissertations. It provides librarians and the nursing academy justification for continuing efforts to preserve, enhance access through digital repositories, and to continue to explore strategies to promote the use of theses and dissertations in research.

UR - http://www.scopus.com/inward/record.url?scp=85098789280&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85098789280&partnerID=8YFLogxK

U2 - 10.18438/eblip29764

DO - 10.18438/eblip29764

M3 - Article

AN - SCOPUS:85098789280

SN - 1715-720X

JO - Evidence Based Library and Information Practice

JF - Evidence Based Library and Information Practice

• Washington State University

BSN student’s thesis popular in nursing journal

An undergraduate thesis by a Bachelor of Science in Nursing student at WSU was one of the top 10 most-downloaded papers in 2020 from the journal Pain Management Nursing.

Selena Clem (BSN ’19) was lead author on the study, “Cannabis Use Motivations among Adults Prescribed Opioids for Pain versus Opioid Addiction.” Co-authors were Teresa Bigand, PhD, nurse scholar at Providence Health & Services, and Marian Wilson, PhD, associate professor at the WSU College of Nursing.

As an Honors College student, Clem was required to complete a senior thesis and present it to faculty before graduation. Wilson was Clem’s honors faculty advisor, and following graduation continued to work with her on the paper that was published in Pain Management Nursing.

Since graduating from WSU, Clem has worked at Seattle Children’s Hospital as an acute-care float pool nurse.

Said Wilson, “Of note, all three authors are WSU College of Nursing graduates – #GoCougs!”

Study : “Cannabis Use Motivations among Adults Prescribed Opioids for Pain versus Opioid Addiction,” by Selena N. Clem, BSN; Teresa L. Bigand, PhD, MSN, CMSRN, CNL; Marian Wilson, PhD, MPH, RN-BC

Washington State University acknowledges that its locations statewide are on the homelands of Native peoples, who have lived in this region from time immemorial. Currently, there are 42 tribes, 35 of which are federally recognized that share traditional homelands and waterways in what is now Washington State. Some of these are nations and confederacies that represents multiple tribes and bands. The University expresses its deepest respect for and gratitude towards these original and current caretakers of the region. As an academic community, we acknowledge our responsibility to establish and maintain relationships with these tribes and Native peoples, in support of tribal sovereignty and the inclusion of their voices in teaching, research and programming. Washington State University established the  Office of Tribal Relations  and  Native American Programs  to guide us in our relationship with tribes and service to Native American students and communities. We also pledge that these relationships will consist of mutual trust, respect, and reciprocity.

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The Philippine Journal of Nursing , an international peer reviewed journal, is the official publication of the Philippines Nurses Association published biannually. It considers original articles written for, but not limited to, Filipino nurses at all levels of health care organizations and in various settings. The Philippine Journal of Nursing will serve as: 1) Venue for the publication of scientific and research papers in the areas of Nursing practice and Nursing education ; 2) Source of updates on policies and standards relevant to Nursing practice and Nursing education, and 3) Medium for collegial interactions among nurses to promote professional growth. The Philippine Journal of Nursing invites original research and scientific papers, full text or abstract, written by registered nurses on different areas of nursing practice, including but not limited to clinical , community, administration, and education.

ERLINDA CASTRO-PALAGANAS Editor-in-Chief

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Burnout in nursing: a theoretical review

Chiara dall’ora.

1 School of Health Sciences, and Applied Research Collaboration Wessex, Highfield Campus, University of Southampton, Southampton, SO17 1BJ UK

2 Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Tomtebodavägen 18a, 17177 Solna, Sweden

Maria Reinius

Peter griffiths, associated data.

Not applicable

Workforce studies often identify burnout as a nursing ‘outcome’. Yet, burnout itself—what constitutes it, what factors contribute to its development, and what the wider consequences are for individuals, organisations, or their patients—is rarely made explicit. We aimed to provide a comprehensive summary of research that examines theorised relationships between burnout and other variables, in order to determine what is known (and not known) about the causes and consequences of burnout in nursing, and how this relates to theories of burnout.

We searched MEDLINE, CINAHL, and PsycINFO. We included quantitative primary empirical studies (published in English) which examined associations between burnout and work-related factors in the nursing workforce.

Ninety-one papers were identified. The majority ( n = 87) were cross-sectional studies; 39 studies used all three subscales of the Maslach Burnout Inventory (MBI) Scale to measure burnout. As hypothesised by Maslach, we identified high workload, value incongruence, low control over the job, low decision latitude, poor social climate/social support, and low rewards as predictors of burnout. Maslach suggested that turnover, sickness absence, and general health were effects of burnout; however, we identified relationships only with general health and sickness absence. Other factors that were classified as predictors of burnout in the nursing literature were low/inadequate nurse staffing levels, ≥ 12-h shifts, low schedule flexibility, time pressure, high job and psychological demands, low task variety, role conflict, low autonomy, negative nurse-physician relationship, poor supervisor/leader support, poor leadership, negative team relationship, and job insecurity. Among the outcomes of burnout, we found reduced job performance, poor quality of care, poor patient safety, adverse events, patient negative experience, medication errors, infections, patient falls, and intention to leave.

Conclusions

The patterns identified by these studies consistently show that adverse job characteristics—high workload, low staffing levels, long shifts, and low control—are associated with burnout in nursing. The potential consequences for staff and patients are severe. The literature on burnout in nursing partly supports Maslach’s theory, but some areas are insufficiently tested, in particular, the association between burnout and turnover, and relationships were found for some MBI dimensions only.

Introduction

The past decades have seen a growing research and policy interest around how work organisation characteristics impact upon different outcomes in nursing. Several studies and reviews have considered relationships between work organisation variables and outcomes such as quality of care, patient safety, sickness absence, turnover, and job dissatisfaction [ 1 – 4 ]. Burnout is often identified as a nursing ‘outcome’ in workforce studies that seek to understand the effect of context and ‘inputs’ on outcomes in health care environments. Yet, burnout itself—what constitutes it, what factors contribute to its development, and what the wider consequences are for individuals, organisations, or their patients—is not always elucidated in these studies.

The term burnout was introduced by Freudenberger in 1974 when he observed a loss of motivation and reduced commitment among volunteers at a mental health clinic [ 5 ]. It was Maslach who developed a scale, the Maslach Burnout Inventory (MBI), which internationally is the most widely used instrument to measure burnout [ 6 ]. According to Maslach’s conceptualisation, burnout is a response to excessive stress at work, which is characterised by feelings of being emotionally drained and lacking emotional resources—Emotional Exhaustion; by a negative and detached response to other people and loss of idealism—Depersonalisation; and by a decline in feelings of competence and performance at work—reduced Personal Accomplishment [ 7 ].

Maslach theorised that burnout is a state, which occurs as a result of a prolonged mismatch between a person and at least one of the following six dimensions of work [ 7 – 9 ]:

• Workload: excessive workload and demands, so that recovery cannot be achieved.
• Control: employees do not have sufficient control over the resources needed to complete or accomplish their job.
• Reward: lack of adequate reward for the job done. Rewards can be financial, social, and intrinsic (i.e. the pride one may experience when doing a job).
• Community: employees do not perceive a sense of positive connections with their colleagues and managers, leading to frustration and reducing the likelihood of social support.
• Fairness: a person perceiving unfairness at the workplace, including inequity of workload and pay.
• Values: employees feeling constrained by their job to act against their own values and their aspiration or when they experience conflicts between the organisation’s values.

Maslach theorised these six work characteristics as factors causing burnout and placed deterioration in employees’ health and job performance as outcomes arising from burnout [ 7 ].

Subsequent models of burnout differ from Maslach’s in one of two ways: they do not conceptualise burnout as an exclusively work-related syndrome; they view burnout as a process rather than a state [ 10 ].

The job resources-demands model [ 11 ] builds on the view of burnout as a work-based mismatch but differs from Maslach’s model in that it posits that burnout develops via two separate pathways: excessive job demands leading to exhaustion, and insufficient job resources leading to disengagement. Along with Maslach and Schaufeli, this model sees burnout as the negative pole of a continuum of employee’s well-being, with ‘work engagement’ as the positive pole [ 12 ].

Among those who regard burnout as a process, Cherniss used a longitudinal approach to investigate the development of burnout in early career human services workers. Burnout is presented as a process characterised by negative changes in attitudes and behaviours towards clients that occur over time, often associated with workers’ disillusionment about the ideals that had led them to the job [ 13 ]. Gustavsson and colleagues used this model in examining longitudinal data on early career nurses and found that exhaustion was a first phase in the burnout process, proceeding further only if nurses present dysfunctional coping (i.e. cynicism and disengagement) [ 14 ].

Shirom and colleagues suggested that burnout occurs when individuals exhaust their resources due to long-term exposures to emotionally demanding circumstances in both work and life settings, suggesting that burnout is not exclusively an occupational syndrome [ 15 , 16 ].

This review aims to identify research that has examined theorised relationships with burnout, in order to determine what is known (and not known) about the factors associated with burnout in nursing and to determine the extent to which studies have been underpinned by, and/or have supported or refuted, theories of burnout.

This was a theoretical review conducted according to the methodology outlined by Campbell et al. and Pare et al. [ 17 , 18 ]. Theoretical reviews draw on empirical studies to understand a concept from a theoretical perspective and highlight knowledge gaps. Theoretical reviews are systematic in terms of searching and inclusion/exclusion criteria and do not include a formal appraisal of quality. They have been previously used in nursing, but not focussing on burnout [ 19 ]. While no reporting guideline for theoretical reviews currently exists, the PRISMA-ScR was deemed to be suitable, with some modifications, to enhance the transparency of reporting for the purposes of this review. The checklist, which can be found as Additional file 2 , has been modified as follows:

• Checklist title has been modified to indicate that the checklist has been adapted for theoretical reviews.
• Introduction (item 3) has been modified to reflect that the review questions lend themselves to a theoretical review approach.
• Selection of sources of evidence (item 9) has been modified to state the process for selecting sources of evidence in the theoretical review.
• Limitations (item 20) has been amended to discuss the limitations of the theoretical review process.
• Funding (item 22) has been amended to describe sources of funding and the role of funders in the theoretical review.

All changes from the original version have been highlighted.

Literature search

A systematic search of empirical studies examining burnout in nursing published in journal articles since 1975 was performed in May 2019, using MEDLINE, CINAHL, and PsycINFO. The main search terms were ‘burnout’ and ‘nursing’, using both free-search terms and indexed terms, synonyms, and abbreviations. The full search and the total number of papers identified are in Additional file 1 .

We included papers written in English that measured the association between burnout and work-related factors or outcomes in all types of nurses or nursing assistants working in a healthcare setting, including hospitals, care homes, primary care, the community, and ambulance services. Because there are different theories of burnout, we did not restrict the definition of burnout according to any specific theory. Burnout is a work-related phenomenon [ 8 ], so we excluded studies focussing exclusively on personal factors (e.g. gender, age). Our aim was to identify theorised relationships; therefore, we excluded studies which were only comparing the levels of burnout among different settings (e.g. in cancer services vs emergency departments). We excluded literature reviews, commentaries, and editorials.

Data extraction and quality appraisal

The following data were extracted from included studies: country, setting, sample size, staff group, measure of burnout, variables the relationship with burnout was tested against, and findings against the hypothesised relationships. One reviewer (MEB) extracted data from all the studies, with CDO and JEB extracting 10 studies each to check for agreement in data extraction. In line with the theoretical review methodology, we did not formally assess the quality of studies [ 19 ]. However, in Additional file 3 , we have summarised the key aspects of quality for each study, covering generalisability (e.g. a multisite study with more than 500 participants); risk of bias from common methods variance (e.g. burnout and correlates assessed with the same survey. This bias arises when there is a shared (common) variance because of the common method rather than a true (causal) association between variables); evidence of clustering (e.g. nurses nested in wards, wards nested in hospitals); and evidence of statistical adjustment (e.g. the association between burnout and correlates has been adjusted to control for potentially influencing variables). It should be noted that cells are shaded in green when the above-mentioned quality standards have been met, and in red when they have not. In the ‘Discussion’ section, we offer a reflection on the common limitations of research in the field and present a graphic summary of the ‘strength of evidence’ in Fig. ​ Fig.1 1 .

Graphical representation of strength of relationships with burnout

Data synthesis

Due to the breadth of the evidence, we summarised extracted data by identifying common categories through a coding frame. The starting point of the coding frame was the burnout multidimensional theory outlined by Maslach [ 7 ]. We then considered whether the studies’ variables fit into Maslach’s categorisation, and where they did not, we created new categories. We identified nine broad categories: (1) Areas of Worklife; (2) Workload and Staffing Levels; (3) Job Control, Reward, Values, Fairness, and Community; (4) Shift Work and Working Patterns; (5) Psychological Demands and Job Complexity; (6) Support Factors: Working Relationships and Leadership; (7) Work Environment and Hospital Characteristics; (8) Staff Outcomes and Job Performance; and (9) Patient Care and Outcomes. In the literature, categories 1–7 were treated as predictors of burnout and categories 8 and 9 as outcomes, with the exception of missed care and job satisfaction which were treated both as predictors and outcomes.

When the coding frame was finalised, CDO and MLR applied it to all studies. Where there was disagreement, a third reviewer (JEB) made the final decision.

The database search yielded 12 248 studies, of which 11 870 were rapidly excluded as either duplicates or titles and/or abstract not meeting the inclusion criteria. Of the 368 studies accessed in full text, 277 were excluded, and 91 studies were included in the review. Figure ​ Figure2 2 presents a flow chart of the study selection.

Study selection flow chart

The 91 studies identified covered 28 countries; four studies included multiple countries, and in one, the country was not reported. Most were from North America ( n = 35), Europe ( n = 28), and Asia ( n = 18).

The majority had cross-sectional designs ( n = 87, 97%); of these, 84 were entirely survey-based. Three studies were longitudinal. Most studies were undertaken in hospitals ( n = 82). Eight studies surveyed nurses at a national level, regardless of their work setting.

Sample sizes ranged from hundreds of hospitals (max = 927) with hundreds of thousands of nurses (max = 326 750) [ 20 ] to small single-site studies with the smallest sample being 73 nurses [ 21 ] (see Additional file 3 ).

The relationships examined are summarised in Table ​ Table1 1 .

Summary of studies’ results

*Partial evidence (e.g. relationship established with some but not all burnout subscales)

**Refuted when there is consistent evidence that a hypothesised relationship does not exist (e.g. large studies with no confidence intervals shown if no association)

***Observed in multiple directions

Measures of burnout

Most studies used the Maslach Burnout Inventory Scale ( n = 81), which comprises three subscales reflecting the theoretical model: Emotional Exhaustion, Depersonalisation, and reduced Personal Accomplishment. However, less than half (47%, n = 39) of the papers measured and reported results with all three subscales. Twenty-three papers used the Emotional Exhaustion subscale only, and 11 papers used the Emotional Exhaustion and Depersonalisation subscales. In nine studies, the three MBI subscales were summed up to provide a composite score of burnout, despite Maslach and colleagues advising against such an approach [ 22 ].

Five studies used the Copenhagen Burnout Inventory (CBI) [ 23 ]. This scale consists of three dimensions of burnout: personal, work-related, and client-related. Two studies used the Malach-Pines Scale [ 24 ], and one used the burnout subscale of the Professional Quality of Life Measure (ProQoL5) scale, which posits burnout as an element of compassion fatigue [ 25 ]. Two studies used idiosyncratic measures of burnout based on items from other instruments [ 20 , 26 ].

Factors examined in relation to burnout: an overview

The studies which tested the relationships between burnout and Maslach’s six areas of worklife—workload, control, reward, community, fairness, and values—typically supported Maslach’s theory that these areas are predictors of burnout. However, some evidence is based only on certain MBI dimensions. High scores on the Areas of Worklife Scale [ 27 ] (indicating a higher degree of congruence between the job and the respondent) were associated with less likelihood of burnout, either directly [ 28 , 29 ] or through high occupational coping self-efficacy [ 30 ] and presence of civility norms and co-worker incivility [ 31 ].

The majority of studies looking at job characteristics hypothesised by the Maslach model considered workload ( n = 31) and job control and reward ( n = 10). While only a few studies ( n = 9) explicitly examined the hypothesised relationships between burnout and community, fairness, or values, we identified 39 studies that covered ‘supportive factors’ including relationships with colleagues and leadership.

A large number of studies included factors that fall outside of the Maslach model. Six main areas were identified:

• Working patterns and shifts working ( n = 15)
• Features inherent in the job such as psychological demand and complexity ( n = 24)
• Job support from working relationships and leadership ( n = 39)
• Hospital or environmental characteristics ( n = 28)
• Staff outcomes and job performance ( n = 33)
• Patient outcomes ( n = 17)
• Individual attributes (personal or professional) ( n = 16)

Workload and staffing levels

Workload and characteristics of jobs that contribute to workload, such as staffing levels, were the most frequently examined factor in relation to burnout. Thirty studies found an association between high workload and burnout.

Of these, 13 studies looked specifically at measures of workload as a predictor of burnout. Workload was associated with Emotional Exhaustion in five studies [ 32 – 36 ], with some studies also reporting a relationship with Depersonalisation, and others Cynicism. Janssen reported that ‘mental work overload’ predicted Emotional Exhaustion [ 37 ]. Three studies concluded that workload is associated with both Emotional Exhaustion and Depersonalisation [ 38 – 40 ]. Kitaoka-Higashiguchi tested a model of burnout and found that heavy workload predicted Emotional Exhaustion, which in turn predicted Cynicism [ 41 ]. This was also observed in a larger study by Greengrass et al. who found that high workload was associated with Emotional Exhaustion, which consequently predicted Cynicism [ 42 ]. One study reported no association between workload and burnout components [ 43 ], and one study found an association between manageable workload and a composite burnout score [ 44 ].

Further 15 studies looked specifically at nurse staffing levels, and most reported that when nurses were caring for a higher number of patients or were reporting staffing inadequacy, they were more likely to experience burnout. No studies found an association between better staffing levels and burnout.

While three studies did not find a significant association with staffing levels [ 32 , 45 , 46 ], three studies found that higher patient-to-nurse ratios were associated with Emotional Exhaustion [ 47 – 49 ], and in one study, higher patient-to-nurse-ratios were associated with Emotional Exhaustion, Depersonalisation, and Personal Accomplishment [ 50 ]. One study concluded that Emotional Exhaustion mediated the relationship between patient-to-nurse ratios and patient safety [ 51 ]. Akman and colleagues found that the lower the number of patients nurses were responsible for, the lower the burnout composite score [ 52 ]. Similar results were highlighted by Faller and colleagues [ 53 ]. Lower RN hours per patient day were associated with burnout in a study by Thompson [ 20 ].

When newly qualified RNs reported being short-staffed, they were more likely to report Emotional Exhaustion and Cynicism 1 year later [ 54 ]. In a further study, low staffing adequacy was associated with Emotional Exhaustion [ 55 ]. Similarly, Leineweber and colleagues found that poor staff adequacy was associated with Emotional Exhaustion, Depersonalisation, and Personal Accomplishment [ 56 ]. Leiter and Spence Laschinger explored the relationship between staffing adequacy and all MBI subscales and found that Emotional Exhaustion mediated the relationship between staffing adequacy and Depersonalisation [ 57 ]. Time pressure was investigated in three studies, which all concluded that reported time pressure was associated with Emotional Exhaustion [ 58 – 60 ].

In summary, there is evidence that high workload is associated with Emotional Exhaustion, nurse staffing levels are associated with burnout, and time pressure is associated with Emotional Exhaustion.

Job control, reward, values, fairness, and community

Having control over the job was examined in seven studies. Galletta et al. found that low job control was associated with all MBI subscales [ 40 ], as did Gandi et al. [ 61 ]. Leiter and Maslach found that control predicted fairness, reward, and community, and in turn, fairness predicted values, and values predicted all MBI subscales [ 35 ]. Low control predicted Emotional Exhaustion only for nurses working the day shift [ 62 ], and Emotional Exhaustion was significantly related to control over practice setting [ 63 ]; two studies reported no effect of job control on burnout [ 44 , 64 ].

Reward predicted Cynicism [ 35 ] and burnout on a composite score [ 44 ]. Shamian and colleagues found that a higher score in the effort and reward imbalance scale was associated with Emotional Exhaustion, and higher scores in the effort and reward imbalance scale were associated with burnout measured by the CBI [ 65 ].

Value congruence refers to a match between the requirements of the job and people’s personal principles [ 7 ]. Value conflicts were related with a composite score of burnout [ 44 ], and one study concluded that nurses with a high value congruence reported lower Emotional Exhaustion than those with a low value congruence, and nurses with a low value congruence experienced more severe Depersonalisation than nurses with a high value congruence [ 66 ]. Low value congruence was a predictor of all three MBI dimensions [ 35 ] and of burnout measured with the Malach-Pines Burnout Scale [ 67 ]. Two studies considered social capital, defined as a social structure that benefits its members including trust, reciprocity, and a set of shared values, and they both concluded that lower social capital in the hospital-predicted Emotional Exhaustion [ 33 , 36 ]. A single study showed fairness predicted values, which in turn predicted all MBI Scales [ 35 ]. Two studies looked at community, and one found that community predicts a composite score of burnout [ 44 ], while the other found no relationships [ 35 ].

While not directly expressed in the terms described by Maslach, other studies demonstrate associations with possible causal factors, many of which are reflected in Maslach’s theory.

In summary, there is evidence that control over the job is associated with reduced burnout, and value congruence is associated with reduced Emotional Exhaustion and Depersonalisation.

Working patterns and shift work

Shift work and working patterns variables were considered by 15 studies. Overall, there was mixed evidence on the relationship between night work, number of hours worked per week, and burnout, with more conclusive results regarding the association between long shifts and burnout, and the potential protective effect of schedule flexibility.

Working night shifts was associated with burnout (composite score) [ 68 ] and Emotional Exhaustion [ 62 ], but the relationship was not significant in two studies [ 69 , 70 ]. Working on permanent as opposed to rotating shift patterns did not impact burnout [ 71 ], but working irregular shifts did impact a composite burnout score [ 72 ]. When nurses reported working a higher number of shifts, they were more likely to report higher burnout composite scores [ 68 ], but results did not generalise in a further study [ 69 ]. One study found working that overtime was associated with composite MBI score [ 73 ]. On-call requirement was not significantly associated with any MBI dimensions [ 71 ].

The number of hours worked per week was not a significant predictor of burnout according to two studies [ 25 , 53 ], but having a higher number of weekly hours was associated with Emotional Exhaustion and Depersonalisation in one study [ 70 ]. Long shifts of 12 h or more were associated with all MBI subscales [ 74 ] and with Emotional Exhaustion [ 49 , 75 ]. A study using the ProQoL5 burnout scale found that shorter shifts were protective of burnout [ 25 ].

Having higher schedule flexibility was protective of Emotional Exhaustion [ 46 ], and so was the ability to schedule days off for a burnout composite score [ 76 ]. Having more than 8 days off per month was associated with lower burnout [ 69 ]. Stone et al. found that a positive scheduling climate was protective of Emotional Exhaustion only [ 77 ].

In summary, we found an association between ≥ 12-h shifts and Emotional Exhaustion and between schedule flexibility and reduced Emotional Exhaustion.

Psychological demands and job complexity

There is evidence from 24 studies that job demands and aspects intrinsic to the job, including role conflict, autonomy, and task variety, are associated with some burnout dimensions.

Eight studies considered psychological demands. The higher the psychological demands, the higher the likelihood of experiencing all burnout dimensions [ 72 ], and high psychological demands were associated with higher odds of Emotional Exhaustion [ 62 , 78 ]. Emotional demands, in terms of hindrances, had an effect on burnout [ 67 ]. One study reported that job demands, measured with the Effort-Reward Imbalance Questionnaire, were correlated with all burnout dimensions [ 79 ], and similarly, Garcia-Sierra et al. found that demands predict burnout, measured with a composite scale of Emotional Exhaustion and Cynicism [ 80 ]. According to one study, job demands were not associated with burnout [ 73 ], and Rouxel et al. concluded that the higher the job demands, the higher the impact on both Emotional Exhaustion and Depersonalisation [ 64 ].

Four studies looked at task nature and variety, quality of job content, in terms of skill variety, skill discretion, task identity, task significance, influenced Emotional Exhaustion through intrinsic work motivation [ 37 ]. Skill variety and task significance were related to Emotional Exhaustion; task significance was also related to Personal Accomplishment [ 60 ]. Having no administrative tasks in the job was associated with a reduced likelihood to experience Depersonalisation [ 71 ]. Higher task clarity was associated with reduced levels of Emotional Exhaustion and increased Personal Accomplishment [ 58 ].

Patient characteristics/requirements were investigated in four papers. When nurses were caring for suffering patients and patients who had multiple requirements, they were more likely to experience Emotional Exhaustion and Cynicism. Similarly, caring for a dying patient and having a high number of decisions to forego life-sustaining treatments were associated with a higher likelihood of burnout (measured with a composite score) [ 76 ]. Stress resulting from patient care was associated with a composite burnout score [ 73 ]. Patient violence also had an impact on burnout, measured with CBI [ 81 ], as did conflict with patients [ 76 ].

Role conflict is a situation in which contradictory, competing, or incompatible expectations are placed on an individual by two or more roles held at the same time. Role conflict predicted Emotional Exhaustion [ 41 ], and so it did in a study by Konstantinou et al., who found that role conflict was associated with Emotional Exhaustion and Depersonalisation [ 34 ]; Levert and colleagues reported that role conflict correlated with Emotional Exhaustion, Depersonalisation, and Personal Accomplishment. They also considered role ambiguity, which correlated with Emotional Exhaustion and Depersonalisation, but not Personal Accomplishment [ 39 ]. Andela et al. investigated the impact of emotional dissonance, defined as the mismatch between the emotions that are felt and the emotions required to be displayed by organisations. They reported that emotional dissonance is a mediator between job aspects (i.e. workload, patient characteristics, and team issues) and Emotional Exhaustion and Cynicism. Rouxel et al. found that perceived negative display rules were associated with Emotional Exhaustion [ 64 ].

Autonomy related to Emotional Exhaustion and Depersonalisation [ 60 ], and in another study, it only related to Depersonalisation [ 43 ]. Low autonomy impacted Emotional Exhaustion via organisational trust [ 82 ]. Autonomy correlated with burnout [ 67 ]. There was no effect of autonomy on burnout according to two studies [ 58 , 63 ]. Low decision-making at the ward level was associated with all MBI subscales [ 77 ]. Decision latitude impacted Personal Accomplishment only [ 36 ], and in one study, it was found to be related to Emotional Exhaustion [ 78 ]. High decision latitude was associated with Personal Accomplishment [ 41 ] and low Emotional Exhaustion [ 33 ].

Overall, high job and psychological demands were associated with Emotional Exhaustion, as was role conflict. Patient complexity was associated with burnout, while task variety, autonomy, and decision latitude were protective of burnout.

Working relationships and leadership

Overall, evidence from 39 studies supports that having positive support factors and working relationships in place, including positive relationships with physicians, support from the leader, positive leadership style, and teamwork, might play a protective role towards burnout.

The quality of the relationship with physicians was investigated by 12 studies. In two studies, having negative relationships with physicians was associated with all MBI dimensions [ 77 , 83 ]; quality of nurse-physician relationship was associated with Emotional Exhaustion and Depersonalisation, but not PA [ 50 ]. Two studies found an association with Emotional Exhaustion only [ 55 , 84 ], and one concluded that quality of relationship with physicians indirectly supported PA [ 36 ]. This was also found by Leiter and Laschinger, who found that positive nurse-physician collaborations predicted Personal Accomplishment [ 57 , 85 ]. When burnout was measured with composite scores of MBI and a not validated scale, two studies reported an association with nurse-physician relationship [ 20 , 76 ], and two studies found no associations [ 56 , 63 ].

Having support from the supervisor or leader was considered in 12 studies, which found relationships with different MBI dimensions. A relationship between low support from nurse managers and all MBI subscales was observed in one study [ 77 ], while two studies reported it is a protective factor from Emotional Exhaustion only [ 58 , 83 ], and one that it was also associated with Depersonalisation [ 86 ]. Kitaoka-Higashiguchi reported an association only with Cynicism [ 41 ], and Jansen et al. found it was only associated with Depersonalisation and Personal Accomplishment [ 60 ]. Van Bogaert and colleagues found that support from managers predicted low Emotional Exhaustion and high Personal Accomplishment [ 84 ], but in a later study, it only predicted high Personal Accomplishment [ 36 ]. Regarding the relationship with the manager, it had a direct effect on Depersonalisation, and it moderated the effect of time pressure on Emotional Exhaustion and Depersonalisation [ 59 ]; a protective effect of a quality relationship with the head nurse on a composite burnout score was also reported [ 76 ]. Two studies using different burnout scales found an association between manager support and reduced burnout [ 25 , 67 ]. Low trust in the leader showed a negative impact on burnout, measured with a composite score [ 87 ]. Two further studies focused on the perceived nurse manager’s ability: authors found that it was related to Emotional Exhaustion [ 46 ], and Emotional Exhaustion and Personal Accomplishment [ 50 ].

Fourteen studies looked at the leadership style and found that it affects burnout through different pathways and mechanisms. Boamah et al. found that authentic leadership—described as leaders who have high self-awareness, balanced processing, an internalised moral perspective, and transparency—predicted higher empowerment, which in turn predicted lower levels of Emotional Exhaustion and Cynicism a year later [ 54 ]. Authentic leadership had a negative direct effect on workplace bullying, which in turn had a direct positive effect on Emotional Exhaustion [ 88 ]. Effective leadership predicted staffing adequacy, which in turn predicted Emotional Exhaustion [ 57 , 85 ]. Authentic leadership predicted all areas of worklife, which in turn predicted all MBI dimensions of burnout [ 30 ], and a similar pathway was identified by Laschiner and Read, although authentic leadership impacted Emotional Exhaustion only and it was also through civility norms and co-worker incivility [ 31 ]. Emotional Exhaustion mediated the relationship between authentic leadership and intention to leave the job [ 89 ]. ‘Leader empowering behaviour’ had an indirect effect on Emotional Exhaustion through structural empowerment [ 29 ], and empowering leadership predicted trust in the leader, which in turn was associated with burnout composite score [ 87 ]. Active management-by-exception was beneficial for Depersonalisation and Personal Accomplishment, passive laissez-faire leadership negatively affected Emotional Exhaustion and Personal Accomplishment, and rewarding transformational leadership protected from Depersonalisation [ 90 ]. Contrary to this, Madathil et al. found that transformational leadership protected against Emotional Exhaustion, but not Depersonalisation, and promoted Personal Accomplishment [ 43 ]. Transformational leadership predicted positive work environments, which in turn predicted lower burnout (composite score) [ 44 ]. Positive leadership affected Emotional Exhaustion and Depersonalisation [ 56 ] and burnout measured with a non-validated scale [ 20 ].

Teamwork and social support were also explored. Co-worker cohesion was only related to Depersonalisation [ 58 ]; team collaboration problems predicted negative scores on all MBI subscales [ 38 ], and workplace support protected from Emotional Exhaustion [ 72 ]. Similarly, support received from peers had a protective effect on Emotional Exhaustion [ 60 ]. Collegial support was related to Emotional Exhaustion and Personal Accomplishment [ 39 ], and colleague support protected from burnout [ 67 ]. Interpersonal conflict affected Emotional Exhaustion through role conflict, but co-worker support had no effect on any burnout dimensions [ 41 ], and similarly, co-worker incivility predicted Emotional Exhaustion [ 31 ], and so did bullying [ 88 ]. Poor team communication was associated with all MBI dimensions [ 40 ], staff issues predicted burnout measured with a composite score [ 73 ], and so did verbal violence from colleagues [ 68 ]. One study found that seeking social support was not associated with any of the burnout dimensions, while another study found that low social support predicted Emotional Exhaustion [ 37 ], and social support was associated with lower Emotional Exhaustion and higher Personal Accomplishment [ 21 ]. Vidotti et al. found an association between low social support and all MBI dimensions [ 62 ].

Work environment and hospital characteristics

Eleven studies were considering the work environment measured with the PES-NWI scale [ 91 ], where higher scores indicate positive work environments. Five studies comprising diverse samples and settings concluded that the better rated the work environment, the lower the likelihood of experiencing Emotional Exhaustion [ 32 , 47 , 49 , 51 , 92 ], and four studies found the same relationship, but on both Emotional Exhaustion and Depersonalisation [ 50 , 66 , 93 , 94 ]; only one study concluded there is an association between work environment and all MBI dimensions [ 95 ]. Negative work environments affected burnout (measured with a composite score) via job dissatisfaction [ 96 ]. One study looked at organisational characteristics on a single scale and found that a higher rating of organisational characteristics predicted lower Emotional Exhaustion [ 82 ]. Environmental uncertainty was related to all MBI dimensions [ 86 ].

Structural empowerment was also considered in relation to burnout: high structural empowerment led to lower Emotional Exhaustion and Cynicism via staffing levels and worklife interference [ 54 ]; in a study using a similar methodology, structural empowerment affected Emotional Exhaustion via Areas of Worklife [ 29 ]. The relationship between Emotional Exhaustion and Cynicism was moderated by organisational empowerment [ 40 ], and organisational support had a protective effect on burnout [ 67 ]. Hospital management and organisational support had a direct effect on Emotional Exhaustion and Personal Accomplishment [ 84 ]. Trust in the organisation predicted lower levels of Emotional Exhaustion [ 82 ] and of burnout measured with a composite MBI score [ 87 ].

Three studies considered whether policy involvement had an effect on burnout. Two studies on the same sample found that having the opportunity to participate in policy decisions was associated with reduced burnout (all subscales) [ 57 , 85 ], and one study did not report results for the association [ 20 ]. Emotional Exhaustion mediated the relationship between nurses’ participation in hospital affairs and their intention to leave the job [ 97 ]; a further study did not found an association between participation in hospital affairs and Emotional Exhaustion, but only with Personal Accomplishment [ 50 ]. Lastly, one study investigated participation in research groups and concluded it was associated with reduced burnout measured with a composite score [ 76 ].

There was an association between opportunity for career advancement and all MBI dimensions [ 77 ]; however, another study found that having promotion opportunities was not related to burnout [ 79 ]. Moloney et al. found that professional development was not related to burnout [ 67 ]. Two studies considered pay. In one study, no effect was found on any MBI dimension [ 73 ], and a very small study ( n = 78 nurses) reported an effect of satisfaction with pay on Emotional Exhaustion and Depersonalisation [ 34 ]. Job insecurity predicted Depersonalisation and PA [ 79 ].

When the hospital adopted nursing models of care rather than medical models of care, nurses were more likely to report high levels of Personal Accomplishment [ 57 , 85 ]. However, another study found no significant relationship [ 20 ]. Regarding ward and hospital type, Aiken and Sloane found that RNs working in specialised AIDS units reported lower levels of Emotional Exhaustion [ 98 ]; however, ward type was not found to be significantly associated with burnout in a study on temporary nurses [ 53 ]. Working in different ward settings was not associated with burnout, but working in hospitals as opposed to in primary care was associated with lower Emotional Exhaustion [ 71 ]. Working in a small hospital was associated with a lower likelihood of Emotional Exhaustion, when compared to working in a community hospital [ 63 ]. Faller’s study also concluded that working in California was a significant predictor of reduced burnout.

When the hospitals’ investment in the quality of care was considered, one study found that having foundations for quality of care was associated with reduced Emotional Exhaustion only [ 50 ], but in another study, foundations for quality of care were associated with all MBI dimensions [ 83 ]. Working in a Magnet hospital was not associated with burnout [ 53 ].

In summary, having a positive work environment (generally work environments scoring higher on the PES-NWI scale) was associated with reduced Emotional Exhaustion, and so was higher structural empowerment. However, none of the organisational characteristics at the hospital level was consistently associated with burnout.

Staff outcomes and job performance

Nineteen studies considered the impact of burnout on intention to leave. Two studies found that Emotional Exhaustion and Cynicism had a direct effect on turnover intentions [ 28 , 99 ], and four studies reported that only Emotional Exhaustion affected intentions to leave the job [ 21 , 32 , 37 , 100 ], with one of these indicating that Emotional Exhaustion affected also intention to leave the organisation [ 32 ], but one study did not replicate such findings [ 101 ] and concluded that only Cynicism was associated with intention to leave the job and nursing. Similarly, one study found that Cynicism was directly related to intention to leave [ 35 ]. A further study found that Emotional Exhaustion affected turnover intentions via job satisfaction [ 88 ], and one article reported that Emotional Exhaustion mediated the effect of authentic leadership on intention to leave [ 89 ]. Emotional Exhaustion was a mediator between nurses’ involvement with decisions and intention to leave the organisation [ 97 ]. Burnout measured on a composite score was associated with a higher intention to leave [ 96 ]. Laeeque et al. reported that burnout, captured with CBI, related to intention to leave [ 81 ]; Estryn-Behar et al. used the same scale to measure burnout and found that high burnout was associated with higher intention to leave in all countries, except for Slovakia [ 102 ]. Burnout, measured with the Malach-Pines Scale, was associated with intention to quit, and stronger associations were found for nurses who had higher perceptions of organisational politics [ 103 ]. Burnout (Malach-Pines Scale) predicted both the intention to leave the job and nursing [ 67 ]. Three studies investigated the relationship between burnout and intention to leave; one of these aggregated all job outcomes in a single variable (i.e. job satisfaction, intention to leave the hospital, applied for another job, and intention to leave nursing) and reported that Depersonalisation and Personal Accomplishment predict job outcomes [ 84 ]; they replicated a similar approach and found the same associations [ 36 ]. They later found that all MBI dimensions were associated with leaving the nursing profession [ 104 ]. Only one study in a sample of 106 nurses from one hospital found an association between Depersonalisation and turnover within 2 years [ 105 ].

Two studies looked at the effect of burnout on job performance: one found a negative association between burnout (measured with CBI) and both task performance and contextual performance [ 106 ]. Only Emotional Exhaustion was associated with self-rated and supervisor-rated job performance of 73 RNs [ 21 ]. Missed care was investigated in three studies, and it was found to be both predictor of Emotional Exhaustion [ 32 ], an outcome of burnout [ 20 , 103 ].

Four studies considered sickness absence. When RNs had high levels of Emotional Exhaustion, they were more likely to experience short-term sickness absence (i.e. 1–10 days of absence), which was obtained from hospital administrative records. Similarly, Emotional Exhaustion was associated with seven or more days of absence in a longitudinal study [ 105 ]. Emotional Exhaustion was significantly associated with reported mental health absenteeism, but not reported physical health absenteeism, and sickness absence from administrative records [ 21 ]. One study did not find any meaningful relationships between burnout and absenteeism [ 107 ].

Emotional Exhaustion was a significant predictor of general health [ 73 ], and in a further study, both Emotional Exhaustion and Personal Accomplishment were associated with perceived health [ 70 ]. Final-year nursing students who experienced health issues were more likely to develop high burnout when entering the profession [ 26 ]. When quality of sleep was treated both as a predictor and outcome of burnout, relationships were found in both instances [ 106 ].

Focussing on mental health, one study found that burnout predicted mental health problems for newly qualified nurses [ 30 ], and Emotional Exhaustion and Cynicism predicted somatisation [ 42 ]. Depressive symptoms were predictive of Emotional Exhaustion and Depersonalisation, considering therefore depression as a predictor of burnout [ 108 ]. Rudman and Gustavsson also found that having depressive mood and depressive episodes were common features of newly qualified nurses who developed or got worse levels of burnout throughout their first years in the profession [ 26 ]. Tourigny et al. considered depression as a predictor and found it was significantly related to Emotional Exhaustion [ 107 ].

Eleven studies considered job satisfaction: of these, three treated job satisfaction as a predictor of burnout and concluded that higher levels of job satisfaction were associated with a lower level of composite burnout scores [ 52 , 96 ] and all MBI dimensions [ 94 ]. According to two studies, Emotional Exhaustion and Cynicism predicted job dissatisfaction [ 54 , 101 ], while four studies reported that Emotional Exhaustion only was associated with increased odds to report job dissatisfaction [ 73 , 82 , 88 , 100 ]; one study reported that Cynicism only was associated with job dissatisfaction [ 99 ]. Rouxel et al. did not find support in their hypothesised model that Emotional Exhaustion and Depersonalisation predicted job satisfaction [ 64 ].

In summary, considering 39 studies, there is conflicting evidence on the direction of the relationship between burnout and missed care, mental health, and job satisfaction. An association between burnout and intention to leave was found, although only one small study reported an association between burnout and turnover. A moderate relationship was found for the effect of burnout on sickness absence, job performance, and general health.

Patient care and outcomes

Among the patient outcomes of burnout, quality of care was investigated by eight studies. Two studies in diverse samples and settings reported that high Emotional Exhaustion, high Depersonalisation, and low Personal Accomplishment were associated with poor quality of care [ 109 , 110 ], but one study found that only Personal Accomplishment was related to better quality of care at the last shift [ 104 ]; Emotional Exhaustion and Cynicism predict low quality of care [ 54 ]; two articles reported that Emotional Exhaustion predicts poor nurse ratings of quality of care [ 82 , 84 ]. A high burnout composite score predicted poor nurse-assessed quality of care [ 96 ]. In one instance, no associations were found between any of the burnout dimensions and quality of care [ 36 ].

Five studies considered aspects of patient safety: burnout was correlated with negative patient safety climate [ 111 ]. Emotional Exhaustion and Depersonalisation were both associated with negative patient safety grades and safety perceptions [ 112 ], and burnout fully mediated the relationship between depression and individual-level safety perceptions and work area/unit level safety perceptions [ 108 ]. Emotional Exhaustion mediated the relationship between workload and patient safety [ 51 ], and a higher composite burnout score was associated with lower patient safety ratings [ 113 ].

Regarding adverse events, high DEP and low Personal Accomplishment predicted a higher rate of adverse events [ 85 ], but in another study, only Emotional Exhaustion predicted adverse events [ 51 ]. When nurses were experiencing high levels of Emotional Exhaustion, they were less likely to report near misses and adverse events, and when they were experiencing high levels of Depersonalisation, they were less likely to report near misses [ 112 ].

All three MBI dimensions predicted medication errors in one study [ 109 ], but Van Bogaert et al. found that only high levels of Depersonalisation were associated with medication errors [ 104 ]. High scores in Emotional Exhaustion and Depersonalisation predicted infections [ 109 ]. Cimiotti et al. found that Emotional Exhaustion was associated with catheter-associated urinary tract infections and surgical site infections [ 114 ], while in another study, Depersonalisation was associated with nosocomial infections [ 104 ]. Lastly, patient falls were also explored, and Depersonalisation and low Personal Accomplishment were significant predictors in one study [ 109 ], while in a further study, only Depersonalisation was associated with patient falls [ 104 ]. There was no association between burnout and hospital-acquired pressure ulcers [ 20 ].

Considering patient experience, Vahey et al. concluded that higher Emotional Exhaustion and low Personal Accomplishment levels were associated with patient dissatisfaction [ 93 ], and Van Bogaert et al. found that Emotional Exhaustion was related to patient and family verbal abuse, and Depersonalisation was related to both patient and family verbal abuse and patient and family complaints [ 104 ].

In summary, evidence deriving from 17 studies points to a negative effect of burnout on quality of care, patient safety, adverse events, error reporting, medication error, infections, patient falls, patient dissatisfaction, and family complaints, but not on pressure ulcers.

Individual characteristics

In total, 16 studies, which had examined work characteristics related to burnout, also considered the relationship between characteristics of the individual and burnout. Relationships were tested on demographic variables, including gender, age, and family status; on personality aspects; on work-life interference; and on professional attributes including length of experience and educational level. Because our focus on burnout is as a job-related phenomenon, we have not reported results of these studies into detail, but overall evidence on demographic and personality factors was inconclusive, and having family issues and high work-life interference was associated with different burnout dimensions. Being younger and not having a bachelor’s degree were found to be associated with a higher incidence of burnout.

This review aimed to identify research that had examined theorised relationships with burnout, in order to determine what is known (and not known) about the factors associated with burnout in nursing and to determine the extent to which studies have been underpinned by, and/or have supported or refuted, theories of burnout. We found that the associations hypothesised by Maslach’s theory between mismatches in areas of worklife and burnout were generally supported.

Research consistently found that adverse job characteristics—high workload, low staffing levels, long shifts, low control, low schedule flexibility, time pressure, high job and psychological demands, low task variety, role conflict, low autonomy, negative nurse-physician relationship, poor supervisor/leader support, poor leadership, negative team relationship, and job insecurity—were associated with burnout in nursing.

However few studies used all three MBI subscales in the way intended, and nine used different approaches to measuring burnout.

The field has been dominated by cross-sectional studies that seek to identify associations with one or two factors, rarely going beyond establishing correlation. Most studies were limited by their cross-sectional nature, the use of different or incorrectly applied burnout measures, the use of common methods (i.e. survey to capture both burnout and correlates), and omitted variables in the models. The 91 studies reviewed, while highlighting the importance of burnout as a feature affecting nurses and patient care, have generally lacked a theoretical approach, or identified mechanisms to test and develop a theory on the causes and consequences of burnout, but were limited in their testing of likely mechanisms due to cross-sectional and observational designs.

For example, 19 studies showed relationships between burnout and job satisfaction, missed care, and mental health. But while some studies treated these as predictors of burnout, others handled as outcomes of burnout. This highlights a further issue that characterises the burnout literature in nursing: the simultaneity bias, due to the cross-sectional nature of the evidence. The inability to establish a temporal link means limits the inference of causality [ 115 ]. Thus, a factor such as ‘missed care’ could lead to a growing sense of compromise and ‘crushed ideals’ in nurses [ 116 ], which causes burnout. Equally, it could be that job performance of nurses experiencing burnout is reduced, leading to increased levels of ‘missed care’. Both are plausible in relation to Maslach’s original theory of burnout, but research is insufficient to determine which is most likely, and thereby develop the theory.

To help address this, three areas of development within research are proposed. Future research adopting longitudinal designs that follow individuals over time would improve the potential to understand the direction of the relationships observed. Research using Maslach’s theory should use and report all three MBI dimensions; where only the Emotional Exhaustion subscale is used, this should be explicit and it should not be treated as being synonymous to burnout. Finally, to move our theoretical understanding of burnout forward, research needs to prioritise the use of empirical data on employee behaviours (such as absenteeism, turnover) rather than self-report intentions or predictions.

Addressing these gaps would provide better evidence of the nature of burnout in nursing, what causes it and its potential consequences, helping to develop evidence-based solutions and motivate work-place change. With better insight, health care organisations can set about reducing the negative consequences of having patient care provided by staff whose work has led them to become emotionally exhausted, detached, and less able to do the job, that is, burnout.

Limitations

Our theoretical review of the literature aimed to summarise information from a large quantity of studies; this meant that we had to report studies without describing their context in the text and also without providing estimates (i.e. ORs and 95% CIs). In appraising studies, we did not apply a formal quality appraisal instrument, although we noted key omissions of important details. However, the results of the review serve to illustrate the variety of factors that may influence/result from burnout and demonstrate where information is missing. We did not consider personality and other individual variables when extracting data from studies. However, Maslach and Leiter recently reiterated that although some connections have been made between burnout and personality characteristics, the evidence firmly points towards work characteristics as the primary drivers of burnout [ 8 ].

While we used a reproducible search strategy searching MEDLINE, CINAHL, and PsycINFO, it is possible that there are studies indexed elsewhere and we did not identify them, and we did not include grey literature. It seems unlikely that these exist in sufficient quantity to substantively change our conclusions.

Patterns identified across 91 studies consistently show that adverse job characteristics are associated with burnout in nursing. The potential consequences for staff and patients are severe. Maslach’s theory offers a plausible mechanism to explain the associations observed. However incomplete measurement of burnout and limited research on some relationships means that the causes and consequences of burnout cannot be reliably identified and distinguished, which makes it difficult to use the evidence to design interventions to reduce burnout.

Supplementary information

Acknowledgements.

We would like to thank Jane Lawless who performed the second screening of the provisionally included papers.

Abbreviations

Authors’ contributions.

CDO led the paper write-up at all stages, designed and conducted the search strategy, completed the initial screening of papers, co-developed the coding frame, and applied the coding frame to all studies. JB conceived the review, co-developed the coding frame, applied the coding frame to all studies, and contributed substantially to drafting the paper at various stages. MR extracted all the data from studies and produced evidence tables. PG conceived the review and contributed substantially to the drafting of the paper at various stages. All authors read and approved the final manuscript.

Availability of data and materials

Ethics approval and consent to participate, consent for publication, competing interests.

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information accompanies this paper at 10.1186/s12960-020-00469-9.

RI's nursing home staffing law isn't being enforced. Now there's a new federal mandate.

The Rhode Island law that was supposed to set minimum staffing standards for nursing homes has never been enforced , but a new federal mandate carries much the same impact.

Under new rules announced by the Biden administration on Monday, all nursing homes that receive federal funding through Medicare and Medicaid will be required to meet certain staff-to-patient ratios.

Rhode Island's "safe-staffing" law, which the General Assembly passed in 2021, established a similar formula but required slightly more daily hours of care for nursing home residents.

The coalition that pushed for the passage of the 2021 law applauded the federal mandate on Tuesday, but said they still want to see the Rhode Island law enforced.

RI nursing home industry says standards are 'unrealistic'

The nursing home industry, which strongly opposed Rhode Island's safe-staffing law, has similar objections to the new federal policy.

“We are dismayed that the Biden administration is moving forward with this one-size-fits-all staffing mandate," John Gage, president and CEO of the Rhode Island Health Care Association, wrote in an email. "In the midst of a historic and deepening caregiver shortage, this unrealistic policy will put access to care at risk for countless seniors across the country."

"When nursing homes can’t find these nurses and/or certified nursing assistants, they will be forced to downsize or, even worse, close their doors altogether, leaving seniors with fewer options to receive the care they need," he added.

Nationally, the nursing home workforce is down by 7.8%, Gage said. In Rhode Island, it's down 15.3%.

"Every nursing home wants more workers, but rather than blanket mandates from Washington, we need supportive policies and investments that will help us recruit and retain caregivers," he said, describing the federal rule as an "unfunded mandate."

Supporters still want 'enforcement of our own staffing standards'

Raise the Bar on Resident Care, which championed Rhode Island's 2021 staffing law and is made up of  labor unions, community organizations and advocacy groups , praised the new federal requirements.

"Raise the Bar on Resident Care applauds the Biden administration for this historic step toward building a long-term care system that will deliver safe, dignified care to nursing home residents by improving staffing levels, investing in training and holding for-profit owners accountable for how they spend the nearly $100 billion annually from American taxpayers," a statement from the coalition said.

"Despite this momentous progress, Rhode Island nursing home residents and caregivers cannot afford to wait," the statement went on to say. "In the last three years, our state ranked second in the nation for serious nursing home deficiencies. We urgently need enforcement of our own staffing standards, which align with higher minimum-staffing standards recommended by experts."

The coalition is currently pushing the General Assembly to pass the Workforce Standards Board Bill , which would create a new board to oversee minimum pay and labor standards for nursing homes.

"We need a holistic solution now that brings together all stakeholders – employers, direct-care staff, residents and government representatives – to create a comprehensive plan addressing the root causes of the staffing crisis: low wages, poor training and high turnover," the group's statement concluded.

How the RI and federal staffing standards compare

Under the Biden administration's new mandate , nursing homes will be required to:

• Provide each resident with a minimum of 3.48 hours of nursing care per day
• That includes at least 0.55 hours of care from a registered nurse
• And 2.45 hours of care from a nurse assistant, according to the announcement.

Under Rhode Island's law , nursing homes were supposed to:

• Provide 3.81 hours of direct nursing care per day by January 2023
• Include 2.6 hours of care provided by a certified nurse assistant.

But the state Department of Health never fined any of the nursing homes that failed to meet the minimum-staffing standards , effectively rendering the law toothless. In December, Gov. Dan McKee suspended the penalties, citing "an unprecedented labor crisis."

Like the Rhode Island law, the federal rule is designed to be implemented in phases over the course of several years. It also includes a number of other requirements, like having a registered nurse on site at all times, and developing a plan to improve recruitment and retention.

"When facilities are understaffed, residents may go without basic necessities like baths, trips to the bathroom and meals – and it is less safe when residents have a medical emergency," a fact sheet from the White House states. "This rule will not only benefit residents and their families, it will also ensure that workers aren’t stretched too thin by having inadequate staff on site, which is currently a common reason for worker burnout and turnover."

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Republican Wisconsin Senate candidate says he doesn’t oppose elderly people voting

FILE - Businessman and Republican U.S. Senate candidate, Eric Hovde speaks Tuesday April 2, 2024, at a former President Donald Trump rally in Green Bay, Wis. Hvode emphasized this week that he doesn’t oppose elderly people voting after initially saying that “almost nobody in a nursing home is in a point to vote.” (AP Photo/Mike Roemer, File)

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MADISON, Wis. (AP) — The Republican candidate in Wisconsin’s closely watched U.S. Senate race emphasized this week that he doesn’t oppose elderly people voting after initially saying that “almost nobody in a nursing home” is at a point in life where they are capable of voting.

Eric Hovde faces Democratic Sen. Tammy Baldwin in the race that is essential for Democrats to win in order to maintain their majority in the Senate. A Marquette University Law School poll this week showed the race is about even among likely voters.

Baldwin and Democrats have been attacking Hovde over comments he first made April 5 on a Fox News radio show about nursing home voting. Who can vote in a nursing home, and how they cast their ballots , has been a hot issue in Wisconsin since 2020 when supporters of former President Donald Trump alleged that people were voting illegally.

No charges were brought, and President Joe Biden’s victory over Trump has withstood a nonpartisan audit , numerous lawsuits, a partial recount and a review by a conservative law firm.

But Hovde has been raising the issue of nursing home voting when discussing what he said were problems with the 2020 election.

“We had nursing homes where the sheriff of Racine investigated, where you had 100 percent voting in nursing homes,” Hovde said.

That claim of 100% voting in nursing homes, first made by former Wisconsin Supreme Court Justice Michael Gableman in a discredited report, has never been verified. Voting data has shown that participation in nursing homes across the state was much lower than 100%.

“If you’re in a nursing home, you only have a five, six-month life expectancy,” Hovde said last week on the “Guy Benson Show.” “Almost nobody in a nursing home is in a point to vote.”

Baldwin, in reaction to Hovde’s comments, said last week that “thousands of Wisconsinites live in nursing homes.”

“Eric Hovde does not have a clue what he’s talking about,” she said on MSNBC.

In two subsequent interviews this week, when asked to clarify his comments in the wake of Democratic criticism, Hovde accused his opponents and the media of “political hits.”

“They tried to say I didn’t want elderly people to vote,” Hovde said Monday on WISN-AM. “I don’t even know how they came up with that.”

Hovde reiterated that his issue was based on reports of people who questioned how their severely ill relatives in nursing homes had voted.

Racine County Sheriff Christopher Schmaling, a Trump backer, said in 2021 that the families of eight residents told investigators they believed their love ones did not have the capacity to vote but ballots were cast for them.

Hovde this week said “a large percentage” of nursing home residents “are not in the mental capacity to (vote).”

But he said that does not mean he thinks elderly people should not be allowed to vote.

“I think elderly should absolutely vote,” he said Wednesday on WSAU-AM.

Nursing home voting became a focus for Trump supporters following his narrow loss in Wisconsin in 2020.

State law requires local election clerks to send so-called special voting deputies to nursing homes to give residents an opportunity to vote.

The Wisconsin Elections Commission, in a bipartisan 5-1 vote in March 2020, determined that poll workers could not be sent into nursing homes to help with voting due to a safer-at-home order issued by Gov. Tony Evers early in the COVID-19 pandemic. The order came at a time when nursing homes were severely limiting who could come into their facilities, often not even allowing immediate family members inside.

An audit by the nonpartisan Legislative Audit Bureau determined that the elections commission broke the law when it told clerks not to send or attempt to send deputies into nursing homes.

Schmaling, the sheriff and a Trump backer, called for criminal charges against the commissioners who voted not to send in voting deputies. But the Racine County district attorney declined to charge , citing lack of jurisdiction. The Milwaukee County district attorney also declined to charge two commissioners in his county, saying there was a lack of evidence that a crime was committed.

Republicans in the Legislature have tried to tighten rules about voting in nursing homes, but the measures have either failed to pass or been vetoed by Evers.

This story has been updated to correct the spelling of Racine County Sheriff Christopher Schmaling’s last name. It is Schmaling, not Shmaling.

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