The Effect of Work Characteristics on Advanced Practice Provider Burnout: a secondary cross-sectional analysis

Background : There are few comprehensive studies looking at burnout and well-being among advanced practice providers (APPs). Most of the studies focus on physicians and nurses. The prevalence of burnout in APPs is limited largely to single center studies or single type of APP specialty. Determining drivers of burnout amongst a heterogenous APP workforce may strengthen the ability to customize support and interventions. In a multicenter randomized control trial studying the feasibility and impact of online group coaching on APPs, we analyzed our baseline data to identify work characteristics associated with APP burnout. Methods : APPs from Emory University, Children's Healthcare of Atlanta, University of Colorado, and Children's Hospital Colorado who enrolled in an APP Coaching study completed a baseline survey which included demographics and Maslach Burnout Inventory Human Services Survey for Medical Personnel (MBI-HSS (MP)). Univariate and multivariate linear and ordinal regression were used for the subdomains of MBI. Univariate predicted probabilities were used for the latent burnout profiles. Results : Of 319 APPs, 305 completed baseline data. 65% (n=198) are Advanced Practice Registered Nurses (APRNs), 35% (n=107) Physician Assistants (PA-C), 53% (n=161) practice in adults, 47% (n=144) practice in pediatrics, 51% (n=157) from Georgia, 49% (n=148) from Colorado, 60% (n=181) work weekday shifts, 40% (n=123) work “off” (night/swing/weekend) shifts, 70% (n=212) work inpatient/ED/Urgent care and 30% (n=93) work outpatient, 35% (n=107) report < 10 years’ experience and 39% (n=118) report > 11 years’ experience. The mean emotional exhaustion (EE) score was 3.32 (SD 1.21). 27% of APPs (n=79) experienced burnout in one dimension and 9% (n=27) in two dimensions. After adjusting for confounding variable, APPs working “off” shifts have decreased personal achievement (PA), APPs who work full-time compared to part-time and PRN have lower EE, and APPs working in adult specialties have more EE and depersonalization (DP). Conclusions : The differences in factors contributing to APP burnout by unique work characteristics identified in this study suggest that a “one size fits all” approach may not be effective. Further studies are needed to determine if customized interventions for surgical and adult specialties, APPs who work “off” shifts, and APPs working part-time or PRN can reduce these disparities.