The Relationship Between Nurse Burnout and Patient Safety Culture During a Crisis: A Mixed Methods Study
Nasra Idilbi, Nosaiba Rayan-Gharra, Layalleh Massalha, Sarit Rashkovits, Gizell GreenIntroduction
Healthcare crises increase nurses’ workload and risk of burnout, which may negatively affect patient safety culture (PSC) and reporting behaviors. However, limited evidence exists regarding the relationship between burnout, intention to report near-miss events, and actual reporting behavior during crises.
Objective(s)
To examine the associations between nurse burnout, patient safety culture, intention to report near-miss events, and actual reporting behavior during the COVID-19 pandemic, while identifying factors associated with these outcomes.
Methods
A mixed-methods cross-sectional study was conducted using convenience sampling among nurses working in intensive care and general medicine wards at a tertiary medical centre between December 2020 and May 2021 (n = 180; mean age = 40.6 ± 9.7 years; 77.8% female). Data were collected using the validated Hebrew versions of the Hospital Survey on PSC (HSOPSC), a burnout questionnaire, and open-ended questions exploring determinants of patient safety and reporting behaviors.
Results
Participants demonstrated elevated burnout levels (mean = 3.3 ± 1.2), with 53.3% exceeding the burnout threshold. Although 60% intended to report near-miss events, only 30% reported actual events, while 36% reported no near-miss incidents. Burnout was significantly inversely associated with patient safety culture, reporting intentions, and actual reporting behavior. In multivariable regression analysis, burnout (B = −6.32, 95% CI [−8.45, −4.20], p < .001) and shift work (B = −10.23, 95% CI [−17.15, −3.30], p = .004) significantly predicted lower PSC scores, explaining 33.2% of the variance (R 2 = .332). Qualitative findings identified limited managerial support and interdepartmental collaboration challenges as barriers to safety culture and reporting.
Conclusion
Nurse burnout, shift work demands, and organizational challenges during healthcare crises are associated with poorer PSC and reduced near-miss reporting. Strengthening leadership support and promoting nurse well-being are essential for improving safety practices.