Prevalence of and Factors Associated With Nurse Burnout in the US | Nursing | JAMA Network Open | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
National Academies Press. Taking action against clinician burnout: a systems approach to professional well-being. National Academies Press; 2019. Accessed August 14, 2020.
United States Department of Labor Bureau of Labor Statistics. Employment by detailed occupation. Published September 1, 2020. Accessed September 2, 2020.
United States Department of Labor Bureau of Labor Statistics. Occupational outlook handbook: registered nurses. Published September 1, 2020. Accessed September 2, 2020.
Aiken  LH, Sloane  DM, Clarke  S,  et al.  Importance of work environments on hospital outcomes in nine countries.   Int J Qual Health Care. 2011;23(4):357-364. doi:10.1093/intqhc/mzr022 PubMedGoogle ScholarCrossref
Institute of Medicine (US) Committee on the Work Environment for Nurses and Patient Safety; Page  A, ed.  Keeping Patients Safe: Transforming the Work Environment of Nurses. National Academies Press; 2004. Accessed July 23, 2020.
US Census Bureau. National Sample Survey of Registered Nurses (NSSRN). Published November 25, 2020. Accessed September 4, 2020.
US Department of Health and Human Services, Health Resources and Services Administration, National Center for Health Workforce Analysis. Technical Report for the National Sample Survey of Registered Nurses. US Department of Health and Human Services; 2019.
Khamisa  N, Peltzer  K, Oldenburg  B.  Burnout in relation to specific contributing factors and health outcomes among nurses: a systematic review.   Int J Environ Res Public Health. 2013;10(6):2214-2240. doi:10.3390/ijerph10062214 PubMedGoogle ScholarCrossref
Maslach  C, Jackson  SE.  The measurement of experienced burnout.   J Organ Behav. 1981;2(2):99-113. doi:10.1002/job.4030020205 Google ScholarCrossref
McHugh  MD, Kutney-Lee  A, Cimiotti  JP, Sloane  DM, Aiken  LH.  Nurses’ widespread job dissatisfaction, burnout, and frustration with health benefits signal problems for patient care.   Health Aff (Millwood). 2011;30(2):202-210. doi:10.1377/hlthaff.2010.0100 PubMedGoogle ScholarCrossref
Moss  M, Good  VS, Gozal  D, Kleinpell  R, Sessler  CN.  An Official Critical Care Societies collaborative statement: burnout syndrome in critical care healthcare professionals: a call for action.   Crit Care Med. 2016;44(7):1414-1421. doi:10.1097/CCM.0000000000001885 PubMedGoogle ScholarCrossref
National Academies of Sciences, Engineering, and Medicine; National Academy of Medicine; Committee on Systems Approaches to Improve Patient Care by Supporting Clinician Well-Being. Factors Contributing to Clinician Burnout and Professional Well-Being. National Academies Press; October 23, 2019. Accessed September 14, 2020.
Aiken  LH, Clarke  SP, Sloane  DM, Sochalski  J, Silber  JH.  Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction.   JAMA. 2002;288(16):1987-1993. doi:10.1001/jama.288.16.1987 PubMedGoogle ScholarCrossref
US Department of Health and Human Services, Health Resources and Services Administration. The Registered Nurse Population: Findings from the 2008 National Sample Survey of Registered Nurses. US Department of Health and Human Services; 2010.
Lasater  KB, Aiken  LH, Sloane  DM,  et al.  Chronic hospital nurse understaffing meets COVID-19: an observational study.  Published online August 8, 2020.  BMJ Qual Saf. PubMedGoogle Scholar
Brooks Carthon  JM, Hatfield  L, Brom  H,  et al.  System-level improvements in work environments lead to lower nurse burnout and higher patient satisfaction.   J Nurs Care Qual. Published online February 24, 2020. doi:10.1097/NCQ.0000000000000475 PubMedGoogle Scholar
Kutney-Lee  A, Wu  ES, Sloane  DM, Aiken  LH.  Changes in hospital nurse work environments and nurse job outcomes: an analysis of panel data.   Int J Nurs Stud. 2013;50(2):195-201. doi:10.1016/j.ijnurstu.2012.07.014 PubMedGoogle ScholarCrossref
Kutney-Lee  A, Stimpfel  AW, Sloane  DM, Cimiotti  JP, Quinn  LW, Aiken  LH.  Changes in patient and nurse outcomes associated with Magnet hospital recognition.   Med Care. 2015;53(6):550-557. doi:10.1097/MLR.0000000000000355 PubMedGoogle ScholarCrossref
Kelly  LA, McHugh  MD, Aiken  LH.  Nurse outcomes in Magnet® and non-Magnet hospitals.   J Nurs Adm. 2011;41(10):428-433. doi:10.1097/NNA.0b013e31822eddbc PubMedGoogle ScholarCrossref
Update on nursing staff ratios. Published March 8, 2018. Accessed September 4, 2020.
Eanes  L.  CE: The potential effects of sleep loss on a nurse’s health.   Am J Nurs. 2015;115(4):34-40. doi:10.1097/01.NAJ.0000463025.42388.10 PubMedGoogle ScholarCrossref
Stewart  NH, Arora  VM.  The impact of sleep and circadian disorders on physician burnout.   Chest. 2019;156(5):1022-1030. doi:10.1016/j.chest.2019.07.008 PubMedGoogle ScholarCrossref
Johnson  AL, Jung  L, Song  Y, Brown  KC, Weaver  MT, Richards  KC.  Sleep deprivation and error in nurses who work the night shift.   J Nurs Adm. 2014;44(1):17-22. doi:10.1097/NNA.0000000000000016 PubMedGoogle ScholarCrossref
Metlaine  A, Sauvet  F, Gomez-Merino  D,  et al.  Sleep and biological parameters in professional burnout: a psychophysiological characterization.   PLoS One. 2018;13(1):e0190607. doi:10.1371/journal.pone.0190607 PubMedGoogle Scholar
García  GM, Calvo  JCA.  Emotional exhaustion of nursing staff: influence of emotional annoyance and resilience.   Int Nurs Rev. 2012;59(1):101-107. doi:10.1111/j.1466-7657.2011.00927.x Google ScholarCrossref
Kowalski  C, Ommen  O, Driller  E,  et al.  Burnout in nurses: the relationship between social capital in hospitals and emotional exhaustion.   J Clin Nurs. 2010;19(11-12):1654-1663. doi:10.1111/j.1365-2702.2009.02989.x PubMedGoogle ScholarCrossref
Fernandez  R, Lord  H, Halcomb  E,  et al.  Implications for COVID-19: a systematic review of nurses’ experiences of working in acute care hospital settings during a respiratory pandemic.   Int J Nurs Stud. 2020;111:103637. doi:10.1016/j.ijnurstu.2020.103637 PubMedGoogle Scholar
Juraschek  SP, Zhang  X, Ranganathan  V, Lin  VW.  United States registered nurse workforce report card and shortage forecast.   Am J Med Qual. 2019;34(5):473-481. doi:10.1177/1062860619873217 PubMedGoogle ScholarCrossref
Cahan  EM, Levine  LB, Chin  WW.  The Human Touch - Addressing Health Care’s Workforce Problem amid the Pandemic.   N Engl J Med. 2020;383(18):e102. Published online October 29, 2020. doi:10.1056/NEJMp2020962PubMedGoogle Scholar
Spetz J. There are not nearly enough nurses to handle the surge of coronavirus patients: here’s how to close the gap quickly. Health Affairs. Published March 31, 2020. Accessed September 4, 2020.
Chmielewski N. Flatten the nursing-profession exodus curve: discussing the long-term COVID-19 impact on nursing shortage. Published May 13, 2020. Accessed September 4, 2020.
Bodenheimer  T, Sinsky  C.  From triple to quadruple aim: care of the patient requires care of the provider.   Ann Fam Med. 2014;12(6):573-576. doi:10.1370/afm.1713 PubMedGoogle ScholarCrossref
Limit 200 characters
Limit 25 characters
Conflicts of Interest Disclosure

Identify all potential conflicts of interest that might be relevant to your comment.

Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Err on the side of full disclosure.

If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.

Not all submitted comments are published. Please see our commenting policy for details.

Limit 140 characters
Limit 3600 characters or approximately 600 words
    Original Investigation
    Health Policy
    February 4, 2021

    Prevalence of and Factors Associated With Nurse Burnout in the US

    Author Affiliations
    • 1Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, Georgia
    • 2Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
    • 3Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
    JAMA Netw Open. 2021;4(2):e2036469. doi:10.1001/jamanetworkopen.2020.36469
    Key Points

    Question  What were the most recent US national estimates of nurse burnout and associated factors that may put nurses at risk for burnout?

    Findings  This secondary analysis of cross-sectional survey data from more than 50 000 US registered nurses (representing more than 3.9 million nurses nationally) found that among nurses who reported leaving their current employment (9.5% of sample), 31.5% reported leaving because of burnout in 2018. The hospital setting and working more than 20 hours per week were associated with greater odds of burnout.

    Meaning  With increasing demands placed on frontline nurses during the coronavirus disease 2019 pandemic, these findings suggest an urgent need for solutions to address burnout among nurses.


    Importance  Clinician burnout is a major risk to the health of the US. Nurses make up most of the health care workforce, and estimating nursing burnout and associated factors is vital for addressing the causes of burnout.

    Objective  To measure rates of nurse burnout and examine factors associated with leaving or considering leaving employment owing to burnout.

    Design, Setting, and Participants  This secondary analysis used cross-sectional survey data collected from April 30 to October 12, 2018, in the National Sample Survey of Registered Nurses in the US. All nurses who responded were included (N = 50 273). Data were analyzed from June 5 to October 1, 2020.

    Exposures  Age, sex, race and ethnicity categorized by self-reported survey question, household income, and geographic region. Data were stratified by workplace setting, hours worked, and dominant function (direct patient care, other function, no dominant function) at work.

    Main Outcomes and Measures  The primary outcomes were the likelihood of leaving employment in the last year owing to burnout or considering leaving employment owing to burnout.

    Results  The weighted sample of 50 273 respondents (representing 3 957 661 nurses nationally) was predominantly female (90.4%) and White (80.7%); the mean (SD) age was 48.7 (0.04) years. Among nurses who reported leaving their job in 2017 (n = 418 769), 31.5% reported burnout as a reason, with lower proportions of nurses reporting burnout in the West (16.6%) and higher proportions in the Southeast (30.0%). Compared with working less than 20 h/wk, nurses who worked more than 40 h/wk had a higher likelihood identifying burnout as a reason they left their job (odds ratio, 3.28; 95% CI, 1.61-6.67). Respondents who reported leaving or considering leaving their job owing to burnout reported a stressful work environment (68.6% and 59.5%, respectively) and inadequate staffing (63.0% and 60.9%, respectively).

    Conclusions and Relevance  These findings suggest that burnout is a significant problem among US nurses who leave their job or consider leaving their job. Health systems should focus on implementing known strategies to alleviate burnout, including adequate nurse staffing and limiting the number of hours worked per shift.