Are you turning into Nurse Ratched? Nurse Burnout & Infections

Caregiver burnout is a well documented phenomenon and it is something we’ve talked about here in this blog. Well intentioned, hardworking, dedicated caregivers struggle on a daily basis. Especially to provide the best possible care and quality of life to their loved ones. It’s overwhelming, emotionally draining and physically exhausting. Well, it turns out that it applies to nurses just as much – and we have the study to prove it!

A new article in the American Journal of Infection Control, by Jeannie Cimiotti RN et al., shows that there is a “significant association between patient-to-nurse ratio and urinary tract infections.” According to the authors, if Pennsylvania hospitals reduced burnout by 30% they would have 4,006 fewer urinary tract infections and see an annual cost saving of $3.3 million.

Cimiotti and her colleagues looked at data from over 7,000 nurses working in 161 hospitals in Pennsylvania. On average, each nurse cared for 5.7 patients and more than 30% of nurses reported job related burnout. Overall, 16 of every 1,000 patients acquired an infection; and the single most common infection was urinary tract infections. They also discovered that the addition of a single patient per nurse increased infection rates by a full point per thousand.

“Fewer infections happen in hospitals in which nurses cared for fewer patients… [at least in part because] high nurse burnout [is] associated with heavier patient caseloads.” The authors suggested one possible explanation, saying: “the cognitive detachment associated with high levels of burnout may result in inadequate hand hygiene practices and lapses in other infection control procedures.”

The lesson: We need to invest more in reducing nurse burnout and patient caseloads. Investing more in staffing, education, performance feedback and support services will pay dividends throughout the system.


One of the study’s authors, Dr. Linda Aiken suggested that “it’s a great time for hospitals to implement evidence-based staffing standards”. However, the good news is that there are some pioneering states leading the charge. In California, the legislature has established minimum requirements for safe staff ratios. A supporting study funded by the Agency for Healthcare Research and Quality (AHRQ), discovered that hospitals with an effective nurse-to-patient ratio had lower rates of adverse patient outcomes (just like the study we looked at above).

In fact, urinary tract infections are only one of many types of hospital-acquired-infections (HAI) which there’s a link to nurse burnout. HAIs kill nearly 100,000 people every year. There’s usually a lot of hand-wringing when they publish these kinds of statistics. And lots of new transformative initiatives that never seem to go anywhere, for instance. One question the healthcare industry has had trouble answering is why simple solutions – like washing your hands or using newer, better products like Men’s Liberty – don’t always get implemented.

And just maybe, this is one of the reasons – health care professionals like nurses are suffering under the crushing weight of a  “do more with less” philosophy that is literally killing people.

What do you think?