Comparison of nurse burnout across Army hospital practice environments.

AbstractPurpose: The primary purpose of this study was to examine the nursing practice environment and burnout of nursing personnel assigned to a deployed combat support hospital CSH). A secondary aim was to compare differences in the level of burnout between the deployed Army nursing personnel and Army nursing personnel assigned to an Army hospital in the United States that served as the U.S. military's primary referral center for American combat casualties evacuated from Iraq.Design: A nonexperimental cross- sectional design was used for this study.Methods: The Maslach Burnout Inventory and the Practice Environment Scale were administered to 105 personnel who deployed with a CSH to Iraq. Data from this study were linked to data obtained from 152 nursing personnel who participated in an earlier burnout study at a large Army hospital in the United States. The linked dataseis yielded a final sample of 257 Army nursing personnel. Analysis of variance and linear regression analysis were used to analyze these data.Findings: Emotional exhaustion was common across groups. For the deployed nursing personnel, emotional exhaustion was related to a perceived lack of support from management, foundations for quality of care, collegial relationships, and extended work schedules. The U.S. -based Army hospital group scored significantly higher emotional exhaustion, but it was related to the additional responsibilities associated with being an Army nurse, working extended schedules, and working with combat casualties for extended periods of time. The U.S. -based group perceived more personal accomplishment from the work they do.Conclusions: Burnout was common across Army hospital settings. Emotional exhaustion was most problematic in the U.S. -based Army hospital; however, there was less cynicism toward patients and a greater perception of personal accomplishment associated with work.Clinical Relevance: This study supports the importance of a professional practice environment for Army nursing personnel both during deployment and in U.S. -based Army hospitals.Key wordsBurnout, military nursing, nurse work environment, nurse outcomesOver the past 1 1 years, contingency operations involving the Global War on Terrorism have involved U.S. Army nursing personnel being deployed to some of the most dangerous parts of the world. In 2009 alone. Army nurses spent over 70,000 hours in deployment settings (Horoho, 2010), some to austere, remote locations with small surgical teams, some as rotary wing flight nurses, but most deployed to Iraq and Afghanistan with combat support hospitals (CSHs; Davis &* Connelly, 201.1; Edgar, 2009; Horoho, 2011). The CSH is where comprehensive battlefield medicine and nursing care is provided to combat casualties. Severely injured American combat casualties (e.g., amputees) are evacuated to U.S. Army hospitals in Germany and the United States after receiving care and stabilization in theater (Keenan, 2012; Schreiber et al., 2008). A typical CSH has the capability to provide trauma resuscitation, perioperative care, intensive care, orthopedics, general medicine, surgery, and humanitarian pediatric care (Bridges & Biever, 2010; Creamer et al., 2009; Filliung et al., 2012; Smith, 2008; Spinella, Borgman, & Azarow, 2008; Venticinque & Grathwohl, 2008). Nursing care is provided in this unique hospital setting by nursing personnel who for the purposes of this study are operationally defined as U.S. Army registered nurses (RNs), licensed practical nurses (LPNs), and combat trained medics. Our operational definition of Army nursing personnel is consistent with the U.S. Army Nurse Corps' view and use of the term (Keenan, 2012).Nursing is a complex and demanding profession; however, the deployment setting can challenge military nursing personnel in ways that are different from what is typical for civilian nursing personnel who practice in a traditional civilian hospital setting (Hough, Sadler, & Patrician, 2003; Scannell-Desch & Doherty, 2010; Smith, 2008). …