What Hospitals Can Learn About RN Satisfaction and Burnout from Travel Nurses

By Marcia Faller, Ph.D., RN, chief clinical officer, AMN Healthcare

April 13, 2011 - Sometimes people in an organization can perceive things in a way that is colored by their internal culture or experiences, and not see all of the forces that impact their employees. Gaining a new perspective from a visitor can often help unearth some truths that may not be so self-evident, and help them make changes for the better. Thus is the case with travel nurses. A new study suggests that hospitals can learn a lot about nurse job satisfaction, burnout and retention from these temporary employees.

I had the privilege of working with three colleagues on this research study that was published in the February issue of the Journal of Nursing Administration (JONA). Entitled “Work-related Burnout, Job Satisfaction, Intent to Leave, and Nurse-Assessed Quality of Care Among Travel Nurses,” our work involved a review of the literature and an online survey of 976 travel nurses working in acute care hospitals across the country.

We examined the individual characteristics of the nurses as well as characteristics of the work setting in order to make a determination about factors that influence a nurse’s level of job satisfaction or burnout. The travel nurses in this study exhibited moderate levels of burnout, with the highest burnout related to the work itself. These results support earlier findings related to the challenges faced by hospital-employed nurses.

What were the workplace issues that made the biggest difference in scores?
• The number of patients assigned during a shift had a significant impact on work-related burnout
• Location: work-related burnout was lower in California, where staffing ratios are in place
• ANCC Magnet status made a difference in job satisfaction and perceptions about quality of care
• Specialty areas/units also had a significant impact on level of burnout

Age, education and family status of the individual nurses affected their burnout levels, as well. The nurses in this study with low work-related burnout levels were more likely to be older, be married, have children in the home, and hold a diploma in nursing—and less likely to hold a bachelor’s degree—than their travel nurse colleagues experiencing high levels of work-related burnout.

Differences between permanent and travel nurses

Although travel nurses make up a very small portion of the nursing population (a 2008 survey of California nurses found that 1.2% were travel nurses and another 3% worked for a per diem agency or registry), their survey responses can help us develop a better understanding of the current high levels of job dissatisfaction and burnout among nurses in general. Travel nurses aren’t that different from your permanent nurse employees, after all, since most of them left a regular hospital staff nurse position to become a travel nurse.

We did note some differences in their personal characteristics, however, when we compared this sample group of travel nurses to the 2004 National Sample Survey of Registered Nurses. The averages of the two groups showed that the travel nurses were:

• Younger, by an average of more than 5 years (37.7 years vs. 43.4 national average)
• More likely to have a bachelor’s degree (52% vs. 39%)
• Less than half as likely to be married (32% vs. 71%)
• One-third as likely to have children in the home (17% vs. 51%)

The family-related statistics aren’t surprising, considering the fact that travel nursing assignments generally place the nurse in a new location away from home for at least 13 weeks at a time.

Nearly half of the travelers worked in adult critical care (48%), while the others were split between adult general (19%), pediatrics and neonatal (12%), perioperative (11%), and maternity (10%). Among the specialties, the travel nurses in critical care and maternity showed the highest levels of burnout, followed by general adult specialties, then perioperative and pediatric/neonatal.

Next steps

While each individual registered nurse has personal factors affecting his or her job decisions, our research team found that a hospital’s workplace characteristics certainly have an influence on the perceptions of quality of care provided and the degree to which a nurse is either burned out or satisfied with his or her job.

So what are some good next steps for hospital administrators, based on these findings?

Here are a few suggestions:

1. Download the full JONA article on the journal’s website to learn more about the factors we found that contribute to job dissatisfaction and burnout. Many of the references would also make for good reading and can add to your understanding of employee satisfaction and retention.

2. Consider pursuing ANCC Magnet status, if you haven’t already. While quite an undertaking, it is a worthwhile journey to help you improve the quality of care you provide to patients and the job satisfaction of your nursing workforce. (You can even download a free AMN white paper that shows how travel nurses can help your facility take this journey.) ANCC also offers a Pathway to Excellence program that can help you focus on your workplace and provide adequate support to nurses on the job.

3. No matter where you operate and whether or not you are currently a Magnet hospital, be sure to include nurses in your staffing committees and give them an active part in the decision making process. Engagement is vital to their satisfaction.

4. Include travel nurses on assignment in your regular staff surveys, when possible. Their answers can provide additional insights into your workplace characteristics and overall culture. You can also survey them separately, during or after their assignments, to gather important feedback and gain that “outsider’s perspective.”

5. Look at each unit or department separately when evaluating job satisfaction and burnout. While some specialty areas are prone to higher levels of stress and potential burnout, alert nurse managers can do more to monitor and support their staff when they really need it.

6. Treat all nurses fairly in regards to pay, benefits and overall respect, but also consider how you can cater to the nurses on your staff in various stages of their life, family and career. Employers who support their staff and help them achieve the right work–life balance will be well rewarded with satisfied employees who want to stay and participate in creating a top-notch healthcare facility.

For more information, download "Work-related Burnout, Job Satisfaction, Intent to Leave, and Nurse-Assessed Quality of Care Among Travel Nurses” from the Journal of Nursing Administration website. Authors: Marcia Faller, Ph.D., RN, chief clinical officer, AMN Healthcare; Michael Gates, Ph.D., RN, assistant nursing professor, San Diego State University; Jane Georges, Ph.D., RN, associate professor of nursing, University of San Diego; and Cynthia Connelly, Ph.D., RN, FAAN, director of nursing research, University of San Diego.