Methods: To ensure protection of human subjects, the study protocol was approved by the Colorado Multiple Institutional Review Board prior to subject recruitment and data collection. This multi-site, multi-state study recruited 28 schools of nursing from all geographic regions of the U.S. to participate in a comprehensive web-based survey of faculty. A portion of the survey items were dedicated exclusively to mid-level academic nurse leaders who devoted 50% or more of their effort to an administrative position within the school, including assistant and associate deans, program directors, and department chairs. Dillman survey methods were used to obtain a robust response rate resulting in a sample of 140 mid-level academic nurse leaders representing all 28 participating schools. Burnout was measured by the Emotional Exhaustion subscale of Maslach Burnout Inventory; scores greater than 27 are indicative of burnout (Maslach & Leiter, 2016). Satisfaction with various dimensions of work life, intent-to-leave their school, and intent-to-leave academic nursing were measured by survey items tested in previous research (Yedidia, Chou, Brownlee, Flynn, & Tanner). Generalized estimating equations, producing robust logistic regression models that account for clustering of respondents within schools, were used to determine the effects of study variables on the odds on burnout and intentions-to-leave.
Results: There were no associations between any demographic characteristics and burnout or intentions-to-leave. A total of 71.2% of mid-level academic nurse leaders reported that they typically worked more than 56 hours per week, and 12.3% reported working more than 66 hours per week. Importantly, 21.2% reported that they planned to leave their school within one year and 18.8% indicated they planned to leave academic nursing within the year. A total of 37.7% of mid-level academic nurse leaders had a high emotional exhaustion subscale score indicting occupational burnout. The prevalence of burnout within this sample was higher than that found among hospital staff nurses as recently measured across 13 countries, including the U.S. Mid-level academic nurse leaders who were dissatisfied with their workloads were almost eight times more likely to have developed occupational burnout [OR = 7.84 (3.12, 20.0)]; respondents who typically worked more than 56 hours per week were almost three times more likely to be suffering from burnout [OR = 2.80 (1.33,5.88)]. In models adjusted and unadjusted for age, mid-level academic nurse leaders suffering from burnout were approximately three times more likely to be planning to leave their school within the year [OR = 2.97 (1.26, 6.94)], and more than three and a half times more likely to be planning to leave academic nursing, entirely [OR = 3.64 (1.42, 8.63].
Conclusion: The future of nursing education can ill afford to lose approximately 20% of the current mid-level academic nurse leaders to attrition that is due mainly to modifiable work environment factors. Fortunately, findings from this study provide valuable insight into strategies that can be implemented to reduce this trend. Heavy workloads and long work weeks contributed to an unacceptably high prevalence of burnout within mid-level academic nurse leaders in this study. Burnout, in turn, was a major predictor of their intentions-to-leave. Schools of nursing must act quickly to re-examine and redesign workloads among this invaluable group of academic experts and future deans. Responsibilities that can be delegated to support staff should be identified, and schools should ensure that supportive resources are available. Although this study was conducted in the U.S., the growing internationalization of nursing education denotes core challenges that are experienced by us all. Findings from this study not only serve to be the proverbial canary in the coal mine, warning of crises to come, but also provide guidance for preventative strategies that could be implemented in schools of nursing around the world.