Investing in nurses tied to lower physician burnout, international study finds

Hospitals with stronger nurse staffing and healthier clinical work environments tend to have physicians who are less burned out, less dissatisfied, and less likely to plan their departure, according to a large international study published in JAMA Network Open. The analysis, led by researchers at the University of Pennsylvania’s Center for Health Outcomes and Policy Research (CHOPR), surveyed more than 6,400 physicians and 15,000 nurses across the United States and six European countries.

The study examined whether hospital-level factors such as nurse staffing adequacy, clinician teamwork and the broader care environment were associated with physicians’ burnout, job dissatisfaction and intent to leave.

All three characteristics — captured through nurse reports — showed strong links to how physicians themselves rated their well-being and workplace outlook.

“Physician burnout is a global crisis, but few actionable solutions have been identified,” said Linda H. Aiken, Ph.D., RN, FAAN, FRCN, professor of nursing and sociology and founding director of CHOPR.

“Our study provides evidence that investing in nurses is a ‘two-for-one’ solution — improving both nurse and physician wellbeing while also strengthening patient care.”

Here’s what they found

Across the United States and Europe, physicians reported high levels of strain.

• 23.8% of U.S. physicians and 29.9% of European physicians said they intended to leave their hospital within a year because of job dissatisfaction.
• Rates of high burnout reached 34.1% in the U.S. and up to 45.3% in some European countries.
• Between 15.6% and 28.5% of physicians reported job dissatisfaction.

But these outcomes varied sharply depending on the hospital environment.

U.S. hospitals

In U.S. hospitals, a 10% improvement in the nurse work environment — measured through factors such as staffing adequacy, managerial responsiveness and overall care coordination — was associated with:

• 22% lower odds of physicians intending to leave.
• 25% lower odds of physicians being unwilling to recommend their hospital as a workplace.
• 19% lower odds of job dissatisfaction.
• 10% lower odds of high burnout.

The clinical care environment also played a major role: more favorable environments were linked to lower burnout and stronger retention intentions.

European hospitals

In European hospitals, the pattern was similar. A 10% increase in nurse staffing adequacy corresponded with:

• 20% lower odds of physicians intending to leave.
• 27% lower odds of not recommending their hospital.
• 15% lower odds of job dissatisfaction.
• 12% lower odds of high burnout.

Hospitals where physicians described stronger physician-nurse teamwork consistently had better physician outcomes as well.

Karen B. Lasater, Ph.D., RN, associate director of CHOPR, said the findings present a clear opportunity for organizations. “These findings highlight a path forward that hospital leaders can act on immediately,” she said. “Improving nurse staffing and creating supportive work environments are organizational reforms that are feasible, evidence-based, and capable of retaining both nurses and physicians.”

A widespread, worsening problem

The study documented substantial variation both across and within countries. Even among hospitals operating under the same national policies, staffing adequacy, teamwork and overall work environments differed widely, translating into equally wide gaps in physician well-being.

In the U.S., all participating hospitals held Magnet recognition — a credential generally associated with stronger nursing environments — yet nurse staffing adequacy still varied considerably.

The authors note that these differences point to substantial room for improvement within existing hospital structures. They also emphasize that many widely promoted clinician wellness interventions focus on individual resilience rather than organizational conditions, despite limited evidence that such programs significantly reduce burnout.

The path forward

The study concludes that organizational reforms, not individual coping strategies, are the strongest evidence-supported targets for improving physician well-being. These include:

• Ensuring adequate nurse staffing.
• Strengthening physician-nurse teamwork.
• Improving the clinical care environment, including management responsiveness and support.

Taken together, the findings suggest that hospitals that prioritize staffing and create more supportive environments may be better positioned to retain physicians and reduce burnout at a time when many health systems are struggling to stabilize their workforce.