Impact of Nurse Burnout and Workload on Patient Safety and Quality of Care in Critical Care Units in Iraq

Abstract

Background: Burnout is a worldwide occupational hazard, especially in resource-stretched health systems. In Iraqi intensive care units (ICUs), the increasing workloads, resource scarcity and institutional support systems make the environment a perfect storm for burnout; however, few quantitative studies have linked burnout with patient safety events in the Iraqi ICU literature. Objective: The present study aimed to investigate associations between nurse burnout, workload, patient safety events and quality of care outcomes in intensive care units (ICUs) of tertiary hospitals in Iraq. Methods: We conducted a cross-sectional, multi-site study, involving 294 ICU nurses from eight tertiary hospitals in the governorates of Baghdad, Basra and Salah al-Din. The Maslach Burnout Inventory - Human Services Survey (MBI-HSS) was used to measure burnout. Nurses were divided into low (n = 86), moderate (n = 112) and high (n = 96) burnout categories. Data on patient safety and quality were extracted from hospital surveillance systems and patient care records for a concurrent six-month period. Predictors of high burnout were determined by binary logistic regression. Results: High-burnout nurses managed significantly more patients per shift (9.8 ± 2.1 vs. 5.4 ± 1.2; p < 0.001) and worked longer weekly hours (58.7 ± 6.3 vs. 44.2 ± 5.1; p < 0.001). Medication errors (6.7 ± 1.8 vs. 1.8 ± 0.7 per 100 orders), patient falls (4.3 ± 1.1 vs. 0.9 ± 0.4 per 100 bed-days), and 30-day mortality indices (13.4 ± 2.8% vs. 5.1 ± 1.6%) were substantially higher in the high-burnout group (all p < 0.001). Logistic regression identified patient load ≥ 8 per shift (OR = 4.62; 95% CI: 2.91–7.34) and weekly hours ≥ 56 (OR = 3.87; 95% CI: 2.43–6.16) as the strongest risk factors for high burnout. Conclusion: Nurse burnout is strongly and negatively related to patient safety and quality of care in Iraqi ICUs. Evidence-based workload management policies, institutional psychological support strategies and mentoring programs by peers should be developed.