Relationship Between Burnout and Quality of Care in Nurses in Banten, Indonesia: A Cross-Sectional Study
Nurses are legally liable and morally responsible for the quality of the care they provide to patients. Nursing is considered to be a high-risk working group, that is high pressure and involves constantly having to handle the needs and emergency conditions of patients. This puts them in conditions with a higher risk of burnout. This cross-sectional study was carried out with nurses at general public hospitals in Banten, Indonesia. Data were collected from January to March 2021. All participants were staff nurses in either the medical, surgical, obstetric, or pediatric care units working in direct care. The total sample was 180. Convenience sampling was used. Burnout was measured using the Maslach Burnout Inventory Human Service Survey. The patient’s perception of nursing care quality was measured using a modified instrument. Linear regression analyses were used to investigate the factors associated with quality of care. Most of the nurses (58.33%) had a nursing diploma, and 7% had been married. Approximately 70% were nurses at the level 1 to 3 range. The mean score was 3.56 (SD = 1.33). The highest domains score was comfort (4.24, SD = 1.44), and the lowest score was physical environment (2.89, SD = 0.81). Burnout and quality of care showed a significant correlation with r ranging from 0.37 to 0.65, with p < 0.05. Nurses are the largest segment of healthcare professionals and so measuring the quality of nursing care is critical for improving practice. Interventions to improve nursing care quality by considering nurse burnout are needed.
Keywords: burnout, quality of care, nurse, Indonesia
 Snowdon DA, Leggat SG, Taylor NF. Does clinical supervision of healthcare professionals improve effectiveness of care and patient experience? A systematic review. BMC Health Serv Res. 2017;17(1):1–11.
 Van der Heijden B, Brown Mahoney C, Xu Y. Impact of Job Demands and Resources on Nurses’ Burnout and Occupational Turnover Intention Towards an Age-Moderated Mediation Model for the Nursing Profession. Int J Environ Res Public Health. 2019 Jun;16(11).
 Aiken LH, Sloane DM, Bruyneel L, Van den Heede K, Griffiths P, Busse R, et al. Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study. Lancet (London, England). 2014 May;383(9931):1824–30.
 Ball JE, Murrells T, Rafferty AM, Morrow E, Griffiths P. “Care left undone” during nursing shifts: associations with workload and perceived quality of care. BMJ Qual Saf. 2014 Feb;23(2):116–25.
 McHugh MD, Stimpfel AW. Nurse reported quality of care: a measure of hospital quality. Res Nurs Health. 2012/08/21. 2012 Dec;35(6):566–75.
 Care Quality Commission. The state of health care and and adult social care in England 2013/2014. London; 2014.
 Aiken LH, Cimiotti JP, Sloane DM, Smith HL, Flynn L, Neff DF. Effects of nurse staffing and nurse education on patient deaths in hospitals with different nurse work environments. Med Care. 2011 Dec;49(12):1047–53.
 Tancred T, Schellenberg J, Marchant T. Using mixed methods to evaluate perceived quality of care in southern Tanzania. Int J Qual Heal care. 2016;28(2):233–9.
 van den Driessen Mareeuw FA, Coppus AMW, Delnoij DMJ, de Vries E. Quality of health care according to people with Down syndrome, their parents and support staff—A qualitative exploration. J Appl Res Intellect Disabil. 2020;33(3):496–514.
 Triyanto J, Janjua PZ, Samad G, Khan N, Ishaq M, Rumiati AT, et al. No Title. J Sains dan Seni ITS [Internet]. 2017;6(1):51–66. Available from: http://repositorio. unan.edu.ni/2986/1/5624.pdf%0A http://fiskal.kemenkeu.go.id/ejournal%0A http:// dx.doi.org/10.1016/j.cirp.2016.06.001%0A http://dx.doi.org/10.1016/j.powtec.2016.12. 055%0A https://doi.org/10.1016/j.ijfatigue.2019.02.006%0A
 Gracia-Gracia P, Oliván-Blázquez B. Burnout and mindfulness self-compassion in nurses of intensive care units: cross-sectional study. Holist Nurs Pract. 2017;31(4):225–33.
 Boamah SA, Read EA, Spence Laschinger HK. Factors influencing new graduate nurse burnout development, job satisfaction and patient care quality: a time-lagged study. J Adv Nurs. 2017;73(5):1182–95.
 Al Sabei SD, Labrague LJ, Miner Ross A, Karkada S, Albashayreh A, Al Masroori F, et al. Nursing work environment, turnover intention, job burnout, and quality of care: the moderating role of job satisfaction. J Nurs Scholarsh. 2020;52(1):95–104.
 Maslach C, Jackson SE, Leiter MP, Schaufeli WB, Schwab RL. Maslach Burnout Inventory 3rd edition manual. Mt View, CA CPP Inc. 1996.
 Maslach C, Schaufeli WB, Leiter MP. Job burnout. Annu Rev Psychol. 2001;52:397– 422.
 Van Bogaert P, Clarke S, Roelant E, Meulemans H, Van de Heyning P. Impacts of unit-level nurse practice environment and burnout on nurse-reported outcomes: a multilevel modelling approach. J Clin Nurs. 2010 Jun;19(11–12):1664–74.
 Messias E, Gathright MM, Freeman ES, Flynn V, Atkinson T, Thrush CR, et al. Differences in burnout prevalence between clinical professionals and biomedical scientists in an academic medical centre: a cross-sectional survey. BMJ Open. 2019;9(2):e023506.
 Luan X, Wang P, Hou W, Chen L, Lou F. Job stress and burnout: A comparative study of senior and head nurses in China. Nurs Health Sci. 2017 Jun;19(2):163–9.
 Lee H-F, Yen M, Fetzer S, Chien T. Predictors of Burnout Among Nurses in Taiwan. Community Ment Health J. 2014 Dec;51.
 da Silva JLL, Soares R da S, Costa F dos S, Ramos D de S, Lima FB, Teixeira LR. Psychosocial factors and prevalence of burnout syndrome among nursing workers in intensive care units. Rev Bras Ter intensiva. 2015;27(2):125–33.
 Halizasia G, Putra A. KEJENUHAN KERJA PADA PERAWAT DIRUANG INTENSIVE CARE RUMAH SAKIT UMUM DAERAH dr. ZAINOEL ABIDIN BANDA. J Ilm Mhs Fak Keperawatan. 2017;2(3).
 Suharti N, Daulima N. Burnout dengan Kinerja Perawat di Rumah Sakit Metropolitan Medical Centre Jakarta. Univ Indones. 2013;
 Van Bogaert P, Adriaenssens J, Dilles T, Martens D, Van Rompaey B, Timmermans O. Impact of role-, job-and organizational characteristics on Nursing Unit Managers’ work related stress and well-being. J Adv Nurs. 2014;70(11):2622–33.
 Van Bogaert P, Kowalski C, Weeks SM, Van Heusden D, Clarke SP. The relationship between nurse practice environment, nurse work characteristics, burnout and job outcome and quality of nursing care: a cross-sectional survey. Int J Nurs Stud. 2013 Dec;50(12):1667–77.
 Liu J, Zhu B, Wu J, Mao Y. Job satisfaction, work stress, and turnover intentions among rural health workers: a cross-sectional study in 11 western provinces of China. BMC Fam Pract. 2019 Jan 14;20.
 Liu Y, Aungsuroch Y. Factors influencing nurse-assessed quality nursing care: A cross-sectional study in hospitals. J Adv Nurs. 2018;74(4):935–45.