Predictors of patient safety incident rate in hospitalized elderly patients with nurse burnout

Abstract

Background: Hospitalized elderly patients experience disproportionately high rates of falls, delirium, medication error, and other preventable safety incidents, and nurse burnout has emerged as a structural predictor of unit-level incident rate rather than a purely individual occupational-health concern.

Objective: This review synthesizes the published evidence on nurse burnout as a predictor of patient safety incident rate in hospitalized elderly patients, and examines the mediating role of nurse staffing, missed nursing care, and the practice environment.

Methods: We synthesized cohort studies, multi-country nurse surveys, systematic reviews, and meta-analyses addressing nurse burnout, staffing, missed care, and safety incident outcomes in acute hospital settings, with emphasis on evidence specific to elderly inpatients.

Findings: Emotional exhaustion is the burnout dimension most consistently associated with reduced surveillance, higher missed-care rates, and elevated incidence of falls, delirium, medication error, pressure injury, and healthcare-associated infection, with staffing ratio and practice environment quality acting as upstream and modifying factors across the reviewed literature.

Conclusions: Nurse burnout should be monitored as a unit-level structural risk factor for patient safety incident rate in elderly inpatients, and interventions targeting staffing ratios and the practice environment are likely to reduce incident rates more reliably than burnout interventions aimed solely at individual nurse coping.