Organizational determinants of burnout among hospital-based nurse practitioners: A structural equation modeling analysis.

Abstract

The nurse practitioner (NP) workforce is rapidly expanding in hospital settings, yet limited evidence exists on how organizational practice environments influence NP burnout. Identifying modifiable workplace factors is critical to improving NP well-being and retention. To examine the associations between dimensions of the NP practice environment and burnout among hospital-based NPs. This cross-sectional observational study used data from the 2024 Penn Nurses4All Study. The analytic sample included 1405 NPs working in hospital settings. The independent variables were the four dimensions of NP practice environment (i.e., professional visibility, NP-administration relations, NP-physician relations, and independent practice and support), and the dependent variable was burnout. Structural equation modeling was conducted to examine associations between the practice environment and burnout, adjusting for age, sex, employment status, and work setting. Among the 1405 hospital-based NPs, the mean age was 50.3 years (SD = 11.2). Most respondents were female (87.1%) and worked full-time (83.9%). Approximately 28.2% worked in emergency department or intensive care unit settings. More favorable practice environment domains, including professional visibility (standardized coefficient β = -.15, p = .035), NP-administration relations (β = -.36, p < .001), and NP-physician relations (β = -.22, p < .001) were significantly associated with lower burnout. Independent practice and support were not significantly associated with burnout. Organizational features of the practice environment play a central role in shaping burnout among hospital-based NPs. Strengthening leadership engagement, interprofessional collaboration, and NP integration within healthcare organizations may be key strategies to reduce burnout and improve workforce retention.