July 24, 2023
- September 09, 2022 - NINR Areas of Emphasis for Research to Optimize Health and Advance Health Equity (R01 Clinical Trial Optional). See NOFO PAR-22-230.
- September 09, 2022 - NINR Areas of Emphasis for Research to Optimize Health and Advance Health Equity (R21 Clinical Trial Optional). See NOFO PAR-22-231.
National Institute of Nursing Research (NINR)
The National Institute of Nursing Research (NINR) seeks research studies to develop and evaluate novel organizational interventions to prevent and mitigate nurse burnout which will build new knowledge and the evidence base for implementation in places where nurses practice: in hospitals and clinics, in schools and workplaces, in homes and long-term care facilities, in justice settings, and throughout communities.
Background
Nurses are the foundation of health care. They promote health and care for individuals, families, and communities across the life course. As both the largest health profession and the largest of all professions in the Nation, nurses are the backbone of health systems in the United States and have ranked as the most trusted profession for 21 years in a row. Nurses have long experienced high levels of burnout, but the COVID-19 pandemic exacerbated its prevalence and severity, and nurse burnout entered the public’s consciousness as a national problem. Nurses from racially and ethnically minoritized backgrounds have been disproportionately impacted.
Burnout is characterized by three dimensions: (1) feelings of energy depletion or exhaustion; (2) increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; and (3) reduced professional efficacy. Research has linked nurse burnout to higher odds of patient mortality, failure to rescue, longer length of stay, poor quality of care, preventable adverse events, increased hospital-acquired infections, and decreased patient satisfaction. Research has shown registered nurses with burnout were five times more likely to leave necessary patient care undone. Burnout increases absenteeism and turnover and negatively impacts other providers, healthcare organizations, and healthcare costs. Burnout has contributed to exacerbation of nationwide nursing workforce shortages. Through resulting increases in nurse-patient staffing ratios, burnout reduces access to safe, high-quality care. These impacts are likely to be greatest in safety-net hospitals, where shortages are particularly acute, and disproportionately affect the high-need marginalized populations they serve.
The World Health Organization recognizes Occupational Burnout as a syndrome resulting from chronic workplace stress. Burnout is a job-induced phenomenon rooted in the work environment. As elucidated in a 2019 consensus study report, the National Academies of Sciences, Engineering, and Medicine described a Systems Model of Clinician Burnout and Professional Well-Being that conceptualized a three-level interacting system—frontline care delivery, the health care organization, and the external environment—that shapes work system factors (job demands and resources) to influence burnout and well-being. Individual factors such as resilience and coping strategies mediate effects of work system factors on nurse burnout and well-being. Thus, individual-level interventions alone are not sufficient to address the problem, and work system factors must be considered within the context of the complex systems that produce them.
While efforts are being made to address burnout and well-being, little research evidence is available to guide them. Organization-directed or whole-system approaches that address structure, organization, and culture –including a focus on diversity and inclusion –show promise in impacting burnout measures. SAMHSA provides an overview of organization factors that contribute to burnout which can help prepare an intervention strategy (Addressing Burnout in the Behavioral Health Workforce through Organizational Strategies (samhsa.gov)). Expanding evidence to support organizational interventions to reduce burnout is also in line with recent national initiatives such as the National Academy of Medicine’s Action Collaborative on Clinician Well-Being and Resilience which highlights the importance of evidence-based, multicomponent solutions, and calls for investment in research on organizational interventions to reduce burnout.
This funding opportunity announcement seeks to encourage the development and evaluation of novel organizational interventions that will build new knowledge on how to prevent and mitigate nurse burnout in settings where nurses practice, including hospitals and clinics, schools and workplaces, homes and long-term care, justice, and other settings.
Research Objectives
NINR seeks research on novel organizational interventions to prevent and mitigate burnout among nurses working in a wide range of practice settings. Research in healthcare systems and system components that function as safety net providers – such as Federally Qualified Health Centers (FQHCs), Rural Health Centers, Disproportionate Share Hospitals (DSH), and Community Health Centers – as well as other community-based settings such as long-term care facilities, nursing homes, justice settings, workplaces, and schools is encouraged. Interdisciplinary research collaborations including experts in human factors engineering, systems design, and human resources or related fields, and between established and newer investigators, are encouraged. Meaningful nurse engagement at all stages of the research process is strongly encouraged.
Organizational interventions may include, but are not limited to, those addressing key factors in healthcare settings that shape frontline care delivery and the work system and influence burnout and well-being such as bureaucracy; organizational mission and values; culture and leadership; policies; nurse engagement; diversity and inclusion; power dynamics; performance and compensation; and administrative burden. Multilevel interventions involving the healthcare organization and frontline care delivery are encouraged but not required. Interventions involving only the environment external to the healthcare organization are discouraged.
The primary goal of this research initiative is the prevention or mitigation of nurse burnout. As such, the primary outcome measure must be well justified based on theory and evidence as to its link to nurse burnout. Studies may include more than one outcome. Additional potential study outcomes could also include, but are not restricted to:
- Nurse outcomes such as nurse satisfaction, engagement, intent to leave, and occupational injury
- System outcomes such as nurse retention, absenteeism, turnover, and costs
Studies are encouraged, but not required, to examine how organizational interventions to reduce nurse burnout also impact individual/patient outcomes such as access to, utilization of, or experience of care; satisfaction; communication; healthcare quality and safety; errors; preventable adverse events; and morbidity and mortality.
Examples of research interest areas under this funding opportunity include, but are not limited to:
- Alternative models of decision-making that impact nurse burnout
- Frontline care delivery and work system factors as mechanisms through which organizational interventions mitigate burnout
- The processes and conditions under which proposed interventions succeed or fail to improve outcomes
- Economic, social, and physical environmental conditions that impact intervention effectiveness
- Nurse, team, or unit-level factors that affect intervention effectiveness
- Interventions to reduce nurse burnout that simultaneously address burnout in one or more other healthcare worker populations
- Interventions that address higher rates of burnout among nurses of racial and ethnic minoritized backgrounds
- Multilevel interventions involving the external environment, healthcare organization, and frontline care delivery
- Effective approaches to engaging nurses in systems redesign to reduce risk of burnout
Study design is not limited; this initiative will support rigorous interventional research designs. Projects may involve collection of primary data and/or analysis of secondary data. Partnerships between various settings, such as community, academic, and health systems settings, are encouraged.
Non-Responsive Applications
This announcement is specifically seeking studies about the job-induced phenomenon of nurse burnout. Studies including other concepts will only be considered responsive if nurse burnout is also included in the study.
Interventions solely at the individual nurse level that seek to improve nurse resilience, stress, and attitudes or other behavioral interventions (e.g., self-care, mindfulness, yoga courses, therapy), without targeting the organizational factors that give rise to burnout, will be considered non-responsive to this announcement.
Interventions involving only the environment external to the healthcare organization will be considered non-responsive to this announcement.
This announcement is not seeking studies on depression, anxiety, posttraumatic stress disorder, etc. While other concepts such as moral distress and injury may contribute to the development of burnout, they are distinct concepts with differential contributors and consequences.
Application and Submission Information
This notice applies to due dates on or after October 05, 2023 and subsequent receipt dates through May 8, 2025.
Submit applications for this initiative using one of the following notices of funding opportunity (NOFO) or any reissues of these announcements through the expiration date of this notice.
- PAR-22-230 - NINR Areas of Emphasis for Research to Optimize Health and Advance Health Equity (R01 Clinical Trial Optional)
- PAR-22-231 - NINR Areas of Emphasis for Research to Optimize Health and Advance Health Equity (R21 Clinical Trial Optional)
All instructions in the SF424 (R&R) Application Guide and the notice of funding opportunity used for submission must be followed, with the following additions:
- For funding consideration, applicants must include “NOT-NR-23-012” (without quotation marks) in the Agency Routing Identifier field (box 4B) of the SF424 R&R form. Applications without this information in box 4B will not be considered for this initiative.
Applications nonresponsive to terms of this NOSI will not be considered for the NOSI initiative.
Please direct all inquiries to the contacts in Section VII of the listed notice of funding opportunity with the following additions/substitutions:
and Human Services (HHS)
