Advanced practice professionals (APPs) who experience job stressors such as role ambiguity, work pressure, and lack of autonomy are significantly more likely to experience burnout and chronic work stress, according to a study published in Nursing Outlook. The study results suggest there is a significant negative correlation between job stressors and work engagement, both of which are mediated by burnout.

To investigate the relationships among burnout, job stressors, work-family balance, and engagement, a team of investigators sent an online questionnaire to 3939 APPs. Of the cohort, there was a 34.7% response rate (n=1368), and 1218 individuals completed the entire questionnaire.

The majority of the included participants were women (84.8%); 90.5% worked full time, and 59% self-reported having ≥6 years of experience. Participants between the ages of 31 and 39 years made up the largest age group of participants (32.7%). Physician assistants (36.7%), ambulatory-based nurse practitioners (30.4%), and acute care nurse practitioners (20.8%) comprised the majority of the APPs surveyed.

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Statistical analysis confirmed that stress was positively related to burnout, burnout was negatively related to work engagement, stress was negatively related to work engagement, and burnout mediated the relationship between job stress and work engagement.

The suggestion that work-family balance is negatively related to stress and burnout and positively related to work engagement was only partly confirmed by the study. Statistical analysis suggested that there was only a significant negative relationship between work-family balance and stress.

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“This study represents the first comprehensive investigation of APPs, which enables future research to be aimed at enhancing the work environment and clinical well-being,” the authors noted.

“Findings of this study lend insights into the current practice climate for APPs and the presence of job-related stressors,” they continued.

“Knowledge of the associations between job stressors, age, and burnout as noted in the mediated structural model represents the first step in determining interventions that can be tested in future studies.”


Klein CJ, Weinzimmer LG, Cooling M, Lizer S, Pierce L, Dalstrom M. Exploring burnout and job stressors among advanced practice providers [published online September 23, 2019]. Nurs Outlook. doi:10.1016/j.outlook.2019.09.005