RPD123 - What is the experience of burnout among inpatient, hospital-based palliative care nurse practitioners?

Key Message : Inpatient, hospital-based palliative care nurse practitioners experience burnout shaped by general healthcare demands, palliative-specific stressors, and systemic and organizational forces. This study, grounded in Cognitive Appraisal Theory, highlights coping resources and autonomy that sustain role fulfilment, culminating in a Conentric Ring Model of Stress and Coping.

Abstract:

Background: Burnout among hospice and palliative care (HPC) clinicians is a critical issue (1,2). Inpatient, hospital-based palliative care (PC) nurse practitioners (NPs) face unique stressors, such as minimal team support, frequent exposure to death and dying, and limited resources, that may further occupational stress, yet little is known about how they experience and respond to these challenges (3). This study explored the burnout experiences of these NPs through the lens of Cognitive Appraisal Theory (CAT) (4), to understand their perceptions, coping strategies, and inform future research.

Methods: A qualitative descriptive study was conducted between January and May 2025 using purposive sampling. Data were collected through a demographic survey and semi-structured interviews and analyzed with descriptive statistics and inductive content analysis, respectively.

Results: Participants (N=21) resided in ten states, within each region of the United States, in urban settings (100%), ranged from 25-65 years, were female (n=19), male (n=2), identified as white (n=20), identified as Mexican-American (n=1), and had been practicing as an inpatient, hospital based PC NP for between 1 and 15 years. Participants described stressors arising from general healthcare demands (workload, documentation, staffing) and palliative-specific challenges (late consults, ethical distress, role ambiguity). Many reported feeling undervalued and marginalized compared to physician colleagues. Coping resources included personal strategies (exercise, boundary-setting, reflection) and professional supports (team debriefs, collaboration, autonomy). A Concentric Ring Model of Stress and Coping was conceptualized to depict the dynamic, layered nature of these experiences.

Conclusions: CAT provides a framework for understanding how inpatient, hospital-based PC NPs appraise and cope with stress. While strong professional commitment fosters resilience, it may also lead to exploitation. The findings underscore the need for interventions to prevent burnout and support this essential workforce.
Keywords: burnout, healthcare, palliative care, nurse practitioners, cognitive appraisal

References: 1.Kamal, A. H., Bull, J. H., Swetz, K. M., Wolf, S. P., Shanafelt, T. D., & Myers, E. R. (2017). Future of the palliative care workforce: Preview to an impending crisis. The American Journal of Medicine, 130(2), 113–114. https://doi.org/10.1016/j.amjmed.2016.08.046
2. Kamal, A. H., Wolf, S. P., Troy, J., Leff, V., Dahlin, C., Rotella, J. D., Handzo, G., Rodgers, P. E., & Meyers, E. R. (2019). Policy changes key to promoting sustainability and growth of the specialty palliative care workforce. Health Affairs (Project Hope), 38(6), 910–918. https://doi.org/10.1377/hlthaff.2019.00018
3. Zogby, C. B. (2023a). Burnout among palliative care providers. Journal of the American Association of Nurse Practitioners, 35(11), 676. https://doi.org/10.1097/JXX.0000000000000912
4. Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and coping. IBN 0-8261-4191-9 Springer Pub. June 10, 2024.