There is a great deal of research on burnout in the literature, but little of it is specific to advanced practice registered nurses (APRNs) and physician assistants (PAs).

“We felt that our roles and responsibilities hold unique characteristics that warranted a separate study,” says April N. Kapu, DNP, APRN, ACNP-BC, FAANP, associate chief nursing officer at Vanderbilt University Medical Center.

Researchers sent a survey to every APRN and PA in the health system. This categorized respondents into three groups: currently burned out, never burned out, and formerly burned out. Of the 433 APRNs and PAs who completed the survey, 26% reported they were currently burned out.1 This group was in worse mental and physical health, and experienced more pain and fatigue than those in the “formerly” or “never” groups.

“We also found that regardless of burnout status, nurses maintained their empathy for their patients,” says Elizabeth Card, MSN, RN, APRN, FNP-BC, one of the study’s authors and a nursing research consultant at Vanderbilt University Medical Center.

The researchers’ previous work started with an examination of the prevalence of burnout, but now focuses on resiliency.2 “That is where we want to go in our understanding,” Card says. The reasoning is that simply knowing the prevalence of burnout is just the first step. “Just identifying burnout alone will not help us improve the situation. Finding [burnout] and nursing resiliency will,” Card offers.

One-third of respondents fell into the “formerly burned out group.” This group interested the researchers. “We were fascinated by the ‘formerly burned out’ group and their responses related to recovery and resilience,” says Kapu, the study’s lead author.

Many formerly burned-out nurses shared insights on how they successfully coped. One theme came up repeatedly: the need to make some type of change. This took many forms — switching jobs, caring for different types of patients, joining a social group, or starting a hobby. “But the point was to ‘make a change,’” Kapu adds.

For Vanderbilt’s ethicists, the study helped evaluate how to help APRNs and PAs prevent and cope with burnout. “We were really excited when this study came out because the data tell us how we can be helpful,” says Kate Payne, JD, RN, NC-BC, an associate professor of nursing at the Vanderbilt Center for Biomedical Ethics and Society.

The ethics department already offered plenty of support to APRNs and PAs. “We are always looking for ways to help support their ethical decision-making, which helps build resilience,” Payne reports.

One way ethicists do this is by making regular rounds at scheduled times in various units. They walk through the department and help with whatever is going on at the time. “We bring it to them. That way they don’t have to drop what they are doing and go to a conference room,” Payne explains.

Ethicists can offer some “sound bite” education, such as a quick review of ethical principles involved in decision-making for pediatric patients. Targeted education for APRNs is important. “Sometimes, we think it would be nice to have joint education sessions for all clinical caregivers. But bedside nurses, physicians, and APRNs each have their own set of ethical commitments,” Payne notes.

Certain APRNs are part of clinical teams that round throughout the hospital, and others are located on units such as trauma or the ICU. Their needs differ somewhat. “It’s like anything in healthcare. We try to tailor it to the needs of the patient, the family, or, in this case, the APRNs and PAs,” Payne says.

Sometimes, an APRN needs a debriefing after a devastating case, but has not called ethics. The regular rounds give them a chance to talk to the ethicist informally. Recently, a young nurse was distressed after her first time working on a cardiac death case that led to a donation.

“There was no ethical dilemma, but the nurse wanted to talk about the case,” Payne recalls. Ethicists listened, affirmed that everything was handled ethically, and reinforced that they are available 24 hours a day.

The study’s findings suggest Vanderbilt’s ethicists are on the right track. About one-quarter of formerly burned out nurses said they changed jobs because of burnout. Yet only about 8% of that group said they would recommend that to someone else. “Not everybody advocated for leaving a job. They were trying to figure out ways to change within their job,” Payne observes.

Limited opportunities for professional growth and development was a variable that correlated with burnout. Payne says the key is to offer APRNs growth without leaving their jobs to find it. Various skill-building workshops are offered, and APRNs are encouraged to become members of the ethics committee. Gaining ethics expertise offers two ways to foster resiliency: it is something new, and it is a way to grow professionally.

On the other hand, taking on an ethics role means less time for self-care. “The hardest thing about it is people don’t have the time to do it,” Payne laments. “It’s a constant balancing act.”

Burnout cannot always be prevented, of course, regardless of how many resources are available. “The nature of the work is difficult,” Payne notes. “But we keep trying to look for little ways to insert resiliency-building.”


  1. Kapu AN, Borg Card E, Jackson H, et al. Assessing and addressing practitioner burnout: Results from an advanced practice registered nurse health and well-being study. J Am Assoc Nurse Pract 2019; Nov 5. doi: 10.1097/JXX.0000000000000324. [Epub ahead of print].
  2. Card EB, Hyman SA, Wells N, et al. Burnout and resiliency in perianesthesia nurses: Findings and recommendations from a national study of members of the American Society of PeriAnesthesia Nurses. J Perianesth Nurs 2019;34:1130-1145.