The relationship between inpatient nurse burnout and safety outcomes in a teaching hospital in Thailand


  • Witoonsut C Department of Community Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University
  • Aekplakorn W Department of Community Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University
  • Phaipayom N Department of Community Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University
  • Wongrathanandha C Department of Community Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University


burnout, inpatient nurse, medication errors, sharp object injuries, safety outcomes


Objectives  To identify the prevalence of inpatient nurse burnout and determine the association between burnout and safety outcomes based on self-reports and system reports, including medication errors, and sharp object injuries.

Methods A cross-sectional study was conducted of 1,464 inpatient nurses at a teaching hospital in Thailand. A self-administered questionnaire was used to collect demographic data, burnout assessment, and self-reported safety outcomes. System-reported safety outcomes were obtained from hospital incident occurrence reports (IOR).  Mixed effect logistic regression and negative binomial regression models were used to explore the association between inpatient nurse burnout and both self-reported and IOR safety outcomes.

Results Of the 702 participating inpatient nurses, 27% reported high emotional exhaustion, 13% reported high depersonalization, and only one nurse reported low personal accomplishment. The high emotional exhaustion dimension was statistically associated with self-reported medication errors (ORadj 1.90, 95%CI 1.1-3.2) and self-reported sharp object injuries (ORadj 3.12, 95%CI 1.2-7.9). For each one-point increase in emotional exhaustion on a 7-point Likert scale, the rate of reported sharp object injuries increased by 15% (p < 0.05).

Conclusions Emotional exhaustion among inpatient nurses was noticeable and could potentially impact on patient and personnel safety. Identification of nurses with emotional exhaustion and provision of support should be considered as a part of included in policies to improve safety outcomes in the healthcare services.


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1. Healthcare Accreditation Institute Information. Patient safety goals: SIMPLE Thailand 2018 [Internet]. Nonthaburi: Healthcare Accreditation Institute; c2019 [updated 2019] [cited 2020 Jan 20]. Available from:
2. Fathi A, Hajizadeh M, Moradi K, Zandian H, Dezhkameh M, Kazemzadeh S, et al. Medication errors among nurses in teaching hospitals in the west of Iran: what we need to know about prevalence, types, and barriers to reporting. Epidemiol Health. 2017;39:1-7.
3. Salmasi S, Khan TM, Hong YH, Ming LC, Wong TW. Medication errors in the Southeast Asian countries: a systematic review. PloS one. 2015;10:1-19.
4. World Health Organization. Medication without harm - global patient safety challenge on medication safety. Geneva, Switzerland: World Health Organization;2017.
5. Sharps Safety for Healthcare Settings | CDC [Internet].;2020 [cited 2020 Nov 26]. Available from:
6. Honda M, Chompikul J, Rattanapan C, Wood G, Klungboonkrong S. Sharps injuries among nurses in a Thai regional hospital: prevalence and risk factors. Int J Occup Environ Med. 2011;2:215-23.
7. Reason J. Human error: models and management. BMJ. 2000;320(7237):768-70.
8. Nantsupawat A, Nantsupawat R, Kunaviktikul W, Turale S, Poghosyan L. Nurse burnout, nurse-reported quality of care, and patient outcomes in Thai hospitals. J Nurs Scholarsh. 2016;48:83-90.
9. Wang S, Yao L, Li S, Liu Y, Wang H, Sun Y. Sharps injuries and job burnout: a cross-sectional study among nurses in China. Nurs Health Sci. 2012;14:332-8.
10. World Health Organization (WHO). Burn-out an “occupational phenomenon”: International classification of diseases [Internet]. Geneva, Switzerland: World Health Organization; 2019 [updated 2019] [cited 2019 Oct 30]. Available from:
11. Maslach C, Jackson SE, Leiter MP, Schaufeli WB, Schwab RL. Maslach burnout inventory. Palo Alto (CA): Consulting Psychologists Press; 1986.
12. Aiken LH, Sloane DM, Clarke S, Poghosyan L, Cho E, You L, et al. Importance of work environments on hospital outcomes in nine countries. Int J Qual Health Care. 2011;23:357-64.
13. AHRQ Patient Safety Network [Internet]. Rockville (MD): Agency for Healthcare Research and Quality; 2015. Burnout among health professionals and its effect on patient safety: Annual perspective 2015;2015 [cited 2019 Oct 30]; [about 3 screens]. Available from:
14. Hall LH, Johnson J, Watt I, Tsipa A, O’Connor DB. Healthcare Staff Wellbeing, Burnout, and Patient Safety: A Systematic Review. PLoS One. 2016;11:e0159015.
15. Bujang MA, Sa’at N, Sidik T, Joo LC. Sample size guidelines for logistic regression from observational studies with large population: emphasis on the accuracy between statistics and parameters based on real life clinical data. Malays J Med Sci. 2018;25:122-30.
16. Mental Health Center 7. Burnout questionnaire for healthcare personnel: the development of the burnout protection reinforcement system including care for the public health officers in the Mental Health Center 7 [Internet]. Khon Kaen: Mental Health Center 7;2017 [cited 2020 Jan 14];[about 3 screens]. Available from:แบบประเมินภาวะหมดไฟ-ฉบับเผยแพร่.pdf [in Thai]
17. About medical errors | NCC MERP [Internet]. [place unknown]: NCC MERP;c2019. About medication errors: What is a medication error?;c2019 [cited 2019 Oct 30];[about 1 screen]. Available from:
18. Heath and social care services - sharps injuries [Internet]. [place unknown]: Health and Safety Executive;2019 [cited 2019 Oct 30];[about 2 screens]. Available from:
19. Bursac Z, Gauss CH, Williams DK, Hosmer D. A purposeful selection of variables macro for logistic regression. Source Code Biol Med. 2007;173:1-5.
20. Moghaddasi J, Mehralian H, Aslani Y, Masoodi R, Amiri M. Burnout among nurses working in medical and educational centers in Shahrekord, Iran. Iran J Nurs Midwifery Res. 2013;18:294-7.
21. Maslach C, Schaufeli WB, Leiter MP. Job burnout. Annu Rev Psychol. 2001;52:397-422.
22. Summawart S. Burnout among the staff nurses in Rama-thibodi hospital (master’s thesis). Nakon Pathom: Mahidol University; 1989. p. 87.
23. Nantsupawat A, Nantsupawat R, Kulnaviktikul W, McHugh MD. Relationship between nurse staffing levels and nurse outcomes in community hospitals, Thailand. Nurs Health Sci. 2015;17:112-8.
24. Hajibabaee F, Joolaee S, Peyravi H, Alijany-Renany H, Bahrani N, Haghani H. Medication error reporting in Tehran: a survey. J Nurs Manag. 2014;22:304-10.
25. Kiymaz D, Koc Z. Identification of factors which affect the tendency towards and attitudes of emergency unit nurses to make medical errors. J Clin Nurs. 2018;27: 1160-9.
26. Hobfoll SE, Halbesleben J, Neveu J-P, Westman M. Conservation of resources in the organizational context: the reality of resources and their consequences. Annu Rev Organ Psychol Organ Behav. 2018;5:103-28.
27. Rudman A, Arborelius L, Dahlgren A, Finnes A, Gustavsson P. Consequences of early career nurse burnout: A prospective long-term follow-up on cognitive functions, depressive symptoms, and insomnia. EClinicalMedicine. 2020;27:1-10.
28. Linden DVD, Keijsers GPJ, Eling P, Schaijk RV. Work stress and attentional difficulties: an initial study on burnout and cognitive failures. Work Stress. 2005;19:23-36.
29. Halbesleben JR. The role of exhaustion and workarounds in predicting occupational injuries: a cross-lagged panel study of health care professionals. J Occup Health Psychol. 2010;15:1-16.




How to Cite

C W, W A, N P, C W. The relationship between inpatient nurse burnout and safety outcomes in a teaching hospital in Thailand. Chiang Mai Med J. [Internet]. 2021 Jul. 1 [cited 2023 Feb. 6];60(3):325-34. Available from:



Original Article