Task delegation and burnout trade-offs among primary care providers and nurses in veterans affairs patient aligned care teams (VA PACTs)

Samuel Edwards, Christian D. Helfrich, David Grembowski, Elizabeth Hulen, Walter L. Clinton, Gordon B. Wood, Linda Kim, Danielle E. Rose, Greg Stewart

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Purpose: Appropriate delegation of clinical tasks from primary care providers (PCPs) to other team members may reduce employee burnout in primary care. However, (1) the extent to which delegation occurs within multidisciplinary teams, (2) factors associated with greater delegation, and (3) whether delegation is associated with burnout are all unknown. Methods: We performed a national cross-sectional survey of Veterans Affairs (VA) PCP-nurse dyads in Department of VA primary care clinics, 4 years into the VA's patient-centered medical home initiative. PCPs reported the extent to which they relied on other team members to complete 15 common primary care tasks; paired nurses reported how much they were relied on to complete the same tasks. A composite score of task delegation/reliance was developed by taking the average of the responses to the 15 questions. We performed multivariable regression to explore predictors of task delegation and burnout. Results: Among 777 PCP-nurse dyads, PCPs reported delegating tasks less than nurses reported being relied on (PCP mean ± standard deviation composite delegation score, 2.97± 0.64 [range, 1-4]; nurse composite reliance score, 3.26 ± 0.50 [range, 1-4]). Approximately 48% of PCPs and 35% of nurses reported burnout. PCPs who reported more task delegation reported less burnout (odds ratio [OR], 0.62 per unit of delegation; 95% confidence interval [CI], 0.49-0.78), whereas nurses who reported being relied on more reported more burnout (OR, 1.83 per unit of reliance; 95% CI, 1.33-2.5). Conclusions: Task delegation was associated with less burnout for PCPs, whereas task reliance was associated with greater burnout for nurses. Strategies to improve work life in primary care by increasing PCP task delegation must consider the impact on nurses.

Original languageEnglish (US)
Pages (from-to)83-93
Number of pages11
JournalJournal of the American Board of Family Medicine
Volume31
Issue number1
DOIs
StatePublished - Jan 1 2018

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Patient Care Team
Veterans
Primary Health Care
Nurses
Odds Ratio
Confidence Intervals
Patient-Centered Care

Keywords

  • Cross-sectional studies
  • Patient care team
  • Patient-centered care
  • Personnel turnover
  • Primary health care
  • Professional burnout
  • Veterans

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Family Practice

Cite this

Task delegation and burnout trade-offs among primary care providers and nurses in veterans affairs patient aligned care teams (VA PACTs). / Edwards, Samuel; Helfrich, Christian D.; Grembowski, David; Hulen, Elizabeth; Clinton, Walter L.; Wood, Gordon B.; Kim, Linda; Rose, Danielle E.; Stewart, Greg.

In: Journal of the American Board of Family Medicine, Vol. 31, No. 1, 01.01.2018, p. 83-93.

Research output: Contribution to journalArticle

Edwards, Samuel ; Helfrich, Christian D. ; Grembowski, David ; Hulen, Elizabeth ; Clinton, Walter L. ; Wood, Gordon B. ; Kim, Linda ; Rose, Danielle E. ; Stewart, Greg. / Task delegation and burnout trade-offs among primary care providers and nurses in veterans affairs patient aligned care teams (VA PACTs). In: Journal of the American Board of Family Medicine. 2018 ; Vol. 31, No. 1. pp. 83-93.
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AU - Edwards, Samuel

AU - Helfrich, Christian D.

AU - Grembowski, David

AU - Hulen, Elizabeth

AU - Clinton, Walter L.

AU - Wood, Gordon B.

AU - Kim, Linda

AU - Rose, Danielle E.

AU - Stewart, Greg

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AB - Purpose: Appropriate delegation of clinical tasks from primary care providers (PCPs) to other team members may reduce employee burnout in primary care. However, (1) the extent to which delegation occurs within multidisciplinary teams, (2) factors associated with greater delegation, and (3) whether delegation is associated with burnout are all unknown. Methods: We performed a national cross-sectional survey of Veterans Affairs (VA) PCP-nurse dyads in Department of VA primary care clinics, 4 years into the VA's patient-centered medical home initiative. PCPs reported the extent to which they relied on other team members to complete 15 common primary care tasks; paired nurses reported how much they were relied on to complete the same tasks. A composite score of task delegation/reliance was developed by taking the average of the responses to the 15 questions. We performed multivariable regression to explore predictors of task delegation and burnout. Results: Among 777 PCP-nurse dyads, PCPs reported delegating tasks less than nurses reported being relied on (PCP mean ± standard deviation composite delegation score, 2.97± 0.64 [range, 1-4]; nurse composite reliance score, 3.26 ± 0.50 [range, 1-4]). Approximately 48% of PCPs and 35% of nurses reported burnout. PCPs who reported more task delegation reported less burnout (odds ratio [OR], 0.62 per unit of delegation; 95% confidence interval [CI], 0.49-0.78), whereas nurses who reported being relied on more reported more burnout (OR, 1.83 per unit of reliance; 95% CI, 1.33-2.5). Conclusions: Task delegation was associated with less burnout for PCPs, whereas task reliance was associated with greater burnout for nurses. Strategies to improve work life in primary care by increasing PCP task delegation must consider the impact on nurses.

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KW - Professional burnout

KW - Veterans

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