Task Delegation and Burnout Trade-offs Among Primary Care Providers and Nurses in Veterans Affairs Patient Aligned Care Teams (VA PACTs)

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

doi:10.3122/jabfm.2018.01.170083

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Task Delegation and Burnout Trade-offs Among Primary Care Providers and Nurses in Veterans Affairs Patient Aligned Care Teams (VA PACTs)

Journal article

Open access

Peer reviewed

Task Delegation and Burnout Trade-offs Among Primary Care Providers and Nurses in Veterans Affairs Patient Aligned Care Teams (VA PACTs)

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

Journal of the American Board of Family Medicine, Vol.31(1), pp.83-93

01/2018

DOI: 10.3122/jabfm.2018.01.170083

PMID: 29330243

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Abstract

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. 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. 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). 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.

Burnout, Professional - prevention & control

Cross-Sectional Studies

Delegation, Professional - organization & administration

Delegation, Professional - statistics & numerical data

Humans

Nurses - organization & administration

Nurses - psychology

Nurses - statistics & numerical data

Patient Care Team - organization & administration

Patient Care Team - statistics & numerical data

Physicians, Primary Care - organization & administration

Physicians, Primary Care - psychology

Physicians, Primary Care - statistics & numerical data

Primary Health Care - organization & administration

Primary Health Care - statistics & numerical data

Surveys and Questionnaires - statistics & numerical data

United States

United States Department of Veterans Affairs - organization & administration

United States Department of Veterans Affairs - statistics & numerical data

Workload - statistics & numerical data

Details

Title: Subtitle: Task Delegation and Burnout Trade-offs Among Primary Care Providers and Nurses in Veterans Affairs Patient Aligned Care Teams (VA PACTs)
Creators: Samuel T Edwards - VA Portland Health Care System
Christian D Helfrich - Oregon Health & Science University
David Grembowski - Department of Veterans Affairs
Elizabeth Hulen - University of Washington
Walter L Clinton - VA Greater Los Angeles Healthcare System
Gordon B Wood - Iowa City VA Health Care System
Linda Kim - University of Iowa
Danielle E Rose - Greater Los Angeles Health Care System Veterans Affairs
Greg Stewart - University of Iowa
Resource Type: Journal article
Publication Details: Journal of the American Board of Family Medicine, Vol.31(1), pp.83-93
DOI: 10.3122/jabfm.2018.01.170083
PMID: 29330243
ISSN: 1557-2625
eISSN: 1558-7118
Language: English
Date published: 01/2018
Academic Unit: Management and Entrepreneurship
Record Identifier: 9984380537102771

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