Abstract
Purpose: To implement real time burnout data that enables nurse leaders to identify and respond based on environmental risk factors.
Background: Burnout and moral injury among nurses are driven by increased demands and emotional toll of care delivery. These conditions compromise nurse well-being and affect patient outcomes and safety.4 Many contributing factors stem from under-resourced environments where nurses cannot provide the care they believe patients need. Resilience training can help mitigate stress, but systemic reform is needed to prevent burnout and moral injury before they occur.2
Methods: In September 2025, the WellNurse Program implemented environmental risk metrics into a dashboard. Metrics are categorized as stressors, protectors, mixed, or outcomes based on their role as leading or lagging indicators of burnout. Each metric is differing data points that increase or decrease the risk of nursing burnout such as workplace violence, injuries, workload, breaks, overtime, floating.1,3 Each are scored using a stoplight model (red: critical, yellow: at risk, green: healthy) and weighted into a composite score to track trends over time. Units scoring in the yellow or red zone can initiate consultation with the Director of Nurse Safety and Well-Being for deeper assessment and co-creation of an evidenced based implementation plan.
Results & Evaluation: Summer 2025 survey results showed 55% of nurses reported emotional exhaustion, 50% job-related frustration, and 58% burnout prior to program implementation. In a recent internal survey using the Moral Injury Symptom Scale-HP15, 51% of over 100 inpatient nurses reported moderate to severe moral injury, impacting personal and professional functioning.5 Qualitative feedback revealed that moral injury often stemmed from being unable to provide care aligned with nurses’ values. To assess program effectiveness, evaluations will occur at 6- and 12-months post-implementation. Key metrics include culture surveys, retention data, patient satisfaction, quality indicators, absenteeism, and focus group feedback. These tools aim to demonstrate meaningful improvements and support long-term systemic change.
Conclusion: Building healthier nurse work environments requires a holistic, data-informed approach. By identifying burnout and moral injury risks and implementing targeted, evidence-based interventions, health systems can foster sustainable, supportive environments where nurses thrive personally and professionally.
Notes
Presenter notes available in attached slide deck.
References:
1. Blake, Nancy. “Starting Now: Implementing the Healthy Work Environment Standards Is More Important than Ever.” AACN Advanced Critical Care, vol. 33, no. 4, 2022, pp. 372–375. https://doi.org/10.4037/aacnacc2022958.
2. Connor, Kathryn M., and Jonathan R. T. Davidson. “Development of a New Resilience Scale: The Connor-Davidson Resilience Scale (CD-RISC).” Depression and Anxiety, vol. 18, no. 2, 2003, pp. 76–82. https://doi.org/10.1002/da.10113.
3. King, Sarah, et al. “Using Real-Time Data to Mitigate Nurse Burnout.” Nurse Leader, vol. 21, no. 6, 2023, pp. 698–701. https://doi.org/10.1016/j.mnl.2023.08.011.
4. Li, Lambert Zixin, et al. “Nurse Burnout and Patient Safety, Satisfaction, and Quality of Care: A Systematic Review and Meta-Analysis.” JAMA Network Open, vol. 7, no. 11, 4 Nov. 2024, e2443059. https://doi.org/10.1001/jamanetworkopen.2024.43059.
5. Mantri, Shailendra, et al. “Identifying Moral Injury in Healthcare Professionals: The Moral Injury Symptom Scale-HP.” Journal of Religion and Health, vol. 59, no. 5, 2020, pp. 2323–2340. https://doi.org/10.1007/s10943-020-01065-w.
Sigma Membership
Non-member
Type
Presentation
Format Type
Text-based Document
Study Design/Type
Other
Research Approach
Other
Keywords:
Workforce, Implementation Science, Stress/Coping, Psychological Stress, Coping, Professional Burnout, Morals, Moral Injury, Nursing Leaders, Work Environment, Professional Burnout--Risk Factors
Recommended Citation
Spohnholtz, Sarrah; Douthit, Brian; and Audit, Carolyn, "Burnout & Moral Injury Metrics Inform Evidence-Based Nursing Workplace Solutions" (2026). Creating Healthy Work Environments (CHWE). 67.
https://www.sigmarepository.org/chwe/2026/presentations_2026/67
Conference Name
Creating Healthy Work Environments
Conference Host
Sigma Theta Tau International
Conference Location
Washington, DC, USA
Conference Year
2026
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2026-05-03
Burnout & Moral Injury Metrics Inform Evidence-Based Nursing Workplace Solutions
Washington, DC, USA
Purpose: To implement real time burnout data that enables nurse leaders to identify and respond based on environmental risk factors.
Background: Burnout and moral injury among nurses are driven by increased demands and emotional toll of care delivery. These conditions compromise nurse well-being and affect patient outcomes and safety.4 Many contributing factors stem from under-resourced environments where nurses cannot provide the care they believe patients need. Resilience training can help mitigate stress, but systemic reform is needed to prevent burnout and moral injury before they occur.2
Methods: In September 2025, the WellNurse Program implemented environmental risk metrics into a dashboard. Metrics are categorized as stressors, protectors, mixed, or outcomes based on their role as leading or lagging indicators of burnout. Each metric is differing data points that increase or decrease the risk of nursing burnout such as workplace violence, injuries, workload, breaks, overtime, floating.1,3 Each are scored using a stoplight model (red: critical, yellow: at risk, green: healthy) and weighted into a composite score to track trends over time. Units scoring in the yellow or red zone can initiate consultation with the Director of Nurse Safety and Well-Being for deeper assessment and co-creation of an evidenced based implementation plan.
Results & Evaluation: Summer 2025 survey results showed 55% of nurses reported emotional exhaustion, 50% job-related frustration, and 58% burnout prior to program implementation. In a recent internal survey using the Moral Injury Symptom Scale-HP15, 51% of over 100 inpatient nurses reported moderate to severe moral injury, impacting personal and professional functioning.5 Qualitative feedback revealed that moral injury often stemmed from being unable to provide care aligned with nurses’ values. To assess program effectiveness, evaluations will occur at 6- and 12-months post-implementation. Key metrics include culture surveys, retention data, patient satisfaction, quality indicators, absenteeism, and focus group feedback. These tools aim to demonstrate meaningful improvements and support long-term systemic change.
Conclusion: Building healthier nurse work environments requires a holistic, data-informed approach. By identifying burnout and moral injury risks and implementing targeted, evidence-based interventions, health systems can foster sustainable, supportive environments where nurses thrive personally and professionally.
Description
The WellNurse Program is designed to help nurse leaders identify and address burnout and moral injury in the nursing work environment. By integrating environmental risk metrics into a dashboard and offering tailored, evidence-based interventions, the program supports systemic change and promotes nurse well-being.