Used up or energetic, frustrated or exhilarated? Associations between scope of nursing practice and burnout Gerardo Melendez-Torres 1,2 ; Robyn Cheung, PhD, RN 2 1 The Wharton School, University of Pennsylvania 2 Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania  Nursing specialties have differential burnout rates (Browning et al., 2007).  Nurse burnout translates to lower patient satisfaction (Vahey, et al., 2004).  Nurse burnout affects healthcare outcomes in hospitals (Sochalski, 2001).  Nurse burnout leads to nurse turnover (Lake, 1998). Background Table 2: Burnout rates, correlates, and p-values 1.Examine the potential relationship between burnout and scope of practice, defined as practice as an NP, CNM, or CRNA or a non- advanced practice registered nurse (RN). 2.Examine potential correlates to burnout as a function of scope of nursing practice. Objectives % APNs reporting % non-APNs reporting p-value Emotional exhaustion2330<.001 Good physician-nurse relations Good physician-nurse teamwork 7368<.001 Good physician-nurse collaboration Nurse contributions acknowledged 6357<.001 Satisfied with job9081<.001  Table above displays data pooled for three states.  We ran the same analyses for the data in each state to control for differential practice environments.  Background. While burnout rates amongst nursing specialties have been studied, burnout as correlated with scope of nursing practice has not been studied.  Objective. We seek to explore the potential relationship between scope of nursing practice and burnout.  Methods. We used data from a 2006 survey of registered nurses in three states (n=58,249).  Results. Fewer advanced practice nurses (APNs) reported high levels of emotional exhaustion as compared to non-APNs.  Conclusions. APNs are less likely to suffer burnout than non-APNs. More research is necessary to see how burnout rates can be lowered across scopes of practice. Abstract  The Maslach Burnout Inventory-Emotional Exhaustion Subscale was included as part of the 2006 Nursing Care and Patient Safety Survey, sent to RNs in CA, PA, and NJ.  A score ≥27 on the MBI-EE indicates high emotional exhaustion among health professionals.  The survey also included questions about job satisfaction and practice environment.  We used Pearson’s chi-square test to verify statistically significant differences in burnout rates and satisfaction amongst APNs and non-APNs. Methods  APNs had significantly lower burnout rates than non-APNs, both across and within the three states.  APNs also reported significantly higher job satisfaction than non-APNs, both across and within the three states.  APNs reported significantly more positive ratings of practice environments than non-APNs across states, but not necessarily within them. Results  These findings suggest that APNs experience less burnout than non-APNs.  These results also suggest that work environments differ between APNs and non-APNs.  Further research is necessary to determine which factors impact the differential burnout rates amongst APNs and non-APNs. Conclusions  Lower burnout rates may attract nurses to pursue careers as APNs.  This may particularly impact nurses at the bedside. A shift towards advanced practice would further exacerbate the bedside nursing shortage.  Comparing differences in practice environments between APNs and non-APNs could help to reduce burnout rates for all nurses, in turn improving patient health outcomes. Policy Implications  Special thanks to Jeannie Cimiotti, RN, DNSc, Tim Cheney, and Eileen Lake, RN, PhD, FAAN for their assistance.  This project was supported by the Leonard Davis Institute’s Summer Undergraduate Minority Research Program.  The 2006 Nursing Care and Patient Safety Survey, administered by the Center for Health Outcomes and Policy Research and affiliates, was funded by NIH/NINR R01-NR (Linda H. Aiken, PI). Acknowledgements Nurses have been providing expanded-scope primary care “unofficially” since the beginning of nursing practice. However, within the last forty years, the function and education of the advanced practice nurse—whether as a nurse practitioner, nurse-midwife, or nurse anesthetist—has been formalized through graduate degrees extending beyond initial bachelor’s level preparation. APNs can practice in all 50 states, and have primary care outcomes equal to—if not better than—physicians. Photo from the American Academy of Nurse Practitioners. Table 1: Characteristics of nurses in the study APNsnon-APNsTotal California New Jersey Pennsylvania Total