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Nationally and in Hawaii, nurses are in crisis with high rates of distress, burnout, and intent to change jobs. Organizations need evidence-based strategies to support nurse well-being.
Informed by the National Academy of Medicine Factors Affecting Clinician Well-Being Model, this study aimed to identify individual and external factors associated with nurses' well-being.
In December 2023, an online survey of hospital-based nurses from two major hospitals, representing various unit types, was conducted in Hawaii. Survey measures included individual (role, personal characteristics, skills/abilities) and external factors (organizational, environmental) that support clinician well-being. The outcome (well-being) was measured using the well-being index (scores ranged from −2 [excellent] to 9 [very poor]). The analysis included general linear modeling with stepwise backward selection.
The final sample included 552 nurses. Years of experience were evenly distributed, and the majority worked ≥ 36 h/week (85.9%), worked in intensive-focused or other specialties units (53.8%), and identified as female (87.3%). The nurses identified their race/ethnicity as 27% Filipino, 23% White, 14% Japanese, 11% Other Asian, 6.1% Hispanic, 5.1% Native Hawaiian/Pacific Islander (NHPI), and 14% mixed or other race. The average well-being score was 2.8 (SD = 2.3). NHPI had the lowest (Mean ± SD = 2.2 ± 2.2), and Filipino and White nurses had the highest well-being scores (3.0 ± 2.2; 3.0 ± 2.0, respectively), although no significant racial/ethnic difference was found. Several internal and external factors were significantly associated with well-being. For example, working ≥ 36 h/week, reports of experienced burnout, having primary caregiving responsibility outside of work, lower self-reported physical health, and the experience of workplace violence all increased average well-being scores (worsened well-being). In contrast, having higher personal resilience, no leadership responsibilities, the belief that their organization is responsive to complaints and concerns, and appropriate ancillary staff to support their work all decreased average well-being scores (improved well-being).
Healthcare organizational leaders and policymakers must urgently correct system issues contributing to burnout, suboptimal mental health, decreased well-being, and attrition among nurses. Healthcare organizations should cultivate wellness cultures and provide infrastructure that offers evidence-based interventions to support nurses' well-being.
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