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Greece and England top nurse 'burn out' league table


Nurses in England have lower levels of job satisfaction and are at higher risk of “burnout” than their counterparts in most other European countries, a major nursing study has revealed.

Only Greece has a higher percentage of nurses that consider themselves to be burnt out, findings from the RN4CAST study show.

Researchers from the University of Southampton and the National Nursing Research Unit at King’s College London surveyed over 2,900 nurses at 46 hospitals. The results were compared with samples from 11 other European countries and the US. More than 150,000 nurses were surveyed in total.

The results – published online in the BMJ – show that 78% of nurses in Greece felt burnt out, followed by 42% in England, 41% in Ireland and 40% in Poland. This is in contrast with the Netherlands and Switzerland, where only 10% and 15% felt burnt out respectively.

Other findings also make for gloomy reading, with 39% of nurses in England saying they were dissatisfied with their job and 44% that they intended to leave their job in the next year. Only nurses in Greece and Ireland were less satisfied.

In addition, 64% of nurses in England were not confident hospital managers would “resolve patients’ problems” and 34% were not confident patients could manage their own care after discharge. But even greater proportions were not confident in those issues in most other countries.

Researchers also recorded nurse staffing ratios. They found the average number of patients per registered nurse in England was 8.6. But in Belgium, Germany, Greece, Poland and Spain there were more than 10 patients per nurse.

The authors said in all the countries surveyed “hospitals with good work environments and better professional nurse staffing have more satisfied patients and nurses, and evidence of better quality and safety of care”.

Peter Griffiths, chair of health services research at Southampton University, said: “We are now analysing hospital data on death rates and rates of complications to see if high patient to staff ratios impact on these outcomes.”

Anne Marie Rafferty, professor of Nursing Policy at King’s College London, added: “It is also clear that England’s nurses are working in highly pressurised environments, resulting in lower levels of job satisfaction and greater ‘burnout’ compared to some other European health economies.”

Commenting on the findings, Lizzie Jelfs, director of policy at the Council of Deans of Health, said: “Given this evidence on the importance of ratios of registered nurses for high quality care, it is crucial that workforce planners consider the possible impact of cuts in the number of places for training adult nurses for the quality of care delivered to patients in years to come.”

The Royal College of Nursing last week published a separate report which recommended at least one registered nurse for between five and seven older patients. It said one nurse currently cared for around nine patients on older people’s wards, based on a survey of 1,700 nurses.

The results of the 2011 NHS staff survey were also released last week, covering 366 organisations and 134,967 staff. It showed 51% of staff would recommend their organisation as a place to work, down from 53% in 2010 and 55% in 2009.


Percentage of nurses in different countries who say they feel burnt out 
Country %
Greece 78
England 42
Poland 40
US 33
Germany     30
Spain  29
Sweden                      29
Belgium                            24
Norway  23
Finland       22
Netherlands  10


Average patient to nurse ratios in each country   
Country  Patients per RN
Greece   10.2
Sweden                                              7.7
Netherlands                     7
Ireland                                                             6.9
Norway     5.4      
US     5.3







Readers' comments (67)

  • Corporate_Care

    I spent four years doing general surgery and A&E in London and I can now tell that it was real tough.

    At the time I thought it was not bad at all because that's all I knew.

    Since I moved to Sydney (Australia) life as a Nurse changed dramatically.

    I found myself more relaxed, my salary doubled and I was providing better patient care. With a nurse-patient ratio of 1:4 and even 2:6 my job satisfaction increased exponentially.

    I wish all the best to the Nurses in England and Greece.

    Feel free to contact me if you want to know more about Nursing in Sydney.

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  • Corporate_Care

    I forgot to mention that we have fought real hard to get what we think is fair.

    Our union has been working overtime to get Nurses what we deserve.

    The salary of the nurses in NSW (New South Wales) has been increased by nearly 10% and our neighbours in VIC (Victoria) have recently been awarded a whooping 21% salary raise. Congratulations to the VIC nurses.

    Let's tweet!


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  • Average patient to nurse ratios in each country

    Patients per RN

    I know nurses are often expected to do the impossible but how does one look after 0.9 of a patient, even on average?

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  • these results are based on self report of 'burnout' and not on confirmed clinical diagnosis of the serious and severe mental health disorder where the patient is unable to work and requires lengthy expert care.

    the burnout here is probably exhaustion and some of the symptoms of the disorder which without adequate measures and support could lead to more severe symptoms and a full blow 'burnout syndrome'.

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  • Corporate_Care | 24-Mar-2012 1:53 am

    might have been helpful if they had included Australia and NZ and other countries were conditions are better in the list for comparison.


    As a general comment, it is quite interesting that the two lists above aren't in the same order.

    It is a shame they didn't post these side by side to make visual comparison easier on a small screen as it wastes too much time to keep scrolling up and down to make these comparisons.

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  • My medical ward has burnt me out. I care for 10 patients on day shift and 15 patients on night shift. Trying to watch out for confused/risk of falling patients along with acutely ill patients is like a juggling act.
    It is the trained nurse that is always at fault.
    It is a blame culture we are working in now which adds to your stress. As for anyone enquiring about my welfare well lets say I am still waiting.

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  • Pirate and Parrot

    78% of nurses in Greece felt burnt out, followed by 42% in England, 41% in Ireland and 40% in Poland. This is in contrast with the Netherlands and Switzerland, where only 10% and 15% felt burnt out respectively.

    Surely the self-reported 'I feel burnt out' is the significant bit, here - the P/N ratios can only be compared if the numbers of other clinical staff and how different staff combine is also included in the thinking, and that would be enormously difficult to do across a range of different countries ?

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  • tinkerbell

    I don't know when this survey was conducted. Was it pre greeks civil unrest due to austerity measures or afterwards?

    Was it pre suicide rates in greece allegedly increasing by 16% of afterwards?

    Was it pre greek public sector workers being laid of or after?

    As one who visits greece regularly i can only say that the greek people i meet say 'our lives are shit' under these austerity cuts.

    A greek family can barely feed their family due to price rises, increased taxation and job losses.

    If you dare mention to a greek that we have problems here in the UK they answer
    'nothing compared to what we are going through, our lives are shit'.

    As they too operate a 2 tier health care system one for the rich and one for the working class/poor and lose their benefits if unemployed i gather, they are now having to seek medical treatments from doctors offering it pro bono.

    Maybe we are headed in this direction too, if the multimillionaire tories have their way, so no wonder greece has the highest burn out rate as they are struggling under the weight of seeing their economy destroyed by the eurozone. You can't just change a culture by changing it currency. As a greek friend said to me 'you have to be wealthy to be healthy here'.

    The wealthy greeks will never pay their taxes, much like most of the wealthy here, there's always wriggle room.

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  • must also depend on what demands, duties and tasks fall to nurses and the organisation of their work in each country as well as just the number of patients in their care.

    A full reference to this study would be helpful.

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  • Anonymous 24-Mar-2012 12:14pm

    Good point

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