Background: Minimal research exists on how engagement, burnout, work-family balance, and job stressors impact advanced practice nurses and physician assistants, collectively referred to advanced practice providers (APPs). Purpose: To investigate the interrelationships among burnout, job stressors, workfamily balance, and engagement with APPs. Methods: An online questionnaire was distributed to APPs working in four healthcare systems. A total of 1,216 APPs completed the survey. A hypothesized model was tested using structural equation modeling. Findings: There was a high correlation of job stressors with development of burnout. A significant negative effect between job stress and work engagement was supported; however, indirect effects of stress through job burnout had a stronger impact on work engagement. Higher levels of work-family balance contributed to a lower level of stress experienced by providers. Discussion: Organizational leaders desiring to improve employee engagement and reduce burnout need to focus on the significance of work-family balance to job stressors.

Introduction

Burnout as a phenomenon has been well documented in nurses who provide direct care and its prevalence has been established (Aiken et al., 2001; McHugh, Kutney-Lee, Cimiotti, Sloane, & Aiken, 2011). Advanced practice providers (APPs) is a term used to describe advanced practice registered nurses (APRNs) and physician assistants (PAs) who work collaboratively with physicians. The rising concern for burnout among nurses and physicians globally (Linzer et al., 2001; Shanafelt et al., 2015) has prompted a need for a closer investigation of its possible existence in APPs who are expected to help address the projected shortage of 23,640 primary care physicians by 2025 within the United States of America (USA) (Health Resources Services Administration, 2016). However, there is very little research on the construct of burnout among APPs. The consequences of burnout within the healthcare professions include stress-related health problems, shorter careers, and turnover (Aiken et al., 2001; Bianchi, Mayor, Schonfield, & Laurent, 2018; Shanafelt et al., 2015; West, Dyrbye, & Shanafelt, 2018). It is difficult to know the degree to which burnout exists among different professionals (Helfrich et al., 2017). Retention of all providers is necessary to enhance the delivery and quality of care as access to care, particularly in rural areas, remains challenging. Emerging models of care that allow all healthcare professionals to work at the full scope and extent of their licensure are recommended as ways to improve efficiency, quality, and to meet healthcare needs; yet considerable challenges to full practice expansion of APRNs persist (Altman, Butler, & Shern, 2015). The expectations for APPs working within these new models suggest a need for consideration of their impact on job stressors. Fortney, Luchterhand, Zakletskaia, Zgierska, and Rakel (2013) proposed addressing elements of the work environment and self-care to avoid alienation and depersonalization, which are viewed as possible effects associated with an increasingly complex healthcare system.