Background: Worldwide, rather few studies have examined the association between burnout and care quality using objectively measured quality indicators, with most of the studies have relied on perceived quality outcomes. This study aimed to examine the association between staff nurses’ burnout and selected objective quality metrics in long-term care wards in Japan. Methods: This is a secondary analysis of a cross-sectional survey. Nurse managers and staff nurses working at randomly selected hospitals with long-term care wards—the equivalent of skilled nursing homes in Western countries— completed self-administered, anonymous questionnaires. The questionnaires collected data regarding care quality indicators, staff nurses’ burnout, and other confounders (e.g., ward size, participants’ years of experience, and patients’ conditions). All statistical analyses were conducted at the ward level. A multivariate regression analysis was used to examine associations between burnout and outcome indicators. Results: Data from 196 wards in 196 hospitals (196 nurse managers and 2473 staff nurses) across Japan were analyzed. Multivariate regression analysis showed that higher emotional exhaustion was associated with higher rates of pneumonia and pressure ulcers (p-value = .036 and .032, respectively), and that reduced personal accomplishment was associated with higher rates of tube feeding (p-value = .018). A larger ward size was also associated with low rates of pneumonia (regression coefficient = −.001, p-value = .019). Conclusions: Staff nurses’ burnout is a significant determinant of care quality in long-term care wards, implying that organizations that implement burnout reducing strategies may see greater benefits in patient outcomes. A large ward size was significantly associated with better care outcomes—specifically, low rates of pneumonia. Future research needs to determine feasible quality improvement measures in small-scale long-term care facilities, and to provide more comprehensive insights on ward-level variables that influence care quality in long-term care settings.

Dealing with an aging society is a global challenge, and more countries than ever before are now mobilizing their healthcare systems to provide high-quality long-term care (LTC) to older adults. This paper reviews the current situation pertaining to aging and the issues for measuring the LTC quality in Japan. It also introduces current efforts to develop quality indicators for measuring LTC quality. Assuring the quality of LTC and developing indicators to measure its quality is a challenge worldwide. Detailed systems for LTC quality measurement have been developed and managed, primarily in the US. In Japan, on the other hand, such systems do not exist; the public LTC system mostly depends on the evaluation of structural aspects, such as facility structure and staffing. Our research group has been developing quality indicators to measure LTC quality. In the future, we aim to evaluate care quality in various LTC settings using the proposed quality indicators, aiming to improve care quality across LTC settings in the community-based integrated care system.