Importance: Occupational burnout syndrome is characterized by emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment and is prevalent among nurses. Although previous meta-analyses have explored the correlates of nurse burnout, none have estimated their association with health care quality and safety and patient morbidity and mortality.Objective: To evaluate the magnitude and moderators of the association between nurse burnout and patient safety, patient satisfaction, and quality of care.Data Source: The Web of Science, Scopus, MEDLINE, Embase, PsycINFO, CINAHL, and ProQuest databases were searched from January 1, 1994, to February 29, 2024.Study Selection: Two reviewers independently identified studies that reported a quantifiable association between nurse burnout and any of the outcomes of patient safety, patient satisfaction, or quality of health care.Data Extraction and Synthesis: The PRISMA 2020 guideline was followed. Two reviewers independently extracted the standardized mean difference (SMD) (Cohen d) estimates for a random-effects meta-analysis. Subgroup analyses and meta-regressions were conducted using prespecified variables.Main Outcomes and Measures: Any measure of patient safety, patient satisfaction, or quality of health care previously associated with nurse burnout.Results: A total of 85 studies (81 cross-sectional and 4 longitudinal) involving 288 581 nurses from 32 countries (mean [SD] age, 33.9 (2.1) years; 82.7% female; mean [SD] burnout prevalence rate with study-specific ascertainments, 30.7% [9.7%]) were included. Nurse burnout was associated with a lower safety climate or culture (SMD, −0.68; 95% CI, −0.83 to −0.54), lower safety grade (SMD, −0.53; 95% CI, −0.72 to −0.34), and more frequent nosocomial infections (SMD, −0.20; 95% CI, −0.36 to −0.04), patient falls (SMD, −0.12; 95% CI, −0.22 to −0.03), medication errors (SMD, −0.30; 95% CI, −0.48 to −0.11), adverse events or patient safety incidents (SMD, −0.42; 95% CI, −0.76 to −0.07), and missed care or care left undone (SMD, −0.58; 95% CI, −0.91 to −0.26) but not with the frequency of pressure ulcers. Nurse burnout was also associated with lower patient satisfaction ratings (SMD, −0.51; 95% CI, −0.86 to −0.17) but not with the frequencies of patient complaints or patient abuse. Finally, nurse burnout was associated with lower nurse-assessed quality of care (SMD, −0.44; 95% CI, −0.57 to −0.30) but not with standardized mortality rate. The associations were consistent across nurses’ age, sex, work experience, and geography and persistent over time. For patient safety outcomes, the association was smaller for the low personal accomplishment subcomponent of burnout than for emotional exhaustion or depersonalization, as well as for nurses with a college education.Conclusions and Relevance: In this systematic review and meta-analysis, nurse burnout was found to be associated with lower health care quality and safety and lower patient satisfaction. This association was consistent across nurse and study characteristics.

Objectives To compare the mental health and life satisfaction of those employed in the gig work and contingent work with those in full-time or part-time work and the unemployed in the UK during the COVID-19 pandemic. To explore the possible mechanisms of latent and manifest benefits of employment, such as financial precarity and loneliness. Design Cross-sectional survey. Participants A representative sample of 17 722 employed and unemployed British adults, including 429 gig workers. People with disability, retirees and full-time students are not included in the sample. Main outcome measures Mental health (General Health Questionnaire-12 score) and life satisfaction (a direct question from UK Household Longitudinal Study (UKHLS)) as outcomes. Self-reported loneliness (four widely used questions from UKHLS) and financial precarity (a direct question from UKHLS) as mediators. Results Gig workers reported mental health and life satisfaction worse than those employed full time and part time, but better than the unemployed. Mediation analyses showed that gig workers’ worse mental health and life satisfaction than other workers were explained by their higher levels of loneliness and financial precarity, while gig workers’ better mental health and life satisfaction than the unemployed were explained by their less financial precarity. Conclusions Informal and freelance economy provided manifest benefits of employment to gig workers compared with unemployment but lacked latent benefits of employment. Public policies should provide social support to freelance and contingent workers to reduce their loneliness and improve their psychological well-being, especially during the COVID-19 pandemic.

Aims: Previous research found an association between leisure time activities such as arts and cultural activities and self-reported health over the life course—a measure prone to response bias. This study tested the relationship between arts and cultural activities and allostatic load, a biomarker of chronic stress, and examined risky health behaviors, including alcohol consumption and smoking, as possible mediators. Methods: The sample consists of 8948 adults from the second wave of the United Kingdom Household Longitudinal Study, which is representative of the British population. The cross-sectional association between arts and cultural activities and allostatic load was tested with negative binomial models, and the mediation roles of alcohol consumption and smoking in the association was tested with the Karlson–Holm–Breen (KHB) decomposition method. Results: Frequent participation in arts, frequent attendance of cultural events, visits to museums or galleries, and visits to historical sites have negative associations with allostatic load. The associations are mediated by lower frequency of alcohol drinking and smoking. Conclusions: Cultural capital may promote health by reducing the frequency of health risk behaviors such as drinking alcohol and smoking. Future research and public health policies should consider whether cultural capital acts as a social determinant of health to promote healthy leisure activities over the life course.