September 28, 2023/Leadership

International Study Examines Mental Health and Well-being of Nurses and Physicians

Magnet4Europe initiative focuses on the value of positive work environments


Cleveland Clinic is one of 67 U.S. hospitals participating in the Magnet4Europe initiative, launched in January 2020 to improve the mental health and well-being of nurses, physicians and other healthcare professionals in Europe. The four-year initiative has two key components:

  • Twinning relationships were formed between U.S. Magnet-accredited hospitals and European hospitals aspiring to improve their work environment by implementing Magnet principles. Cleveland Clinic’s relationship with Magnet4Europe was covered in a February 2023 ConsultQD article.
  • A concurrent research study was conducted on the mental health and well-being of the nurse and physician workforce and the value of positive work environments for well-being.


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“The international research project looked at a multitude of themes related to professionalism and workplace well-being, including associated outcomes, in U.S. and European health systems that participated in the Magnet4Europe initiative,” explains Nancy M. Albert, PhD, CCNS, CHFN, CCRN, NE-BC, FAHA, FCCM, FHFSA, FAAN, ACNO of the Office of Nursing Research and Innovation, who led Cleveland Clinic’s involvement in the study.

“Clinician burnout in healthcare – and particularly nurses working in hospital settings – is a major problem that affects workplace environment, retention and recruitment, and patient outcomes,” says Dr. Albert. “In many studies in the literature, authors found that nurses who were more engaged in professional activities and were committed to ensuring patients received evidence-based care had higher resilience to stress and less burnout, despite organizational workload demands.”

Hospitals in the United States participated in a one-time survey, the U.S. Clinician Wellbeing Study. European hospitals participated in an initial study, as well as a follow-up study to ascertain if there were any changes after twinning with a U.S. hospital and adopting Magnet Recognition Program® principles.


Study methods and results

The U.S. Clinician Wellbeing Study was a cross-sectional multicenter survey conducted in 2021 with clinicians at 60 U.S. Magnet hospitals and two large non-Magnet health systems, including 15,738 nurses and 5,312 physicians. Data were obtained via electronic surveys using multiple validated tools to measure well-being (burnout, job dissatisfaction and intention to leave, depression, anxiety, work-life balance, overall health, overall sleep and other factors) and quality of care and patient safety.

At Cleveland Clinic’s main campus, participants were acute care clinical nurses, advance practice providers and physicians. The lead investigators studied hospital nurses that did not participate in the Magnet Recognition Program as a comparator group. In that way, each site could compare nurses’ responses to non-Magnet site nurse responses. Among site participants (within and external to Cleveland Clinic’s site), aggregate data were categorized and described by participant type: clinical nurse, advance practice provider and physician.

Results of the study were published in JAMA Health Forum. Some of the findings included:

  • Across U.S. hospitals, 47% of nurses reported experiencing high burnout. However, the percentage ranged substantially between individual hospitals (28% to 66%).
  • 22% of nurses reported job dissatisfaction, and 40% indicated they intended to leave in the next year, if possible.
  • Nurse turnover was significantly associated with nurse burnout, nurse dissatisfaction and nurses’ intentions to leave their current job.

Value of participation

For the Cleveland Clinic main campus site, the U.S. Clinician Wellbeing Study provided insight on clinician well-being and work environment during the COVID-19 pandemic.

“Data were shared with physician and nursing leaders. The findings gave us data on areas where we were doing well in terms of resources and also opportunities for changes and improvement,” says Dr. Albert.


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