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Unit-Level Burnout Dimensions and Patient Experience: A Multilevel Study of Aggregated Contextual Strain in a Southeast European Health System

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  • Edona Haxhija
  • Drita Kruja

Abstract

PurposeTo examine whether aggregated unit-level nurse burnout is associated with patient-reported experience across hospital units using a multilevel framework, conceptualizing burnout as aggregated contextual strain rather than homogeneous unit climate.MethodsA cross-sectional multilevel study was conducted across 11 regional public hospitals in Albania (October 2024–July 2025). Nurse burnout was assessed using the Maslach Burnout Inventory among 2000 nurses, and patient experience was measured with HCAHPS among 679 patients. Burnout scores were aggregated at the clinical-unit level. Multilevel linear modeling with patients nested within units examined associations between emotional exhaustion, depersonalization, personal accomplishment, and patient experience. Cluster-robust standard errors and leave-one-unit-out sensitivity analyses were conducted to assess estimate stability.ResultsPatient experience varied significantly between units (ICC = 0.229). In the multilevel model, higher unit-level emotional exhaustion and depersonalization were both associated with lower patient experience. Under cluster-robust estimation (t-distribution, df = 9), depersonalization remained statistically significant (robust p

Suggested Citation

  • Edona Haxhija & Drita Kruja, 2026. "Unit-Level Burnout Dimensions and Patient Experience: A Multilevel Study of Aggregated Contextual Strain in a Southeast European Health System," Nursing Research and Practice, Hindawi, vol. 2026, pages 1-18, October.
    • Handle: RePEc:hin:jnlnrp:7626110
    DOI: 10.1155/nrp/7626110
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