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. 2022 Oct 14;30(8):4015–4023. doi: 10.1111/jonm.13831

Work environment, resilience, burnout, intent to leave during COVID pandemic among nurse leaders: A cross‐sectional study

Aoyjai P Montgomery 1,✉, Patricia A Patrician 2
PMCID: PMC9874867  PMID: 36190507

Abstract

Aims

The aims of this work are to (1) investigate the work environment, resilience, burnout, and turnover intention and (2) examine how work environment and personal resilience impact burnout and turnover intention among nurse leaders in the midst of the COVID‐19 crisis.

Background

The COVID‐19 pandemic introduced tremendous stressors to nurse leaders, for example, managing the complex staffing situation while balancing patients' and family's needs.

Methods

During May to September 2021, an electronic survey was sent out to nurse leaders in Birmingham, Alabama, USA, and surrounding areas.

Results

Fifty‐six respondents were included in the study. The composite score of the work environment measure was moderately to highly related to resilience [ρ (rho) = .59] and burnout [ρ = −.63 to −.68] but had small association to intent to leave [ρ = −.30]. The resilience was highly correlated to burnout [ρ = −.53 to −.59] and moderately associated to intent to leave [ρ = −.32].

Conclusions

A better work environment for nurse leaders is related to higher resilience, lower burnout, and lower turnover intention. Resilience impacts burnout and turnover intention among nurse leaders.

Implications for Nursing Management

Health care organizations and stakeholders should implement effective strategies to improve the work environment, which could lead to enhanced resilience, reduced burnout, and lower turnover intention of their nurse leaders especially during and following this pandemic.

Keywords: coronavirus, nurse administrator, professional burnout, psychological resilience, workplaces

1. BACKGROUND

In March of 2020, the first case of COVID‐19 was announced in Alabama, USA; all schools in the state were ordered to close, and a state of public emergency was declared by the governor (State of Emergency: Coronavirus (COVID‐19), 2022). By the end of 2020, COVID‐19 hospitalizations peaked, with an average of 680 patients per day hospitalized for COVID‐19 in Birmingham and surrounding Jefferson County, Alabama (Allen et al., 2022). A second peak of hospitalized COVID‐19 patients occurred September 2021, with approximately 600 cases per day. As of 1 September 2021, 64% of Alabama residents received at least one dose of COVID vaccine, 52% were fully vaccinated, and 20% received a booster dose (USAFacts, 2022).

The COVID‐19 pandemic has deeply altered general working environments in many ways including social distancing, isolation periods, anxiety of getting sick, and fear of the future (Kawohl & Nordt, 2020). The workplace can play a significant role on worker mental health especially among frontline health care workers (Giorgi et al., 2020). Attributed to the COVID‐19 pandemic, anecdotal reports of overwork, burnout, turnover, and even suicide of health care professionals is being shared in the news and on social media (Dean, 2020). The cost of high turnover impacts hospitals' financial health and patient care quality (Duffield et al., 2014).

Nurse leaders play a crucial role in health care settings in balancing the needs of their staff (not only nursing staff but also all professional who work on their units or divisions) and the needs of the patients and families. They have been working to minimize the negative impact of the pandemic on their staff, such as moral distress, and at the same time, maximize success for all key stakeholders (Prestia, 2020). Nevertheless, the pandemic introduced new stressors to nurse leaders, for example, managing the complex staffing situation (staff shortages, reassigning nurses to cover COVID‐19 units, limited bed capacity, high patient acuities, shortage of personal protective equipment), while supporting their staff nurses (Hofmeyer et al., 2020). Struggling to maintain nurse staffing and reduce turnover may contribute to burnout and turnover among nurse leaders. Furthermore, nurse leaders have struggled to be resilient in this extremely chaotic health care environment (Udod et al., 2021). Thus, it is even more critical now to address the first objective of National Occupational Research Agenda (NORA) for Healthcare and Social Assistance, that is, to assess how work organization impacts both worker and patient safety, with specific research needs focusing on the connections between organization, staffing, and adverse health and safety outcomes in health care workers and their leaders (CDC, 2018).

Nurses' work environment is a multi‐dimensional concept defined as the organizational factors that contribute to or detract from a nurse's ability to conduct professional nursing and to provide high quality of care (Lake, 2002). A healthy work environment can reduce the impact of stress (Lowe, 2013) and foster resilience, that is, the capacity to cope and bounce back from unanticipated events (Wildavsky, 1988). Before the COVID‐19 pandemic, studies have shown that a healthy work environment and greater resilience can protect nurse leaders from experiencing burnout (Brown et al., 2018; Rushton et al., 2015), a syndrome of physical and emotional exhaustion caused by long‐term exposure to emotionally demanding situations, especially in people‐oriented occupations such as human services and health care (Maslach & Goldberg, 1998; Pines & Aronson, 1988). The consequences of nurse burnout include poor patient outcomes, such as decreased patient satisfaction, and a decline in nurse‐rated quality of care and patient safety (Montgomery et al., 2021, 2022), organizational outcomes such as diminished organizational commitment and turnover (Zanabazar & Jigjiddorj, 2022), and nurse outcomes, such as job dissatisfaction, and intention to leave (de Cordova et al., 2022; Dobson et al., 2021; Payne et al., 2020). Intent to leave or intention to leave can be defined as an intention of a worker to leave his or her present position or organization (Cho et al., 2009).

The Conservation of Resources (COR) theory has been adapted to guide the study. The COR theory can be applied to explain the nature of burnout (Hobfoll, 1989; Prapanjaroensin et al., 2017). According to the COR theory, a persistent threat to valued resources (example of valued resources are work environment and resilience and when these valued resources were threatened to be poor work environment and low resilience) culminates in burnout (Di Trani et al., 2021; Hobfoll, 1989; Montgomery et al., 2021), and threats to work environment and resilience could also be connected to low job performance, low job satisfaction, and high intent to leave (de Cordova et al., 2022; Hobfoll, 1989; Pozanti et al., 2022).

Since COVID‐19 began, there has been research concerning work environment, resilience, burnout, and turnover intention among nursing staff, but limited evidence among nurse leaders. Therefore, the aims of this study were to (1) investigate the work environment, resilience, burnout, and turnover intention and (2) examine how work environment and personal resilience impact burnout and turnover intention rates among nurse leaders in the midst of the COVID‐19 crisis in Birmingham, Alabama, hospitals.

2. METHODS

This descriptive, cross‐sectional study employed an electronic Qualtrics™ survey of several instruments to measure work environment, resilience, burnout, and turnover intention among nurse leaders.

2.1. Sample/subjects

The snowball sampling method was used in this study. Inclusion criteria were hospital‐based nurse leaders who work in Birmingham and surrounding areas, that is, nurse managers, directors of nursing, and other nurses in administrative roles. All Birmingham, Alabama, and surrounding area hospitals were affected to varying degrees by the pandemic. To identify if the hospital setting that participant worked, each participant was asked to indicate the hospital that he/she worked for; however, the hospital names were not reported for confidential purposes.

2.2. Data collection

The first author introduced this study at the bimonthly, local nurse leader organization meeting via Zoom and invited nurse leaders to respond to the survey using the weblink that was provided in the chat function of Zoom. Furthermore, a survey invitation was sent out during May to September 2021 via emails to this local nurse leader group, and members were asked to forward the weblink to other nurse leaders not affiliated with the local nurse leader organization.

2.3. Measures

2.3.1. Nurse manager practice environment scale

Work environment was measured by the Nurse Manager Practice Environment Scale (NMPES). The 44‐item NMPES has eight dimensions (i.e., Empowering Administrative Leaders Create a Culture of Patient Safety, Constructive Nurse Manager‐director Relationships, Culture of Generativity, Adequate Budgeted Resources, Culture of Meaning, Collegial Relationships between Nurse Managers and Physicians, Effective Nurse Manager‐Unit Staff Relationships, and Fair and Manageable Workload) (Warshawsky et al., 2013). The items were scored using a 6‐point Likert scale ranged from 1 (Strongly Disagree) to 6 (Strongly agree). The items within a subscale were averaged. Higher scores mean better work environments (Warshawsky et al., 2013). Cronbach's α ranged from .72 to .97 (Warshawsky et al., 2013).

2.3.2. Connor–Davidson Resilience Scale

Resilience was measured by the Connor–Davidson Resilience Scale (CD‐RISC‐25). The original 25‐item scale was designed with higher scores indicating high resilience. Scoring of the scale was based on summing the total of all items, each of which were scored from 0 = not true at all to 4 = true nearly all of the time (the total possible scores range from 0 to 100). An example of a resilience scale item is, “I am able to adapt when changes occur.” The Cronbach α was .89 and test–retest reliability correlation was .87 (Connor & Davidson, 2003).

2.3.3. Copenhagen Burnout Inventory (CBI)

Burnout was measured by the CBI. The CBI has three dimensions (i.e., Personal, Client‐related, and Work‐related burnout) with 19 items. An example of a CBI question is, “How often do you feel weak and susceptible to illness?” The items were scored using a 5‐point Likert scale that varies with the specific questions. For example, the first three items of the Work‐related Burnout subscale were scored as a 5 = very high degree, 4 = high degree, 3 = somewhat high degree, 2 = low degree, and 1 = very low degree, whereas the last four items of the Work‐related Burnout subscale were scored as 5 = always, 4 = often, 3 = sometimes, 2 = seldom, 1 = never/almost never. The response items were recoded into scores of 100, 75, 50, 25, and 0 from 100 = always to 0 = never. The items within a subscale were then averaged. Higher scores indicated a higher degree of burnout. The reliability of the three subscales was between .89 and .92 (Kristensen et al., 2005).

2.3.4. Intent to leave

A single item question for turnover intention was used, that is, “Do you plan to leave your present position?” The responses are 0 = No plans to leave, 1 = Yes, within the next 12 months, and 2 = Yes, within the next 6 months (Flinkman et al., 2010). While the use of single‐item measures can be seen as a limitation, there is evidence that a single‐item measure is highly correlated to the multiple‐item measures of the same concept and the test–retest reliability estimates of the single‐item measure are adequate when they measure a global concept such as job satisfaction (Dolbier et al., 2005; Patrician, 2004).

2.4. Statistical methods

Data were exported from Qualtrics™ into Microsoft Excel, and analyses were performed using SPSS version 28. To characterize the sample, descriptive statistics were used, with mean, standard deviation, and range for continuous variables, as well as frequency and percentages for categorical variables. Data were tested for normalcy using the Shapiro–Wilk test. A nonparametric correlation method (Spearman's rho) was used to examine how work environment and personal resilience impact burnout and turnover intention rates.

2.5. Ethical considerations

The study was approved as exempt human subjects research by the Institutional Review Board (No. IRB‐300006271) of the University of Alabama at Birmingham. Consent to participate was determined by the submission of the survey, as indicated in the survey introduction.

3. RESULTS

3.1. Descriptive statistics findings

Among participants, an average of years as nurse leaders was 10.86 years (SD = 8.88), the majority were female (89.3%), married or living with partner (78.6%), White (75%), had graduate degree (67.9%), and were either a nurse manager (42.9%) or a nursing director (35.7%). Table 1 shows the participant demographics in detail.

TABLE 1.

Participants demographics

Variables Mean SD Median Range
Years as nurse leader 10.86 8.88 7 1–40
Frequency Percentage
Gender
Male 6 10.7
Female 50 89.3
Marital status
Married/living with partner 44 78.6
Single/divorce/separated/widowed 12 21.4
Race
White 42 75.0
African American 13 23.2
American Indian 1 1.8
Education
Associate degree 7 12.5
Undergraduate 11 19.6
Graduate 38 67.9
Position
Advanced practice registered nurse 1 1.8
Chief nurse executive 4 7.1
Nurse educator 7 12.5
Nurse manager 24 42.9
Nursing director 20 35.7
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Table 2 shows the descriptive statistics of work environment, resilience, burnout, and intent to leave. Nurse leaders rated the following work environment subscales as the highest scores: Effective Nurse Manager‐Unit Staff Relationships (M = 4.98, SD = 0.9), Culture of Meaning (M = 4.94, SD = 0.8), and Constructive Nurse Manager‐director Relationships (M = 4.84, SD = 1.1) while they rated the following subscales as the lowest scores: Adequate Budgeted Resources (M = 3.96, SD = 1.2), Culture of Generativity (M = 4.28, SD = 1.0), and Fair and Manageable Workload (M = 4.67, SD = 0.9). An average resilience score was 76.46 (SD = 11.1) which is lower than the recommendation from the measure's developer (Resilience is defined as a mean score of ≥82) (Connor & Davidson, 2003). Nurse leaders rated high burnout levels on Personal Burnout (M = 54.76, SD = 22.5) and Work‐related Burnout (M = 52.81, SD = 21.5). Lastly, 91% of nurse leaders had no plans to leave their respective positions within a year.

TABLE 2.

Descriptive statistics of NMPES, CD‐RISC, CBI, and turnover intention (N = 56)

Variables Descriptive statistics
Nurse manager practice environment scale (NMPES) Mean SD Median Min Max
Empowering administrative leaders create a culture of patient safety 4.69 0.94 4.84 2.20 6.00
Constructive nurse manager‐director relationships 4.84 1.10 5.00 1.67 6.00
Culture of generativity 4.28 1.04 4.17 1.83 6.00
Adequate budgeted resources 3.96 1.22 4.00 1.00 6.00
Culture of meaning 4.94 0.83 5.00 2.25 6.00
Collegial relationships between nurse managers and physicians 4.76 1.18 5.00 1.00 6.00
Effective nurse manager‐unit staff relationships 4.98 0.90 5.00 1.33 6.00
Fair and manageable workload 4.67 0.90 4.67 2.67 6.00
Composite score 4.64 0.83 4.76 2.07 6.00
Connor‐Davidson Resilience Scale (CD‐RISC)
Composite score 76.46 11.13 73.50 49.00 99.00
Copenhagen Burnout Inventory (CBI)
Personal burnout 54.76 22.48 56.25 8.33 100.00
Work‐related burnout 52.81 21.49 53.57 7.14 96.43
Client‐related burnout 38.09 22.66 45.83 0.00 91.67
Turnover intention N %
No 51 91.1
Yes 5 8.9
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3.2. Correlations between work environment, resilience, burnout, and intent to leave

Because many variables and subscales did not meet the normality assumption (p of Shapiro–Wilk <.05), nonparametric correlation tests (Spearman's rho) were conducted. Table 3 shows the associations between work environment, resilience, burnout, and turnover intention. The NMPES subscales were significantly positively correlated (with moderate to large effect size) to each other except correlations between (1) Collegial Relationships between Nurse Managers and Physicians and Culture of Generativity (ρ (rho) = .26), (2) Fair and Manageable Workload and Collegial relationships between Nurse Managers and Physicians (ρ (rho) = .26), and (3) Fair and Manageable Workload and Effective Nurse Manager‐Unit Staff Relationships (ρ (rho) = .26). Burnout subscales were positively correlated to each other which indicates that if nurse leaders rated high burnout in one subscale, they were more likely to rate high burnout in other subscales as well.

TABLE 3.

The correlations between work environment, resilience, burnout, and intent to leave (Spearman's rho correlations)

1 2 3 4 5 6 7 8 9 10 11 12 13
1. Empowering administrative leaders a 1.00
2. Constructive nurse manager‐director relationships .82** 1.00
3. Culture of generativity .65** .69** 1.00
4. Adequate budgeted resources .69** .70** .77** 1.00
5. Culture of meaning .70** .60** .59** .63** 1.00
6. Collegial relationships b .34* .38** 0.26 .36* .56** 1.00
7. Effective nurse manager‐unit staff relationships .49** .63** .53** .55** .72** .64** 1.00
8. Fair and manageable workload .52** .44** .48** .47** .32* .26 .26 1.00
9. NMPES composite score .91** .91** .82** .82** .77** .49** .67** .55** 1.00
10. Resilience composite score .52** .47** .56** .37** .49** .34* .37* .43** .59** 1.00
11. Personal burnout −.62** −.52** −.61** −.57** −.32* −.23 −.29 −.56** −.63** −.53** 1.00
12. Work‐related burnout −.68** −.53** −.68** −.63** −.41** −.23 −.27 −.60** −.68** −.54** .85** 1.00
13. Client‐related burnout −.60** −.54** −.60** −.51** −.47** −.18 −.44** −.39** −.63** −.59** .57** .70** 1.00
14. Turnover intention −.29* −.27 −.34* −.35* −.20 −.02 −.22 −.33* −.30* −.32* .33* .30* .24
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Note: Client‐related burnout included your staff nurses, your direct reports, and/or patients and their family members.

a

Empowering Administrative Leaders Create a Culture of Patient Safety.

b

Collegial Relationships between Nurse Managers and Physicians.

*

p < .05.

**

p < .01.

All work environment subscales and the composite scores were positively related to nurse leaders' resiliency (ρ (rho) = .34–.59, p < .05). Work environment subscales were negatively related to burnout subscales [ρ (rho) = −.32 to −.68, p < .05]; however, two subscales of the NMPES, Collegial Relationships between Nurse Managers and Physicians and Effective Nurse Manager‐Unit Staff Relationships, were not significantly associated with burnout subscales [ρ (rho) = −.18 to −.29]. Three work environment subscales (i.e., Culture of Generativity, Adequate Budgeted Resources, and Fair and Manageable Workload) [ρ (rho) = −.33 to −.35] and the composite score [ρ (rho) = −.30] were correlated to turnover intention with moderate effect sizes while other subscales had small effect sizes [ρ (rho) = −.02 to −.27].

Nurse leaders' resiliency was negatively associated with burnout with a large effect size [ρ (rho) = −.53 to −.59] as well as with turnover intention with moderate effect size [ρ (rho) = −.32] which indicate that nurse leaders with higher resiliency reported lower burnout in all three subscales and were less likely to leave their positions.

4. DISCUSSION

Based on the study aim 1, the results reveal that these nurse leaders rated the following dimensions low: (1) Adequate Budgeted Resources, meaning having sufficient human and material resources and effective process to support the work of the unit, and (2) Culture of Generativity, meaning that nurse leaders have adequate time to coach and develop their frontline staff to improve patient care processes. These nurse leaders rated their resilience lower than the instrument developers' recommendation for what constitutes resilience (Connor & Davidson, 2003). Nurse leaders reported high Personal and Work‐related Burnout scores. However, only 9% of sample had planned to leave their positions within a year. For aim 2, results revealed that work environment was related to resilience, burnout, and intent to leave. Resilience was inversely correlated to burnout and intent to leave. According to the COR theory, this study reiterates that a persistent threat to valued resources (including poor work environment and lower resilience) culminates in burnout, and threats to these resources are also connected to intent to leave.

Comparing our findings of nurse leader work environment to the Warshawsky et al. (2013) study, our sample rated lower on Effective Nurse Manager‐Unit Staff Relationships, Empowering Administrative Leaders Create a Culture of Patient Safety. This may be a result of the COVID‐19 pandemic in that there is an increase in travel nursing staff and decrease in permanent nursing staff in the Birmingham, Alabama, area. This could explain the difficulty building relationships with a rather transient staff. In term of patient safety, COVID‐19 has impacted health care‐associated infection incidence in U.S. hospitals. Weiner‐Lastinger and colleagues reported a significant increase of central–line–associated bloodstream infections, catheter‐associated urinary tract infections, ventilator associated events, and methicillin‐resistant Staphylococcus aureus (MRSA) nationwide (Weiner‐Lastinger et al., 2022). However, when we compared our findings to the international study (Aslan et al., 2022), our sample reported lower scores in all subscales of the work environment except Fair and Manageable Workload. This could be explained by the different hospital types and presence of the COVID‐19 pandemic in our study (mostly public hospitals during COVID‐19 pandemic) versus the Turkish study (only private hospital and prior to the pandemic) (Aslan et al., 2022).

Our sample rated higher on Culture of Meaning, Culture of Generativity, Collegial Relationships between Nurse Managers and Physicians, Constructive Nurse Manager‐Director Relationships, Fair and Manageable Workload, and Adequate Budgeted Resources compared to Warshawsky and colleague's study. Warshawsky and colleagues also found that these dimensions were significant predictors of intent to leave which might explain that 91% of our nurse leader sample did not plan to leave their positions within a year (Warshawsky et al., 2013). However, it should be noted that our sample and Warshawsky and colleagues' sample have the following differences: our sample had (1) more years of experience as nurse leaders (Warshawsky and colleagues; M = 7.4, SD = 7.3), and (2) a higher percent of nurse leaders educated at the graduate level (Warshawsky and colleagues; 25%) (Warshawsky et al., 2013). Lastly, Warshawsky and colleagues' study included a more geographically dispersed group. It was conducted among 356 nurse leaders who worked in 25 hospitals in nine health care systems in six states (HI, KY, NC, PA, TX, VA) (Warshawsky et al., 2013).

An international study concluded that work environment plays a significant role in nurses' resilience even prior to the pandemic (Tabakakis et al., 2019). Nurses and nurse leaders working in poor work environments are at increased risk for manifesting physical and psychological symptoms of burnout syndrome, compassion fatigue, and post‐traumatic stress disorder (Lowe, 2013; Mealer et al., 2012). On the other hand, nurses and nurse leaders who can possess the capability to tolerate the devastating effects of stressful environments (including exposure to traumatic events such as COVID‐19 pandemic) are demonstrating the capacity to deliver high quality patient care despite unfavourable work conditions (Mealer et al., 2012). These nurses and nurse leaders who have learned to adapt and thrive in the midst of adversity are recognized as resilient. During COVID‐19, a group of researchers reported that constant adaptation to change and management of uncertainty were parts of resilience that they found in the experiences of frontline nurse managers (Vázquez‐Calatayud et al., 2022).

We found that resilience levels decrease with higher Personal, Work‐, and Client‐related Burnout and with the intent to leave one's position within a year which is congruent with the findings among staff nurses during the COVID‐19 pandemic in other countries (e.g., Lebanon, India, and Portugal) (Alameddine et al., 2021; Duarte et al., 2020; Jose et al., 2020). Being resilient can help nurse leaders to recover or deal better with trauma, which could lead to less burnout and a decreased likelihood to leave their jobs. Hence, health care organizations should implement effective strategies to enhance resilience of their nurse leaders especially in times of crisis, such as the COVID‐19 pandemic.

Limitations of this study include the use of a convenience sample of nurse leaders who worked in Birmingham, Alabama, and surrounding areas, and the homogenous nature of the study population, which was primarily female and White. Secondly, this study contained a small sample of participants. Future studies could benefit from exploring the experiences of nurse leaders who work in other states or countries to enhance generalizability. In addition, a self‐reported survey was used to assess all variables of interest (work environment, burnout, resilience, burnout, and turnover intention), which always raises the risk of response bias.

5. CONCLUSIONS

In conclusion, satisfaction with work environment dimensions among nurse leaders are different when we compared with studies prior to the COVID‐19 pandemic; however, work environment continues to play a significant role in resilience, burnout, and intent to leave among nurse leaders. The top three work environment dimensions that nurse managers during COVID‐19 pandemic rated scored high on were Effective Nurse Manager‐Unit Staff Relationships, Culture of Meaning, and Constructive Nurse Manager‐Director Relationships. Nurse leaders reported low resilience and high Personal and Work‐related Burnout. However, 91% of nurse leaders had no plans to leave their respective positions within a year. Better work environments are related to higher resilience, lower burnout, and less chance that nurse leaders would leave their jobs. Also, resilience impacts burnout levels and turnover intention among nurse leaders.

6. IMPLICATIONS FOR NURSING MANAGEMENT

Overall, this study contributes to knowledge in the area of work environment, burnout, resilience, and turnover intention among nurse leaders during the COVID‐19 pandemic. Overall, health care organizations and stakeholders should implement effective strategies to improve the work environments, which could lead to nurse leaders' enhanced resilience, reduced burnout, and less intention to leave especially during times of crisis.

Health care organizations should provide adequate resources that can support the administrative and supervisory responsibilities of nurse leaders. Nurse leaders should focus on the management aspects of their roles, be strategic, set clear priorities, and avoid micro‐management, so they may have more time available to coach and mentor their staff nurses. To be strategic, nurse leaders also need good mentorship to guide the individual in operations, management, and competing priorities. A new mentoring methodology in 2019 shows that a dyad model for mentoring between chief nursing officer and nurse manager was a success and helped nurse leaders to achieve executive nursing practice which support an individual career development (Sittler & Criswell, 2019).

Lastly, from a burnout standpoint, one of the simplest strategies to reduce burnout among nurses and nurse leaders is everyday recognition and appreciation (Raso, 2022). When peers, bosses, direct reports, or colleagues acknowledge the value in what nurse leaders do, a feeling of self‐worth and purpose is generated and magnified.

CONFLICT OF INTEREST

All authors declare that they have no conflict of interest.

ETHICS STATEMENT

The study was approved as exempt human subjects research by the University of Alabama at Birmingham Institutional Review Board (No. IRB‐300006271).

Montgomery, A. P. , & Patrician, P. A. (2022). Work environment, resilience, burnout, intent to leave during COVID pandemic among nurse leaders: A cross‐sectional study. Journal of Nursing Management, 30(8), 4015–4023. 10.1111/jonm.13831

Funding Information The Versant Center for the Advancement of Nursing (VCAN) by Association for Leadership Science in Nursing.

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

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