“My voice does not matter…” a qualitative analysis of clinician experiences with psychological safety, the work environment, and burnout

Clinician burnout remains prevalent, exacerbated by factors such as inadequate staffing, a lack of organizational support, devaluation, and poor interpersonal relations. Amidst provider shortages, the nurse practitioner (NP) workforce is expanding, paralleling high rates of burnout. This study, conducted from September to November 2022 with 17 California-based NPs, utilized a qualitative descriptive approach within a social ecological framework to examine NP experiences concerning burnout and psychological safety. Six themes were found: Burnout is dread, Illusion of autonomy, No voice. No value., Lacking psychological safety, Lost vocation, and Finding solutions. Results indicate that NPs experiencing burnout feel marginalized within hierarchical work environments, constrained by institutional practices, and fearful of voicing concerns. Conversely, NPs without burnout report having a significant voice and actively shaping their roles by advocating for autonomy. Opportunities for policy and practice improvements are discussed, including promoting NP autonomy, fostering a culture where all voices are valued, and recognizing burnout as a quality indicator beneficial for all members of the healthcare system.