Multilevel Work Environment Factors and Occupational Well-Being Among APRNs Delivering Opioid Use Disorder Treatment: A Multistate Cross-Sectional Study

Background: Advanced practice registered nurses (APRNs) are central to delivering opioid use disorder (OUD) treatment, yet little is known about the individual and organizational factors related to the delivery of OUD care. Objectives: To examine associations between psychosocial and organizational factors among APRNs delivering OUD treatment. Design: Multistate cross-sectional study. Methods: An anonymous online survey of licensed and certified U.S. APRNs providing OUD care assessed nursing stress, burnout, vicarious trauma (VT) exposure, perceived stigma, organizational climate, training, clinical experience, and confidence in delivering OUD treatment. Participants were recruited nationally from February to June 2025 through professional nursing organizations and healthcare networks. Validated instruments were used, supplemented by empirically informed measures. Data were analyzed using descriptive statistics, Spearman’s rho correlations, and exploratory multivariable linear regression analyses informed by the Job Demands-Resources (JD-R) framework. Results: Among 400 APRNs (mean age=46.0 years, SD=11.77), 41% reported burnout related to OUD care, with moderate nursing stress (BNSS mean=14.01, SD=6.83) and high exposure to VT (78%). Younger age and racial minority status were associated with higher stress and burnout (Spearman’s rho (ρ) range=0.17–0.27, p≤0.004). Perceived stigma toward patients with OUD was positively correlated with stress and burnout (ρ=0.27-0.41, p<0.001), while organizational climate was inversely correlated with stress and burnout and positively correlated with confidence in OUD care (ρ=-0.24 to -0.37, p<0.001). In exploratory multivariable analyses, VT demonstrated the strongest adjusted associations with burnout (β=0.478, p<0.001) and nursing stress (β=0.411, p<0.001), while organizational climate remained inversely associated with both outcomes. X-waiver training (β=0.263, p<0.001) and organizational climate (β=0.207, p<0.001) demonstrated the strongest adjusted associations with confidence in OUD care. Conclusion: APRNs delivering OUD treatment report substantial occupational strain associated with psychosocial and organizational factors, including VT, stigma, organizational climate, and OUD-specific training. Further research is needed to understand these relationships and support APRN engagement in OUD care.