Burnout, self- and supervisor-rated job performance, and absenteeism among nurses

Patient-Centered Medical Home Implementation and Burnout Among VA Primary Care Employees

Burnout is widespread throughout primary care and is associated with negative consequences for providers and patients. The relationship between the patient-centered medical home model and burnout remains unclear. Using survey data from 8135 and 7510 VA primary care employees in 2012 and 2013, respectively, we assessed whether clinic-level medical home implementation was independently associated with burnout prevalence and estimated whether burnout changed among this workforce from 2012 to 2013. Adjusting for differences in respondent and clinic characteristics, we found that burnout was common among primary care employees, increased by 3.9% from 2012 to 2013, and was not associated with the extent of medical home implementation.

The Cross-Level Effect of Authentic Leadership on Teacher Emotional Exhaustion: The Chain Mediating Role of Structural and Psychological Empowerment

Although previous research has found that authentic leadership has a negative effect on employee burnout through structural empowerment, lack of psychological empowerment in the research cannot present a complete picture on how authentic leadership influences burnout because employees must experience being psychologically empowered for empowerment to be effective. Drawing on empowerment-related theories, this study integrates the three different perspectives of empowerment (authentic leadership, structural empowerment, and psychological empowerment) to examine their effects on emotional exhaustion, the core component of burnout, at multiple levels of analysis. Using a sample of 378 teachers from 59 primary and secondary schools in China, multilevel structural equation modelling results revealed that: (1) authentic leadership had an indirect effect on psychological empowerment partially through structural empowerment, (2) psychological empowerment played a full mediating role in the relationship between structural empowerment and emotional exhaustion, and (3) structural empowerment and psychological empowerment sequentially mediated the effect of authentic leadership on emotional exhaustion. Theoretical and practical implications are discussed.

Burnout, associated comorbidities and coping strategies in French community pharmacies-BOP study: A nationwide cross-sectional study

Background

Work-related stress and burnout syndromes are unfortunately common comorbidities found in health professionals. However, burnout syndrome has only been partly and episodically assessed for community pharmacists whereas these professionals are exposed to patients’ demands and difficulties every day. Prevalence of burnout, associated comorbidities and coping strategies were assessed in pharmacy teams (pharmacists and pharmacy technicians) in French community pharmacies.

Methods

This online survey was performed by emails sent to all French community pharmacies over 3 months. The survey assessed the prevalence of burnout (Maslach Burnout Inventory—MBI—questionnaire), anxiety, depression and strategies for coping with work-related stress.

Results

Of the 1,339 questionnaires received, 1,322 were completed and useable for the analysis. Burnout syndrome was detected in 56.2% of respondents and 10.5% of them presented severe burnout syndrome. Severe burnout syndrome was significantly associated with men, large urban areas and the number of hours worked. Depression and anxiety were found in 15.7% and 42.4% of respondents, respectively. These co-morbidities were significantly associated with severe burnout syndrome. Higher MBI scores were significantly associated with medical consultations and medicinal drug use. Conversely, respondents suffering from burnout syndrome declared they resorted less to non-medical strategies to manage their work-related stress (leisure, psychotherapy, holidays and time off).

Conclusion

This study demonstrated that community pharmacists and pharmacy technicians presented high prevalence of burnout syndrome, such as many healthcare professionals. Unfortunately, burnout syndrome was associated with several comorbidities (anxiety, depression and alcohol abuse) and the consumption of health resources. The psychological suffering of these healthcare professionals underlines the necessity to deploy a strategy to detect and manage burnout in community pharmacy.

Prevalence of and factors associated with burnout among health care professionals in Arab countries: a systematic review

BACKGROUND

Burnout among healthcare professionals is one of the key challenges affecting health care practice and quality of care. This systematic review aims to (1) estimate the prevalence of burnout among health care professionals (HCP) in Arab countries; and (2) explore individual and work-related factors associated with burnout in this population.

METHODS

Multiple electronic databases were searched for studies published in English or Arabic from January 1980 to November 2014 assessing burnout (using the Maslach Burnout Inventory; MBI) amongst health care professionals (HCP) in Arab countries.

RESULTS

Nineteen studies (N = 4108; 49.3% females) conducted on HCP in Bahrain, Egypt, Jordan, Lebanon, Palestine, Saudi Arabia and Yemen were included in this review. There was a wide range of prevalence estimates for the three MBI subscales, high Emotional Exhaustion (20.0-81.0%), high Depersonalization (9.2-80.0%), and low Personal Accomplishment (13.3-85.8%). Gender, nationality, service duration, working hours, and shift patterns were all significantly associated with burnout.

CONCLUSIONS

Within the constraints of the study and the range of quality papers available, our review revealed moderate-to-high estimates of self-reported burnout among HCP in Arab countries that are similar to prevalence estimates in non-Arabic speaking westernized developed countries. In order to develop culturally appropriate interventions, further research using longitudinal designs is needed to confirm the risk factors for burnout in specific HCP settings and specialties in Arab countries.

The Association of Team-Specific Workload and Staffing with Odds of Burnout Among VA Primary Care Team Members

BACKGROUND

Work-related burnout is common in primary care and is associated with worse patient safety, patient satisfaction, and employee mental health. Workload, staffing stability, and team completeness may be drivers of burnout. However, few studies have assessed these associations at the team level, and fewer still include members of the team beyond physicians.

OBJECTIVE

To study the associations of burnout among primary care providers (PCPs), nurse care managers, clinical associates (MAs, LPNs), and administrative clerks with the staffing and workload on their teams.

DESIGN

We conducted an individual-level cross-sectional analysis of survey and administrative data in 2014.

PARTICIPANTS

Primary care personnel at VA clinics responding to a national survey.

MAIN MEASURES

Burnout was measured with a validated single-item survey measure dichotomized to indicate the presence of burnout. The independent variables were survey measures of team staffing (having a fully staffed team, serving on multiple teams, and turnover on the team), and workload both from survey items (working extended hours), and administrative data (patient panel overcapacity and average panel comorbidity).

KEY RESULTS

There were 4610 respondents (estimated response rate of 20.9%). The overall prevalence of burnout was 41%. In adjusted analyses, the strongest associations with burnout were having a fully staffed team (odds ratio [OR] = 0.55, 95% CI 0.47-0.65), having turnover on the team (OR = 1.67, 95% CI 1.43-1.94), and having patient panel overcapacity (OR = 1.19, 95% CI 1.01-1.40). The observed burnout prevalence was 30.1% lower (28.5% vs. 58.6%) for respondents working on fully staffed teams with no turnover and caring for a panel within capacity, relative to respondents in the inverse condition.

CONCLUSIONS

Complete team staffing, turnover among team members, and panel overcapacity had strong, cumulative associations with burnout. Further research is needed to understand whether improvements in these factors would lower burnout.

The role of psychosomatic medicine in intensive care units

Critically ill patients, their relatives, and intensive care staff are consistently exposed to stress. The principal elements of this exceptional burden are confrontation with a life-threatening disease, specific environmental conditions at the intensive care unit, and the social characteristics of intensive care medicine. The short- and long-term consequences of these stressors include a feeling of helplessness, distress, anxiety, depression, and even posttraumatic stress disorders. Not only the patients, but also their relatives and intensive care staff are at risk of developing such psychopathologies. The integration of psychosomatic medicine into the general concept of intensive care medicine is an essential step for the early identification of fear and anxiety and for understanding biopsychosocial coherence in critically ill patients. Preventive measures such as the improvement of individual coping strategies and enhancing the individual's resistance to stress are crucial aspects of improving wellbeing, as well as the overall outcome of disease. Additional stress-reducing measures reported in the published literature, such as hearing music, the use of earplugs and eye-masks, or basal stimulation, have been successful to a greater or lesser extent.

Influence of organizational context on nursing home staff burnout: A cross-sectional survey of care aides in Western Canada

PURPOSE

Our study examined care aide characteristics, organizational context, and frequency of dementia-related resident responsive behaviours associated with burnout. Burnout is the experience of emotional exhaustion, cynicism, and professional inefficacy. Care aide burnout has implications for turnover, staff health, and quality of care.

DESIGN AND METHODS

We used surveys collected from 1194 care aides from 30 urban nursing homes in three Western Canadian provinces. We used a mixed-effects regression analysis to assess care aide characteristics, dementia-related responsive behaviours, unit and facility characteristics, and organizational context predictors of care aide burnout. We measured burnout using the Maslach Burnout Inventory, Short Form.

RESULTS

We found that care aides were at high risk for emotional exhaustion and cynicism, but report high professional efficacy. Statistically significant predictors of emotional exhaustion included English as a second language, medium facility size, organizational slack-staff, organizational slack-space, health (mental and physical) and dementia-related responsive behaviours. Statistically significant predictors of cynicism were care aide age, English as a second language, unit culture, evaluation (feedback of data), formal interactions, health (mental and physical) and dementia-related responsive behaviours. Statistically significant predictors of professional efficacy were unit culture and structural resources. Greater care aide job satisfaction was significantly associated with increased professional efficacy.

IMPLICATIONS

This study suggests that individual care aide and organization features are both predictive of care aide burnout. Unlike care aide or structural characteristics of the facility elements of the organizational context are potentially modifiable, and therefore amenable to intervention.

Evaluation of the prevalence of burnout and psychological morbidity among radiation oncologist members of the Kyoto Radiation Oncology Study Group (KROSG)

This study aimed to evaluate the self-reported prevalence of burnout and psychological morbidity among radiation oncologists members of the Kyoto Radiation Oncology Study Group (KROSG) and to identify factors contributing to burnout. We mailed an anonymous survey to 125 radiation oncologists members of the KROSG. The survey included; the demographic data, the Maslach Burnout Inventory - Human Services Survey (MBI-HSS) and the 12-item General Health Questionnaire (GHQ-12). There were 87 responses out of 125 eligible respondents (69.6% response rate). In terms of burnout, three participants (3.4%) fulfilled the MBI-HSS criteria of having simultaneously high emotional exhaustion (EE), high depersonalization (DP) and low sense of personal accomplishment (PA). Eighteen (20.6%) reported a high score for either EE or DP meeting the alternative criteria for burnout with three of these simultaneously having high EE and high DP. The prevalence of psychological morbidity estimated using GHQ-12 was 32%. A high level of EE and low level of PA significantly correlated with high level of psychological morbidity with P < 0.001 and <0.01 respectively. Having palliative care activities other than radiotherapy and number of patients treated per year were the only factors associated with burnout. This is the first study investigating the prevalence of burnout and psychological morbidity among radiation oncologists in Japan. Compared with other studies involving radiation oncologists, the prevalence of low personal accomplishment was particularly high in the present study. The prevalence of psychological morbidity was almost the double that of the Japanese general population and was significantly associated with low PA and high EE.

Employee Burnout: A Meta-Analysis of the Relationship Between Age or Years of Experience

This study examined the relationship between age or years of experience and employee burnout by performing a meta-analysis on research studies that present findings on relationships between employee burnout and age or years of experience. The problem has practical significance in that the appropriateness of approaches to addressing employee burnout may depend on whether age or years of experience is a factor related to burnout. Results indicated that there was a small negative correlation between employee age and emotional exhaustion, one of the components of burnout, at least for employees in some fields in the United States, and possibly a small negative correlation between years of experience in a field and emotional exhaustion.

Emotional Exhaustion and Job Satisfaction in Airport Security Officers - Work-Family Conflict as Mediator in the Job Demands-Resources Model

The growing threat of terrorism has increased the importance of aviation security and the work of airport security officers (screeners). Nonetheless, airport security research has yet to focus on emotional exhaustion and job satisfaction as major determinants of screeners’ job performance. The present study bridges this research gap by applying the job demands–resources (JD–R) model and using work–family conflict (WFC) as an intervening variable to study relationships between work characteristics (workload and supervisor support), emotional exhaustion, and job satisfaction in 1,127 screeners at a European airport. Results of structural equation modeling revealed that (a) supervisor support as a major job resource predicted job satisfaction among screeners; (b) workload as a major job demand predicted their emotional exhaustion; and (c) WFC proved to be a promising extension to the JD–R model that partially mediated the impact of supervisor support and workload on job satisfaction and emotional exhaustion. Theoretical and practical implications are discussed.

Comparing Burnout Across Emergency Physicians, Nurses, Technicians, and Health Information Technicians Working for the Same Organization

Studies on the topic of burnout measure the effects of emotional exhaustion (EE), depersonalization (DP) (negative or cynical attitudes toward work), and reduced sense of personal accomplishment (PA). While the prevalence of burnout in practicing emergency medicine (EM) professionals has been studied, little is known of the prevalence and factors across physicians, nurses, technicians, and health information technicians working for the same institution. The aim of this study was to assess burnout differences across EM professional types.The total population of 250 EM professionals at 2 public urban hospitals in Turkey were surveyed using the Maslach Burnout Inventory and basic social- and work-related demographics. Descriptive statistics, ANOVA, and additional post hoc tests were computed.Findings show that EE and DP scores were high across all occupational groups, while scores on PA were low. There was a statistically significant difference between nurses and medical technicians (P < 0.05) for EE; and between physicians and both nurses and medical technicians (P < 0.05) for PA; while no group differences were found for DP. Age, gender, economic well-being, and income level were all significant; while patient load and marital status showed no significance.Burnout can be high across occupational groups in the emergency department. Burnout is important for EM administrators to assess across human resources. Statistically significant differences across socio-demographic groups vary across occupational groups. However, differences between occupational groups may not be explained effectively by the demographic factors assessed in this or other prior studies. Rather, the factors associated with burnout are incomplete and require further institutional, cultural, and organizational analyses including differentiating between job tasks carried out by each EM job type.

Factors Modifying Burnout in Osteopathic Medical Students

OBJECTIVE

The purposes of the current study are to examine factors modifying burnout and identify which of these factors place osteopathic medical students at risk for developing burnout.

METHODS

The current study used a cross-sectional study design and an anonymous, web-based survey to assess burnout and depression in osteopathic medical students. The survey included Maslach Burnout Inventory, the Patient Health Questionnaire, the Stressors and their impact scale, students' sleeping and studying habits, and students' extracurricular involvement.

RESULTS

In total, 1294 osteopathic medical students completed the survey. Burnout was present in 516 (39.9%) osteopathic medical students, and 1006 (77.0%) met criteria for depression. Females were 1.5 times more likely to be burned out in comparison to males. For the burnout subscales, males had lower emotional exhaustion, slightly higher depersonalization, and lower personal accomplishment. Lesbian/gay/bisexual/asexual students were 2.62 times more likely to be burned out compared with heterosexual students. Depression and academic, personal, and family stressors were all strongly linked to overall burnout. Finally, for modifiable factors, average hours of sleep, average hours spent studying, and club involvement appeared to be linked to burnout.

CONCLUSIONS

The current study suggested that a variety of factors, including non-modifiable, situational, and modifiable, impact burnout in osteopathic medical students. Future research is necessary since burnout in physicians affects the quality of care provided to patients.

Stress, Burnout and Coping Strategies in Preclinical Medical Students

It is acknowledged that physicians do not seek the same expert aid for themselves as they would offer their patients. In their preclinical years, medical students appear to espouse comparable behavior. To many, medicine is described as a never-ending path that places the student under heavy stress and burnout from the beginning, leaving him/her vulnerable and with insufficient coping methods. Hence, the objective of this study is to 1) explore the prevalence of stress and burnout among preclinical medical students, and 2) propose solutions to decrease stress and burnout and improve medical education in the preclinical years. A detailed scholarly research strategy using Google Scholar, Scopus, Embase, MEDLINE and PubMed was implemented to highlight key themes that are relevant to preclinical medical students' stress and burnout. Stress varied among different samples of medical students and ranged between 20.9% and 90%. Conversely, burnout ranged between 27% and 75%. Methods that help in reducing the incidence of stress and burnout by promoting strategies that focus on personal engagement, extracurricular activities, positive reinterpretation and expression of emotion, student-led mentorship programs, evaluation systems, career counseling and life coaching should be adopted.

Dual Effects of Job Complexity on Proactive and Responsive Creativity: Moderating Role of Employee Ambiguity Tolerance

Departing from existing studies based on general notion of creativity, we highlight the driver or initiating force behind creative engagement in organizations. To this end, we distinguish between proactive and responsive creativity and provide a nuanced perspective on the processes underlying distinct types of employee creativity. We propose that job complexity indirectly affects proactive and responsive creativity of employees by promoting psychological empowerment and cognitive overload, respectively. The ambiguity tolerance of employees is hypothesized to moderate the indirect effects of job complexity on the two types of creativity. Data collected from 143 employee–supervisor dyads in various companies in Sweden and Korea supported most of our hypotheses. For employees with high ambiguity tolerance, job complexity exhibited a significant indirect effect on proactive creativity through psychological empowerment. For employees with low ambiguity tolerance, job complexity exerted a significant indirect effect on responsive creativity via cognitive overload. By revealing distinct psychological paths toward different types of creativity and identifying a boundary condition for such processes, the present study provides an ecologically valid explanation regarding creativity in organizations.

Recommendations for enhancing psychosocial support of NICU parents through staff education and support

Providing psychosocial support to parents whose infants are hospitalized in the neonatal intensive care unit (NICU) can improve parents' functioning as well as their relationships with their babies. Yet, few NICUs offer staff education that teaches optimal methods of communication with parents in distress. Limited staff education in how to best provide psychosocial support to families is one factor that may render those who work in the NICU at risk for burnout, compassion fatigue and secondary traumatic stress syndrome. Staff who develop burnout may have further reduced ability to provide effective support to parents and babies. Recommendations for providing NICU staff with education and support are discussed. The goal is to deliver care that exemplifies the belief that providing psychosocial care and support to the family is equal in importance to providing medical care and developmental support to the baby.

Intensivist-to-patient ratios in ICUs: is there a number?

PURPOSE OF REVIEW

Growth in critical care services has led to a dramatic increase in the need for ICU physicians. The supply of intensivists is not easily increased and there is pressure to solve this problem by increasing the number of patients per intensivist. There is a scarcity of published data addressing this issue, and until recently, there were no guidelines on appropriate ratios of intensivists to patients.

RECENT FINDINGS

In 2013, the Society of Critical Care Medicine formed a task force to address this issue and published written guidelines to aid hospitals in determining their intensivist staffing. This study reviews the published data which can aid these decisions and summarize the SCCM Taskforce's recommendations.

SUMMARY

The complex nature of critical care patients and ICUs make it difficult to provide one specific maximum intensivist-to-patient ratio, but common-sense rules can be applied. These recommendations are predicated on the principles that staffing can impact patient care as well as staff well-being and workforce stability. Also, that worsening patient outcomes, teaching, and workforce issues can be markers of inappropriate staffing. Finally, if the predicted daily workload of an intensivist exceeds the time of a work shift, then adjustments need to be made.

Burnout among Nursing Professionals in Tertiary Care Hospitals of Delhi

Introduction:

There has been growing evidence that stress and burnout at work have undesirable effects not only on the worker but also on the organizations (Aiken et al. 2002a, 2002b; Felton 1998). It is perceived more among nursing professionals because of the specific roles and responsibilities, increased workload, dealing with high-risk cases, emotional aspects of patient care and other factors inherent in the nature of work.

Objective:

This article is developed with the broad objective to determine the level of burnout among the nursing professionals with the following specific objectives: To determine the level of burnout and to determine the work-related factors associated with burnout among nursing professionals in selected tertiary care hospitals of Delhi.

Methodology:

This descriptive study was carried out on a total of 200 staff nurses. One hundred staff nurses from each of the two randomly selected tertiary care hospitals in New Delhi were taken, comprising 25 staff nurses from each of the four speciality wards (Medicine, Surgery, Obstetrics & Gynaecology and Paediatrics). Tools used were socio-demographic tool, work profile tool and standardized Maslach Burnout Inventory (MBI) tool to measure burnout. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 17.

Results:

Overall, the nurses reported a low mean score for emotional exhaustion (14.39 ± 6.87) and depersonalization (4.84 ± 3.34), and an average score (34.72 ± 6.33) for personal accomplishment. Work profile variables found to be associated with burnout were ‘staff shortage with respect to nurse–patient ratio’, ‘number of night duties’, ‘demands of patient’ attendants’, ‘duty roster’, ‘death/critical condition of a patient’, ‘conflicts at work place’, study leave’ and ‘category of employment (regular/contractual)’.

Conclusions and Recommendations:

Though the nurses, in the present study, did not show very high levels of burnout, nonetheless, there was noted a significant association of burnout with certain work profile and organizational factors. On this ground, one can conclude that a lot of reforms are required at the organizational and work environmental levels. On the basis of these findings and conclusions formed, the authors suggest certain recommendations, in which reforms for human resource (HR) for health form a prominent part.

Perceived employability and psychological functioning framed by gain and loss cycles

Purpose

– The purpose of this paper is to test the gain and loss cycle ideas from the Conservation of Resources (COR) theory with regard to perceived employability and psychological functioning among employed workers and unemployed job seekers, respectively.

Design/methodology/approach

– More specifically, the authors argue that perceived employability may trigger a gain cycle toward well-being among employed workers (H1), while ill-being may trigger a loss cycle toward reduced (perceived) employability among unemployed job seekers (H2). The authors test these ideas with cross-lagged analysis.

Findings

– Results confirm the hypotheses: perceived employability at Time 1 positively affects well-being at Time 2 among employed workers and ill-being at Time 1 negatively impacts perceived employability at Time 2 among unemployed job seekers.

Research limitations/implications

– Future research should study the gain and loss cycles with more than two waves of data as this allows for a more adequate test of these ideas.

Practical implications

– As for practitioners, the results suggest that investing in the worker’s perceived employability by offering training, career counseling, and networking opportunities, pays off as it promotes the employee’s psychological functioning. With regard to unemployed job seekers the authors advise investing in psychological counseling: the unemployed job seeker will be more able to invest in a job search, and hence perceive employability if helped in coping with job loss.

Originality/value

– This study offers a new perspective on the relationship between perceived employability and psychological functioning by involving the principles of COR theory, in particular the gain and loss cycles.

Content Comparison of Patient-Reported Outcome Instruments Used to Measure Burnout

The aim of this article is to compare the content of patient-reported outcome (PRO) burnout measures and to examine the degree of overlap between them and psychosocial difficulties (PSD) experienced by persons with burnout. The most frequently used PRO and qualitative studies were identified in two systematic literature reviews. Psychosocial difficulties identified in both sources were standardized and a qualitative content comparison was performed. Seven PROs and seven qualitative studies were selected. Energy and drive, emotional functions and work were key themes of both sources. Disparities were observed for problems in areas such as sleep, attention or family relationships, which were reported in several qualitative studies, but are seldom addressed in PROs. Several areas important to persons with burnout, such as family relationships, are seldom measured by currently used PROs. From a biopsychosocial perspective, these instruments cannot therefore be considered comprehensive enough to capture the whole experience of burnout and should be improved.

Using a single item to measure burnout in primary care staff: a psychometric evaluation

BACKGROUND

Burnout affects nearly half of all U.S. nurses and physicians, and has been linked to poor outcomes such as worse patient safety. The most common measure of burnout is the well-validated Maslach Burnout Inventory (MBI). However, the MBI is proprietary and carries licensing fees, posing challenges to routine or repeated assessment.

OBJECTIVE

To compare a non-proprietary, single-item burnout measure to a single item from the MBI Emotional Exhaustion (MBI:EE) subscale that has been validated as a standalone burnout measure.

DESIGN

Cross-sectional online survey.

PARTICIPANTS

A sample of primary care providers (PCPs), registered nurses, clinical associates (e.g., licensed practical nurses (LPNs), medical technicians), and administrative clerks in the Veterans Health Administration surveyed in 2012.

MAIN METHODS

We compared a validated one-item version of the MBI:EE and a non-proprietary single-item burnout measure used in the Physician Work Life Study. We calculated kappa statistics, sensitivity and specificity, positive predictive (PPV) and negative predictive values (NPV), and area under the receiver operator curve (AUC). We conducted analyses stratified by occupation to determine the stability of the correlation between the two measures.

KEY RESULTS

We analyzed responses from 5,404 participants, including 1,769 providers and 1,380 registered nurses. The prevalence of burnout was 36.7% as measured on the single MBI:EE item and 38.5% as measured on the non-proprietary single-item measure. Relative to the MBI:EE, the non-proprietary single-item measure had a correlation of 0.79, sensitivity of 83.2%, specificity of 87.4%, and AUC of 0.93 (se = 0.004). Results were similar when stratified by respondent occupation.

CONCLUSIONS

A non-proprietary single-item measure served as a reliable substitute for the MBI:EE across occupations. Because it is non-proprietary and easy to interpret, it has logistical advantages over the one-item MBI.

The mediating role of burnout on the relationship of emotional intelligence and self-efficacy with OCB and performance

Purpose

– This study aims to examined the relationship between emotional intelligence (EI), self-efficacy and two outcome variables: in-role performance and organizational citizenship behavior (OCB). The study also examined whether burnout mediates this relationship. The target population included Arab teachers in Israel.

Design/methodology/approach

– A survey was performed. Usable questionnaires were returned by 221 teachers; therefore, the response rate was 88 per cent.

Findings

– Hierarchical linear models and mediation analyses showed that EI and self-efficacy are related to OCB, and in-role performance and burnout have a strong and negative relationship with the outcome variables. Mediation analysis using Preacher and Hayes’s (2004, 2008) approach showed that burnout mediates the relationship of EI and self-efficacy with the three outcome variables.

Practical implications

– The findings emphasize the role of the two personal variables examined here as important determinants of job performance and OCB, and demonstrate the importance of burnout in understanding OCB.

Originality/value

– This study will contribute to the literature on OCB and work performance by examining the rarely researched relationships between EI and self-efficacy, on the one hand, and between OCB and in-role performance, on the other. Further, this study will argue that burnout mediates the relationship between these personal and outcome variables.

Elements of team-based care in a patient-centered medical home are associated with lower burnout among VA primary care employees

BACKGROUND

A high proportion of the US primary care workforce reports burnout, which is associated with negative consequences for clinicians and patients. Many protective factors from burnout are characteristics of patient-centered medical home (PCMH) models, though even positive organizational transformation is often stressful. The existing literature on the effects of PCMH on burnout is limited, with most findings based on small-scale demonstration projects with data collected only among physicians, and the results are mixed.

OBJECTIVE

To determine if components of PCMH related to team-based care were associated with lower burnout among primary care team members participating in a national medical home transformation, the VA Patient Aligned Care Team (PACT).

DESIGN

Web-based, cross-sectional survey and administrative data from May 2012.

PARTICIPANTS

A total of 4,539 VA primary care personnel from 588 VA primary care clinics.

MAIN MEASURES

The dependent variable was burnout, and the independent variables were measures of team-based care: team functioning, time spent in huddles, team staffing, delegation of clinical responsibilities, working to top of competency, and collective self-efficacy. We also included administrative measures of workload and patient comorbidity.

KEY RESULTS

Overall, 39 % of respondents reported burnout. Participatory decision making (OR 0.65, 95 % CI 0.57, 0.74) and having a fully staffed PACT (OR 0.79, 95 % CI 0.68, 0.93) were associated with lower burnout, while being assigned to a PACT (OR 1.46, 95 % CI 1.11, 1.93), spending time on work someone with less training could do (OR 1.29, 95 % CI 1.07, 1.57) and a stressful, fast-moving work environment (OR 4.33, 95 % CI 3.78, 4.96) were associated with higher burnout. Longer tenure and occupation were also correlated with burnout.

CONCLUSIONS

Lower burnout may be achieved by medical home models that are appropriately staffed, emphasize participatory decision making, and increase the proportion of time team members spend working to the top of their competency level.

A comparison of burnout among oncology nurses working in adult and pediatric inpatient and outpatient settings

PURPOSE/OBJECTIVES

To investigate differences in burnout among oncology nurses by type of work setting, coping strategies, and job satisfaction.

DESIGN

Descriptive.

SETTING

A metropolitan cancer center.

SAMPLE

A convenience sample of 74 oncology nurses.

METHODS

Participants completed a demographic data form, the Nursing Satisfaction and Retention Survey, and the Maslach Burnout Inventory.

MAIN RESEARCH VARIABLES

Burnout, coping strategies, job satisfaction, and oncology work setting (inpatient versus outpatient and adult versus pediatric).

FINDINGS

The participants most often used spirituality and coworker support to cope. Emotional exhaustion was lowest for youngest nurses and highest for outpatient RNs. Personal accomplishment was highest in adult settings. Job satisfaction correlated inversely with emotional exhaustion and the desire to leave oncology nursing.

CONCLUSIONS

The findings support that the social context within the work environment may impact emotional exhaustion and depersonalization, and that demographics may be more significant in determining burnout than setting.

IMPLICATIONS FOR NURSING

The findings raise questions of whether demographics or setting plays a bigger role in burnout and supports organizational strategies that enhance coworker camaraderie, encourage nurses to discuss high-stress situations, and share ways to manage their emotions in oncology settings.

KNOWLEDGE TRANSLATION

Spirituality and coworker relationships were positive coping strategies among oncology nurses to prevent emotional exhaustion. Nurses who rely on supportive social networks as a coping mechanism have lower levels of depersonalization. Age was inversely related to emotional exhaustion.

Effects of perceived workplace politics in hospitals on nurses' behavioural intentions in Ghana

AIM

To examine the effects of perceived workplace politics in hospitals on nurses' job satisfaction, commitment, exit intention, job neglect, absenteeism and performance.

BACKGROUND

One of the factors contributing to nurses' poor advancement in clinical practice is the existence of petty politics, which has given rise to competing self-interest. However, little evidence exists to inform policy direction on the implication of politics on nurses' behaviour.

METHOD

A total of 610 nurses comprising associate and nursing professionals completed a structured questionnaire modelled on workplace politics and its outcome variables. Descriptive statistics and mean comparisons were used to analyse data. A multivariate regression model was computed to examine association between perceived politics and nurses' behavioural intentions.

RESULT

Perceived politics potentially leads to decline in job satisfaction, commitment and work performance. However, perceived workplace politics is associated with high intention to leave, negligent behaviour and absenteeism.

CONCLUSION

Measures aimed at improving nursing management and health-care delivery should be directed at minimising the use of politics to promote self-interest.

IMPLICATION FOR NURSING MANAGEMENT

Evidence-based best practices in nursing management centred on the creation of an enabling environment for nurses to participate in decision-making should be given critical attention.

Linkages between workplace stressors and quality of care from health professionals' perspective - Macedonian experience

OBJECTIVES

During last two decades, within the process of transition, the socio-economic reforms in Republic of Macedonia reflected on the national health care system. The objective of this article was to identify workplace stressors and factors that influence quality of care, from the perspective of health professionals (HPs), and to understand how they were linked in the context of such social circumstances.

METHODS

A qualitative research based on focus group (FG) methodology was conducted in a general teaching hospital. Two main topics were the subjects of discussion in FGs: workplace stressors and factors that influence quality of care, from the HPs perspective. Six FGs were conducted with a total of 56 HPs (doctors, nurses, interns, and residents) divided into two sets of three FGs for each topic separately. Two sets of data were processed with thematic analysis, and the obtained results were compared with each other.

RESULTS

By processing the data, we identified themes relating to factors that generate stress among HPs and factors that influence quality of care, from HPs' perspective. By comparing the two sets of themes, we found that many of them were identical, which means factors that increase workplace stress at the same time reduce quality of care.

CONCLUSIONS

Implementation of specific organizational interventions in the hospital setting can lead to the prevention of work-related stress and improvement in quality of care. Our research suggests that the prevention of work-related stress will impact positively on the quality of care, which may contribute to establish criteria and recommendations for the improvement in organizational culture and climate in hospitals.

STATEMENT OF CONTRIBUTION

What is already known on this subject? Psychosocial stress at work among health professionals is often present and well studied, but relations between job stress and quality of care were rarely examined. Job demands-resources model by Demerouti, Bakker, Nachreiner and Schaufeli (2001), for assessment of job stress includes job demands (working environment, work overload, time pressures, recipient contact, shift work) and job resources (feedback, rewards, job control, participation, job security, supervisor support) was applied in different studies. There is scientific evidence that burned-out physicians have shown depersonalization from their patients, they have withdrawn from patients, demonstrated sub-optimal care, and sometimes burnout has been related to serious mistakes and patient death. Different research has shown that some workplace factors contributed to the development of work-related stress and burnout among HPs whereas others contributed protectively. What does this study add? Similar and overlapping workplace factors in hospital setting produce stress in health professionals and influence quality of care. Impact of specific socioeconomic environment in Macedonia as a country in transition and EU candidate country on job stress among health professionals and quality of care. Development of criteria and recommendations for the job stress prevention and improvement of the organizational culture and climate in hospital settings.

Aerobic exercise training and burnout: a pilot study with male participants suffering from burnout

Background

Occupational burnout is associated with severe negative health effects. While stress management programs proved to have a positive influence on the well-being of patients suffering from burnout, it remains unclear whether aerobic exercise alleviates burnout severity and other parameters related to occupational burnout. Therefore, the main purpose of this study was to pilot-test the potential outcomes of a 12-week exercise training to generate hypotheses for future larger scale studies.

Methods

The sample consisted of 12 male participants scoring high on the MBI emotional exhaustion and depersonalization subscales. The training program took place in a private fitness center with a 17.5 kcal/kg minimum requirement of weekly energy expenditure.

Results

The key findings are that increased exercise reduced overall perceived stress as well as symptoms of burnout and depression. The magnitude of the effects was large, revealing changes of substantial practical relevance. Additionally, profiles of mood states improved considerably after single exercise sessions with a marked shift towards an iceberg profile.

Conclusion

Among burnout patients, the findings provide preliminary evidence that exercise has the potential to reduce stress and prevent the development of a deeper depression. This has important health implications given that burnout is considered an antecedent of depressive disorders.

Trial registration

ClinicalTrials.gov Identifier: ISRNCT01575743

Open Access to General Practice Was Associated with Burnout among General Practitioners

Walk-in open access in general practice may influence the general practitioner's (GP's) work, but very little research has been done on the consequences. In this study from Danish general practice, we compare the prevalence of burnout between GPs with a walk-in open access and those without. In a questionnaire study (2004), we approached all 458 active GPs in the county of Aarhus, Denmark, and 376 (82.8%) GPs returned the questionnaire. Walk-in open access was defined as at least 30 minutes every weekday where patients could attend practice without an appointment. Burnout was measured by the Maslach Burnout Inventory. Analyses using logistic regression were adjusted for gender, age, marital status, job satisfaction, minutes per consultation, practice organisation, working hours, number of listed patients per GP, number of contacts per GP, continuing medical education- (CME-) activities, and clusters of GPs. In all, 8% of GPs had open access and the prevalence of burnout was 24%. GPs with walk-in open access were more likely to suffer from burnout. Having open access was associated with a 3-fold increased likelihood of burnout (OR = 3.1 (95% CI: 1.1-8.8, P = 0.035)). Although the design cannot establish causality, it is recommended to closely monitor possible negative consequences of open access in general practice.

The factors associated with the burnout syndrome and fatigue in Cypriot nurses: a census report

Background

Fatigue and burnout are two concepts often linked in the literature. However, regardless of their commonalities they should be approached as distinct concepts. The current and ever-growing reforms regarding the delivery of nursing care in Cyprus, stress for the development of ways to prevent burnout and effectively manage fatigue that can result from working in stressful clinical environments.

Methods

To explore the factors associated with the burnout syndrome in Cypriot nurses working in various clinical departments. A random sampling method taking into account geographical location, specialty and type of employment has been used.

Results

A total of 1,482 nurses (80.4% were females) working both in the private and public sectors completed and returned an anonymous questionnaire that included several aspects related to burnout; the MBI scale, questions related to occupational stress, and questions pertaining to self reported fatigue. Two-thirds (65.1%) of the nurses believed that their job is stressful with the majority reporting their job as stressful being female nurses (67.7%). Twelve point eight percent of the nurses met Maslach’s criteria for burnout. The prevalence of fatigue in nurses was found 91.9%. The prevalence of fatigue was higher in females (93%) than in males (87.5%) (p = 0.003). As opposed to the burnout prevalence, fatigue prevalence did not differ among the nursing departments (p = 0.166) and among nurses with a different marital status (p = 0.553). Burnout can be associated adequately knowing if nurses find their job stressful, their age, the level of emotional exhaustion and depersonalization. It has been shown that the fatigue may be thought of as a predictor of burnout, but its influence is already accounted by emotional exhaustion and depersonalization.

Conclusion

The clinical settings in Cyprus appear as stress generating environment for nurses. Nurses working both in the private and public sector appear to experience low to severe burnout. Self-reported fatigue interferes to the onset of emotional exhaustion and depersonalization.

Stress ratings and health promotion practices among RNs: a case for action

OBJECTIVE

: The objective of this study was to investigate associations between RN perceptions of their stress levels, health-promoting behaviors, and associated demographic variables.

BACKGROUND

: Stress and burnout are occupational hazards resulting in absenteeism, illness, and staff turnover, factors important to nurse administrators. Personal health behaviors among nurses have been linked to less stress and the delivery of health-promotion teaching.

METHOD

: An electronic survey with 2 standardized measures and demographic questions was completed by 2,247 staff nurses from a large Midwestern academic medical center.

FINDINGS

: Stress levels were inversely correlated with overall health-promoting behavior scores. Outside caregiver responsibilities were associated with higher stress and lower health-promoting behaviors scores.

CONCLUSIONS

: Findings support work-site interventions that promote nurses' health and wellness, reduce work and home stress, and influence positive patient care and outcomes.

The influence of personal dispositional factors and organizational resources on workplace violence, burnout, and health outcomes in new graduate nurses: a cross-sectional study

BACKGROUND

The alarmingly high rate of illness-related absenteeism among nurses and recent reports of workplace violence and burnout are problematic for both the current workforce shortage and the recruitment and retention of new nurses.

OBJECTIVES

To test a model derived from Leiter and Maslach's (2004) Six Areas of Worklife Model linking workplace factors (six areas of worklife, experiences of bullying and burnout) and a personal dispositional factor (psychological capital) to new graduates mental and physical health in their first year of practice.

METHODS

A cross-sectional survey design was utilized to survey 165 Ontario nurses with one year or less experience in nursing. Participants completed measures of nurses' work environment quality, psychological capital, bullying exposure, burnout, and physical and mental health. Structural equation modelling was used to test the hypothesized model.

RESULTS

The fit indices suggested a reasonably adequate fit of the data to the hypothesized model (χ2=27.75, df=12, CFI=.97, IFI=.97, RMSEA=.09), however an additional direct path from psychological capital to emotional exhaustion substantially improved the model fit (χ2=17.94, df=11, CFI=.99, IFI=.99, RMSEA=.06). Increased psychological capital positively influenced nurses' perceived person-job fit, which in turn was negatively related to bullying exposure and emotional exhaustion, and ultimately influenced their physical and mental health.

CONCLUSIONS

The findings suggest that psychological capital and perceived person-job fit are key variables in new graduate nurses' worklife, which may contribute to decreased nurses' burnout and increased physical and mental well-being. The results support an expanded conceptualization of the areas of worklife model.

Stressors and coping strategies for HIV-test counselors giving rapid HIV-test results: an exploratory qualitative study

Stress has been extensively researched in the HIV services field. Yet, research regarding stress related to HIV-test counseling has solely focused on stressors related to giving results, even though stress on the HIV test counselor can occur at many points within a counseling session. This exploratory, qualitative study examines the stressors faced and coping mechanisms utilized by HIV-test counselors at AIDS service organizations (ASOs) during rapid HIV-test counseling sessions. Forty-two HIV test counselors were interviewed regarding HIV-test counseling sessions in which they provided preliminary-positive/reactive, negative/nonreactive, and invalid results. Regardless of the test result, HIV test counselors faced stressors, including giving HIV test results; dealing with emotions; difficult clients; self-doubt; and systemic stressors. Most stress was managed through social support, preparatory coping strategies, respite, and putting things into perspective. Despite the exploratory nature of the study, the findings suggest that strengthening support bases and improving current training standards will increase the well-being of HIV test counselors.

Predictors of nurse absenteeism in hospitals: a systematic review

AIM

This study aimed to identify and examine predictors of short-term absences of staff nurses working in hospital settings reported in the research literature.

BACKGROUND

Front-line staff nurse absenteeism contributes to discontinuity of patient care, decreased staff morale and is costly to healthcare.

EVALUATION

A systematic review of studies from 1986 to 2006, obtained through electronic searches of 10 online databases led to inclusion of 16 peer-reviewed research articles. Seventy potential predictors of absenteeism were examined and analysed using content analysis.

KEY ISSUE

Our findings showed that individual 'nurses' prior attendance records', 'work attitudes' (job satisfaction, organizational commitment and work/job involvement) and 'retention factors' reduced nurse absenteeism, whereas 'burnout' and 'job stress' increased absenteeism. Remaining factors examined in the literature did not significantly predict nurse absenteeism.

CONCLUSIONS

Reasons underlying absenteeism among staff nurses are still poorly understood. Lack of robust theory about nursing absenteeism may underlie the inconsistent results found in this review. Further theory development and research is required to explore the determinants of short-term absenteeism of nurses in acute care hospitals.

IMPLICATIONS FOR NURSING MANAGEMENT

Work environment factors that increase nurses' job satisfaction, and reduce burnout and job stress need to be considered in managing staff nurse absenteeism.

Job Resources Buffer the Impact of Work-Family Conflict on Absenteeism in Female Employees

This study examines the relationship between work-family conflict and objective absenteeism 1 year later, by demonstrating that several job resources buffer the impact of work-family conflict on absenteeism. Female employees (N = 386) of a large financial services organization participated in the study. Four job resources (i.e., relationship with colleagues, relationship with supervisor, participation in decision-making, and developmental possibilities) were used to test the central hypothesis that the interaction between (high) work-family conflict and (low) job resources results in absenteeism (absence frequency and duration). Results of moderated structural equation modeling showed that only participation buffered the effect of work-family conflict on absence frequency, while the buffer hypothesis was confirmed for absence duration since all four two-way interactions were significant. The theoretical and practical implications of these findings are discussed.

Conceito(s) de burnout: questões atuais da pesquisa e a contribuição da clínica

Considerando o crescente interesse científico no fenômeno burnout, apresentamos uma amostra da diversidade teórica que forma o campo de pesquisa neste tema a partir de algumas questões atuais de discussão sobre o seu conceito. Discutimos aparentes limitações da abordagem empírica à compreensão da natureza conceitual do burnout, apontando uma possível contribuição da clínica (dentro do campo da Psiquiatria) a este debate.

A self-referral preventive intervention for burnout among Norwegian nurses: one-year follow-up study

OBJECTIVE

Burnout among nurses is an issue of concern, and preventive interventions are important to implement and evaluate. This study investigated levels and predictors of change in burnout dimensions after an intervention for help-seeking nurses.

METHODS

Nurses participating in a self-referral, counseling intervention, from 2004 to 2006 in Norway, were followed with self-reporting assessments. One-year follow-up was completed by 160/172 (93%, 155 women and 5 men).

RESULTS

Mean level of emotional exhaustion (one dimension of burnout, scale 1-5) was significantly reduced from 2.87 (SD 0.79) to 2.52 (SD 0.8), t=5.3, p<0.001, to the level found in a representative sample of Norwegian nurses. The proportion of nurses seeking psychotherapy increased after the intervention, from 17.0% (25/147) to 34% (50/147), p<0.001. Less reduction in emotional exhaustion was independently predicted by reporting a work-related conflict (beta -0.53 (SE 0.13), p<0.001) or by getting a period of sick leave (beta -0.28 (SE 0.12), p<0.05) after the intervention.

CONCLUSIONS

A short-term preventive intervention could contribute to reduction of emotional exhaustion in nurses. Work-related conflict and sick leave after the intervention were negatively associated with this reduction.

PRACTICE IMPLICATIONS

Preventive interventions to reduce burnout for nurses should be considered, as well as programs for preventing or handling conflicts at work.

Job Burnout, Health-Related Quality of Life, and Sickness Absence in Greek Health Professionals

This study examined how job burnout was associated with sick-leave absence and quality of life in a sample of 487 nurses working in the National Health Care System. Burnout was measured with the Maslach Burnout Inventory, while quality of life was measured with Short-Form Health Survey (SF-36). Data on sick leaves were collected from hospital personnel records. Logistic regression indicated that levels of burnout (emotional exhaustion) were significant predictors of short-term (but not long-term) sickness absence. Long-term sickness absence could be predicted by poor physical health. The findings indicate that burnout not only may negatively impact on quality of life of health-care providers, but also may influence short sick leaves. Implications for the implementation of absence reduction programs are discussed.