Sickness present with signs of burnout: The relationship between burnout and sickness presenteeism among university hospital physicians in four European countries

Burnout and Its Consequences among Vascular Surgeons and Trainees: A Danish National Survey

BACKGROUND

Burnout among physicians has widespread negative consequences. Little is known about burnout among European vascular surgeons (VS). A previously published study found that 82% of VS and vascular surgical trainees (VST) in Denmark experience burnout symptoms. The present study aimed to investigate work- and health-related consequences of burnout.

STUDY DESIGN

An electronic survey was distributed to all VS/VST in Denmark in January 2020. Validated assessment tools were used to measure burnout, mental health, and psychosocial work environment aspects.

RESULTS

Of 104 invited VS/VST, 82% (n = 85) completed the survey. VS accounted for 72% (n = 61) of the respondents, and 40% (n = 33) were female. Statistically significant associations were found between higher levels of burnout and a range of work- and health-related outcomes, including a sense of meaning at work, workplace commitment, conflicts between work and private life, work stress, sick leave, and depressive symptoms. VS/VST using pain medication daily or weekly had significantly higher burnout scores than respondents who rarely or never use pain medication. A significant association between burnout and job satisfaction and retention was found, with respondents indicating an intention to stay within the specialty having significantly lower burnout scores than those who considered leaving within 5 years. Among those who indicated leaving the specialty, 35% (n = 13) attributed this to their current working conditions.

CONCLUSIONS

Burnout among VS/VST in Denmark is negatively associated with various work- and health-related outcomes. The work environment seems to play an essential role in these associations, and alterations in workplace organization may remedy this situation.

Design and validation of the presenteeism scale in nursing

BACKGROUND

The instruments used to measure presenteeism are all flawed and only incompletely measure the concept of presenteeism in employees of the general population. As a result, the concept of presenteeism is not measured, and in most of these instruments, the population for which the instrument has been developed differs from the nursing population. The present research was conducted to design and validate the instrument for evaluating presenteeism in nursing.

METHODS

The present study was part of an exploratory sequential mixed study. In this study, the instrument for measuring the level of presenteeism among nurses was developed and validated based on the results of the qualitative stage. To this end, the instrument's psychometric properties were investigated using face, content, and construct validity, as well as reliability through internal consistency and stability.

RESULTS

In this study, an instrument containing 17 items and three dimensions (imperfect cognitive presence, imperfect emotional presence, and imperfect movement presence) with favorable validation characteristics was developed. Therefore, the instrument was able to explain 56.375% of the total variance. Furthermore, Cronbach's alpha and McDonald's omega coefficients were 0.881 and 0.815, respectively. The intra-cluster correlation coefficient (ICC) was also reported as 0.972 for the entire instrument, with a 95% confidence interval of 0.941 to 0.987.

CONCLUSION

Based this study, it was possible to measure the level of nurses' presenteeism through an instrument with favorable psychometric properties. This study helps health managers lay the groundwork for designing a system for measuring presenteeism among Iranian nurses using the developed instrument.

Internal medicine trainee perspectives on back-up call systems and relationships to burnout

INTRODUCTION

As burnout within medicine escalates, residency programmes should strive to understand how training structures may contribute. Back-up call systems that address gaps in overnight resident call coverage are one possible contributing structure. However, the intersection between back-up call policies and burnout remains unclear. The authors explored residents' decision-making process when deciding whether or not to activate a back-up resident for call coverage, perspectives surrounding the legitimacy of call activations and the impact of back-up call systems on education and experienced burnout.

METHODS

Internal medicine residents at the University of Toronto were recruited through email. Eighteen semi-structured one-on-one interviews were conducted with residents from September 2019 to February 2020. Interviews explored participants' experiences and perceptions with back-up call and call activations. A constructivist grounded theory approach was used to develop a conceptual understanding of the back-up system as it relates to residents' decisions underlying activations, downstream impacts and relationships to burnout.

RESULTS

Residents described a complex thought process when deciding whether to activate back-up. Decisions were coloured by inner conflicts including sense of collegiality, need to maintain an image and time of year balanced against self-reported burnout. Residents described how back-up calls can lead to burnout, usually in the form of exhaustion, lowering their threshold to trigger future back-up activations. Impacts included anxiety of not knowing whether an activation would occur, decreased educational productivity and the 'domino effect' of increased workload for colleagues.

DISCUSSION

Residents weigh inner tensions when deciding to activate back-up. Their collective experience suggests that burnout is both a trigger and consequence of back-up calls, creating a cyclical relationship. Escalating rates of call activations may signal that burnout amongst residents is high, warranting educational leads to assess for resident wellness and to critically evaluate the structure of such systems with respect to unintended consequences.

Three Pathways Into Chronic Lack of Energy as a Mental Health Complaint

Abstract. Many disturbances of physical, social, and mental health have conditions involving lack of energy, difficulty in making decisions, and low interest or motivation. Laboratory studies of willpower depletion have produced similar states in a temporary fashion. The present review uses extant literature to develop and test three theories about how temporary states of low willpower could become chronic. The first is ongoing and repeated exposure to depleting circumstances, such as caregiver fatigue, burdensome financial debts, and high-stress jobs. The second focuses on inadequate recoveries, such as poor sleep, insufficient nutrition, or unsatisfying vacations. The third invokes dispositional vulnerabilities that predispose some people to become depleted more frequently than others. A wide-ranging search for evidence concluded that the first two theories have more support than the third, though all further merit research. Additional possible contributions to chronicity are discussed, such as the emergence of vicious circles.

Bedürfnisorientierte Arbeitswelten im Krankenhaus: Entwicklung und Akzeptanz des HEMI-Architekturkonzepts

Dieser Beitrag in der Zeitschrift Gruppe. Interaktion. Organisation (GIO), Themenheft New Work – Inspirierende, kooperationsfördernde Arbeitsumgebungen beschreibt die Entwicklung und wissenschaftliche Prüfung eines Architekturkonzepts zur evidenzbasierten Gestaltung innovativer und bedürfnisorientierter Arbeitswelten im Krankenhaus. Das Konzept basiert auf einer berufsunabhängigen Neubewertung der Krankenhausumgebung und definiert fünf Umgebungskategorien und architektonische Qualitäten: (H) hands on/off (Arbeiten mit oder ohne direktem Patientenkontakt), (E) eyes on/off (Arbeiten mit oder ohne indirektem Patientenkontakt), (M) mind on (konzentrierte Arbeiten), mind off (Entspannung und Regeneration) und (I) interact on/off (Arbeiten mit oder ohne Kontakt zu Kollegen). Die Kategorien lassen Rückschlüsse auf den psycho-emotionalen Stress und die kognitive Beanspruchung der Mitarbeitenden zu und bestimmen die auf diese reagierende architektonische Gestaltung. Im Unterschied zum bisherigen deutschen Krankenhausentwurf durchbricht das (HEMI) Architekturkonzept veraltete Organisationsstrukturen, geht architekturpsychologisch auf die steigende Belastung der Mitarbeitenden ein und formuliert räumliche Lösungen. Die Akzeptanz der zentralen Arbeitswelt, die das Konzept u. a. vorsieht und die in einer bundesweiten Befragung an Klinikärztinnen und -ärzten durchgeführt wurde, ist hoch und abhängig von Alter‑, Einkommen und Dienstjahren.

Investigating the links between diagnostic uncertainty, emotional exhaustion, and turnover intention in General Practitioners working in the United Kingdom

BACKGROUND

General Practitioners (GPs) report high levels of burnout, job dissatisfaction, and turnover intention. The complexity of presenting problems to general practice makes diagnostic uncertainty a common occurrence that has been linked to burnout. The interrelationship between diagnostic uncertainty with other factors such as burnout, job satisfaction and turnover intention have not been previously examined.

OBJECTIVES

To examine associations between diagnostic uncertainty, emotional exhaustion (EE), depersonalization (DP), job satisfaction, and turnover intention in GPs.

METHODS

Seventy general practices in England were randomly selected through the Oxford-Royal College of General Practitioners Research and Surveillance Centre (RCGP-RSC). A total of 348 GPs within 67 these practices completed a 10-item online questionnaire which included questions on GP characteristics, work-life balance, job satisfaction, sickness presenteeism, diagnostic uncertainty, turnover intention as well as EE and DP. Associations between diagnostic uncertainty and each of EE, DP, job satisfaction, and turnover intention were evaluated in multivariate mixed-effect ordinal logistic regressions whilst adjusting for covariates, to account for the correlation in the three outcomes of interest.

RESULTS

Almost one-third of GPs (n = 101; 29%) reported experiencing >10% of diagnostic uncertainty in their day-to-day practice over the past year. GPs reporting greater diagnostic uncertainty had higher levels of EE [OR = 3.90; 95% CI = (2.54, 5.99)], job dissatisfaction [OR = 2.01; 95% CI = (1.30, 3.13)] and turnover intention [OR = 4.51; 95% CI = (2.86, 7.11)]. GPs with no sickness presenteeism had lower levels of EE [OR = 0.53; 95% CI = (0.35, 0.82)], job dissatisfaction [OR = 0.56; 95% CI = (0.35, 0.88)], and turnover intention [OR = 0.61; 95% CI = (0.41, 0.91)].

CONCLUSION

Diagnostic uncertainty may not only negatively impact on the wellbeing of GPs, but could also have adverse implications on workforce retention in primary care.

The nurse without a nurse: the antecedents of presenteeism in nursing

BACKGROUND

Presenteeism describes the state in which staff who lack the conditions for being present at work and need rest and leave for various reasons (such as illness, low spirits, fatigue, etc.) are present at the workplace. Due to the lack of knowledge about the antecedents of presenteeism in nurses and the context-based nature of this concept, the present study was conducted to explain the reasons for presenteeism in nurses.

METHODS

This qualitative study was performed using the qualitative content analysis method. The study population consisted of 17 nurses working in different wards of hospitals. In this regard, data were collected from February to June 2020 using individual, face-to-face, in-depth, semi-structured interviews and were analyzed using qualitative content analysis.

RESULTS

The nurse without a nurse was a category introduced as an antecedent of presenteeism. In this respect, nurses experienced limited power, injustice, compulsory presence, inadequate structural facilities, damaged professional identity, manager-nurse disconnect, insufficient knowledge, physical and mental health complications, job stress, job burnout, multitasking, and impaired communication.

CONCLUSION

The nurse, who has been responsible for caring, supporting, advising, advocating, and educating the patient, has now been left without a nurse. In other words, not nursing the nurse has given rise to the emergence of presenteeism. It is recommended that the results of this study be used in making health policies. The results of this study can make nurses' voices heard by health leaders and managers. A voice that has never been heard as it deserves.

Burnout and presenteeism among healthcare workers in Nigeria: Implications for patient care, occupational health and workforce productivity

Background: Burnout and presenteeism are two emerging occupational health challenges which share same locus among healthcare workers, and the trend is rising. We aim to define the magnitude of burnout and presenteeism among frontline members of the health workforce and explore any correlation between the two in order to provide empirical data from our socioeconomic and geographical background.

Design and Methods: We used self-administered questionnaire to conduct a cross-sectional study among the physicians and nurses in a regional trauma centre in Enugu, Eastern Nigeria; with the respondents selected by stratified random sampling. The Oldenburg burnout inventory and Stanford presenteeism scale were used to measure burnout and presenteeism respectively, while the 2-item patient-health questionnaire (PHQ-2) was used to screen for depression. The level of statistical significance was determined by a p value of <0.05.

Results: Among the healthcare workers surveyed (n=155); 34 (21.9%) were physicians, while 121 (78.1%) were nurses. Burnout prevalence was 69%. Burnout was associated with self-rated health status and length of years in professional service but not the occupation or depression screen status of the worker. Sixty-two healthcare workers (40%) screened positive for depression. A positive screen for depression was the only factor that had significant association with lower presenteeism scores (p=0.002). The mean presenteeism scores had strong negative correlation with both the exhaustion (p<0.001) and disengagement (p<0.001) domains of burnout.

Conclusion: Burnout is high among the healthcare workers and correlates with presenteeism scores. The mental health of the workforce greatly impaired their productivity.

Exploring the concept of presenteeism in nursing: A hybrid concept analysis

PURPOSE

To explore the concept of presenteeism in nursing.

METHOD

A three-phase concept analysis using a hybrid model was used. In the theoretical phase (first phase), a literature review was conducted using PubMed, Web of Science, Proquest, EBSCO, Scopus, OVID, Cochrane Library, PsycINFO, Google Scholar, SID, and Iranmedex. In the fieldwork phase (second phase), semistructured interviews with 17 nurses were used. In the final analytical phase (third phase), the results of the previous phases were combined.

FINDINGS

In the final definition, presenteeism can be considered as a kind of fall from balance, in whose nature lies the non-actualization of capacities. If the imbalance of presence is due to the body, we are faced with the non-actualization of movement capacity, and regarding the imbalance caused by the soul, cognitive and emotional actualization is challenged.

CONCLUSION

Exploration of the concept of presenteeism in the nursing is the basis for identifying this concept in a profession that deals with health as the most valuable human property.

IMPLICATIONS FOR NURSING PRACTICE

The identified attributes of presenteeism provide a deep insight for nurse managers into the nature of presenteeism. Nurse managers cannot deal with a destructive phenomenon without exploring and identifying its exact meaning.

Predictors of Presenteeism Among Hospital Employees-A Cross-Sectional Questionnaire-Based Study in Switzerland

OBJECTIVE

The aim of this cross-sectional study was to examine work- and person-related predictors of the largely "invisible" behavior and phenomenon of presenteeism among employees in a health-care setting in German-speaking Switzerland.

METHODS

Self-reported survey data from 1840 employees of four hospitals and two rehabilitation clinics collected in 2015 and 2016 were utilized and analyzed.

RESULTS

All studied work-related factors such as patient contact, job satisfaction, high work load, forced overtime, fear of job-loss, and particularly mental strain turned out to be significant and relevant predictors of presenteeism. Younger employees, female workers, and employees with a chronic disease also were more likely to show presenteeism.

CONCLUSION

Work stress, work without patients, job dissatisfaction, a chronic disease, and/or a younger age or rather less work experience seem to increase the chances of presenteeism among health-care workers.

Presenteeism exposures and outcomes amongst hospital doctors and nurses: a systematic review

Background

Presenteeism is a behavior in which an employee is physically present at work with reduced performance due to illness or other reasons. Hospital doctors and nurses are more inclined to exhibit presenteeism than other professional groups, resulting in diminished staff health, reduced team productivity and potentially higher indirect presenteeism-related medical costs than absenteeism. Robust presenteeism intervention programs and productivity costing studies are available in the manufacturing and business sectors but not the healthcare sector.

This systematic review aims to 1) identify instruments measuring presenteeism and its exposures and outcomes; 2) appraise the related workplace theoretical frameworks; and 3) evaluate the association between presenteeism, its exposures and outcomes, and the financial costs of presenteeism as well as interventions designed to alleviate presenteeism amongst hospital doctors and nurses.

Methods

A systematic search was carried out in ten electronic databases from 1998 to 2017 and screened by two reviewers. Quality assessment was carried out using the Critical Appraisal Skills Program (CASP) tool. Publications meeting predefined assessment criteria were selected for data extraction.

Results

A total of 275 unique English publications were identified, 38 were selected for quality assessment, and 24 were retained for data extraction. Seventeen publications reported on presenteeism exposures and outcomes, four on financial costing, one on intervention program and two on economic evaluations. Eight (39%) utilized a theoretical framework, where the Job-Demands Resources (JD-R) framework was the most commonly used model. Most assessed work stressors and resources were positively and negatively associated with presenteeism respectively. Contradictory and limited comparability on findings across studies may be attributed to variability of selected scales for measuring both presenteeism and its exposures/outcomes constructs.

Conclusion

The heterogeneity of published research and limited quality of measurement tools yielded no conclusive evidence on the association of presenteeism with hypothesized exposures, economic costs, or interventions amongst hospital healthcare workers. This review will aid researchers in developing a standardized multi-dimensional presenteeism exposures and productivity instrument to facilitate future cohort studies in search of potential cost-effective work-place intervention targets to reduce healthcare worker presenteeism and maintain a sustainable workforce.

Electronic supplementary material

The online version of this article (10.1186/s12913-018-3789-z) contains supplementary material, which is available to authorized users.

A study of unreasonable illegitimate tasks, administrative tasks, and sickness presenteeism amongst Norwegian physicians: an everyday struggle?

BACKGROUND

It has been shown that a recently defined stressor, 'illegitimate tasks', has negative effects on employees' work motivation and health. Better understanding of the illegitimate tasks undertaken by physicians might contribute to a more resource-efficient division of labour within the health care system, with beneficial effects on organisational economics and employee performance. We aimed to investigate the prevalence of unreasonable illegitimate tasks, their associations with workplace variables and their impact on health, in particular sickness presenteeism.

METHODS

Cross-sectional data were collected in 2012. A sample of 545 Norwegian physicians answered an online questionnaire. The response rate was high (71.8%). The data were analysed using independent-samples t-tests, ANOVA and logistic regression.

RESULTS

About 50.2% of physicians in all clinical positions reported that at least 11% of their everyday tasks could have been done by other hospital personnel. Seven percent of the physicians reported that at least 31% of their daily workload consisted of unreasonable illegitimate tasks. There were no significant differences in unreasonable illegitimate tasks according to clinical position, age or gender. Administrative task load and role conflict were positively associated with unreasonable illegitimate tasks that physicians reported could be reallocated to non-medical professionals. Moreover, unreasonable illegitimate task was associated with a higher probability of sickness presenteeism after controlling for age, gender, role conflict, control over work pace, exhaustion and administrative tasks.

CONCLUSIONS

The results confirm that physicians' workload includes a high proportion of unreasonable illegitimate tasks and that this can contribute to sickness presenteeism. Investigation of work environmental factors can provide insight into the mechanisms behind unreasonable illegitimate tasks. Decreasing the amount of administrative tasks and role conflicts faced by physicians should be a priority. These findings could be used to make hospital task management more resource-efficient. Our results indicate that a substantial proportion of physicians' work capacity could be re-allocated to core tasks. Further research is needed into the specific type and content of unreasonable illegitimate tasks undertaken by physicians in order to determine to whom they should be allocated to ensure a healthy and motivated workforce and provision of high quality, resource-efficient health care services.

Why hospital physicians attend work while ill? The spiralling effect of positive and negative factors

BACKGROUND

Recurrent reports from national and international studies show a persistent high prevalence of sickness presence among hospital physicians. Despite the negative consequences reported, we do not know a lot about the reasons why physicians choose to work when ill, and whether there may be some positive correlates of this behaviour that in turn may lead to the design of appropriate interventions. The aim of this study is to explore the perception and experience with sickness presenteeism among hospital physicians, and to explore possible positive and negative foundations and consequences associated with sickness presence.

METHODS

Semi-structured interviews of 21 Norwegian university hospital physicians.

RESULTS

Positive and negative dimensions associated with 1) evaluation of illness, 2) organizational structure, 3) organizational culture, and 4) individual factors simultaneously contributed to presenteeism.

CONCLUSIONS

The study underlines the inherent complexity of the causal chain of events affecting sickness presenteeism, something that also inhibits intervention. It appears that sufficient staffing, predictability in employment, adequate communication of formal policies and senior physicians adopting the position of a positive role model are particularly important.