Emotional Labor and Burnout of Public Health Nurses during the COVID-19 Pandemic: Mediating Effects of Perceived Health Status and Perceived Organizational Support

Prevalence of Burnout Among Public Health Professionals: A Systematic Review

CONTEXT

Since the initial outbreak of COVID-19, health professionals-both clinical health care, as well as public health concentrations-have faced tremendous pressures. A growing body of literature indicates the pandemic has magnified already prevalent burnout rates among clinical health professionals and to what extent for public health professionals remains to be determined.

OBJECTIVE

This study purpose is to conduct a systematic review of literature examining burnout prevalence among public health professionals before and during the COVID-19 pandemic-nationally and internationally-with identification of potential risk factors.

DESIGN

We conducted a literature search in PubMed, EMBASE, PsycINFO, SocINDEX, and ClinicalKey since inception through April 4, 2023. Inclusion criteria included peer-reviewed, original research studies (qualitative or quantitative), in English, assessing prevalence of, or risk factors for, burnout in public health professionals. Two authors independently screened abstracts, titles, full report of studies and abstracted data related to burnout. This review was conducted using Joanna Briggs Institute Systematic Reviews guidelines and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines with narrative synthesis. Protocol for this review registered on PROSPERO (CRD42023424468).

RESULTS

Of 3327 health-related articles mentioning burnout, 15 met inclusion criteria (11 quantitative and 4 qualitative) with 10 in international settings and 5 in US majority of quantitative studies were from international settings and only 1 in United States. Seventy-eight percent of studies that included prevalence data, exhibited a burnout prevalence greater than 50% (with a range of 19%-81%). The pandemic likely heightened (13% increase) already elevated burnout prevalence. Major risk factors identified included overwork, lack of support, changing roles, and full-time employment status, though many risk factors had not been studied in the United States.

CONCLUSIONS

Burnout is prevalent among public health professionals, nationally and internationally, and likely heightened by the COVID-19 pandemic. More research is warranted assessing burnout among differing public health concentrations and interventions developed. Public health is an essential framework for protecting and promoting health nationally and internationally, and we need to ensure and support solidity of that framework.

Emotional Exhaustion in Healthcare Workers: Moving Beyond Coping Skills to Improve Organizational Conditions

OBJECTIVE

Emotional exhaustion (EE)-the first stage of burnout-is related to preventable work environment exposures. We examined the understudied impact of organizational support for safety (OSS) and safety hazards (SH) on EE in a mixed licensed and unlicensed population of healthcare workers (HCWs).

METHODS

A work environment exposures survey was conducted in five US public healthcare facilities in 2018-2019. A total of 1059 questionnaires were collected from a predominantly female population of mixed HCWs.

RESULTS

Mean EE scores were higher among women, direct care workers, and younger subjects. In linear regression models, EE was positively associated with SH, emotional labor, psychological demands, physical demands, job strain, assault, and negative acts, while OSS was negatively associated. Safety hazard s both mediated and moderated the relationship between OSS and EE.

CONCLUSIONS

When perception of SH is high, OSS has less impact on reducing EE, suggesting a need to effectively put safety policies to practice for improving EE in HCWS.

The Health Narratives Research Group (HeNReG): A self-direction process offered to help decrease burnout in public health nurse practitioners

Founded in accordance with 19th century sex roles and public health concerns, nursing evolved as other-directed, dependent on physician-focused diagnosis, prescription decisions, and public health advancements. The result of this other direction is that public health nurse practitioners have endured significant workplace stress resulting in burnout, especially during COVID-19. To help decrease their burnout, nurses require development of self-direction. The Health Narratives Research Group (HeNReG) has the potential to reduce burnout in nurse practitioners by encouraging the development of self-direction. The HeNReG process is presented through historically analyzed documents regarding reducing burnout in health researchers by developing self-direction including: (1) three years of archived year-end feedback results provided by participants, (2) archived participant responses to specific HeNReG-related writing prompts, and (3) a comparison of HeNReG results with the outcomes of resilience programs. The conclusion-the HeNReG offers an effective option for reducing burnout in health researchers that has the potential to decrease nurse practitioner burnout in a way that resilience programs do not. Tailoring the HeNReG process to public health nurses is discussed, inviting future research for reducing burnout in public health nurses.

Emotional labour and turnover intention among nurses in China: Mediating effects of nurse-patient relationship and self-rated health

AIM

This study tested the mediating role of the nurse-patient relationship and self-rated health in the effect of emotional labour on turnover intention among nurses in China.

BACKGROUND

The underlying mechanism behind the effect of emotional labour on turnover intention remains inadequately understood.

INTRODUCTION

Nurses with a high level of emotional labour are predisposed to experiencing poor health and tension in their relationships with patients, which may increase turnover intention.

METHODS

A cross-sectional survey of 527 nurses in a public tertiary hospital in Qiqihar, located in China's Heilongjiang province, was conducted. Emotional labour and turnover intention were assessed using existing validated scales containing multiple items, while the nurse-patient relationship and self-rated health were assessed using single items, respectively. Baron and Kenny's causal steps and the Karlson/Holm/Breen method were adopted to test the mediating effects of the nurse-patient relationship and self-rated health in the association between emotional labour and turnover intention after adjusting for variations in sociodemographic and job characteristics.

RESULTS

Emotional labour was positively associated with turnover intention. Self-rated poor health and a disharmonious nurse-patient relationship partially mediated the positive effect of emotional labour on turnover intention.

CONCLUSIONS

Emotional labour significantly affects the turnover intention of nurses working in public tertiary hospitals in China, and this effect is partially mediated by self-rated health and the nurse-patient relationship.

IMPLICATIONS FOR NURSING PRACTICE AND NURSING POLICY

Giving more attention to nurses' negative emotions and work attitudes is crucial. Developing comprehensive strategies for enhancing nurses' emotional management ability, promoting their physical and psychological well-being, and improving nurse-patient relationship to reduce nurses' turnover.

The experiences of public health nurses during the COVID-19 in Taiwan: A qualitative study

AIM

The coronavirus disease 2019 (COVID-19) pandemic has had a substantial effect on frontline health care workers and caused public health nurses (PHNs) to come under various forms of pressure. PHNs face high-risk challenges in their work environment, and their professional commitment and adaptability are key concerns. The aim of this qualitative study was to describe the experiences of PHNs during the COVID-19 outbreak.

METHODS/DESIGN

Twenty PHNs who worked during the COVID-19 outbreak were recruited from seven public health centres through posters. Data were collected through in-depth interviews that comprised semi-structured and open-ended questions; subsequently, the data were analysed through content analysis.

RESULTS

Three themes emerged from the study findings, namely (1) the disorderliness of COVID-19 pandemic prevention work, (2) managing stress and fear, and (3) the establishment of a new normal. Because of the severity of the pandemic, the workload and stress associated with epidemic prevention policies continue to increase. PHNs may infect their family members and experience a sense of alienation and distance. They must also deal with irrationality and reactions in the people within their community.

CONCLUSION

Health department directors and policymakers should provide the necessary support and assistance to frontline pandemic prevention workers to increase the efficiency of pandemic prevention efforts.

PATIENT OR PUBLIC CONTRIBUTION

The participants agreed to participate in the qualitative study during the study period.

Enhancing the work engagement of frontline nurses during the COVID-19 pandemic: the mediating role of affective commitment and perceived organizational support

BACKGROUND

Overload and anxiety were common phenomena among frontline nurses during the pandemic. Understanding the potential pathway for fostering engagement in high-stress working conditions can provide evidence of targeted intervention to facilitate nurses' well-being and safety practices. This study aims to investigate the level of nurses' work engagement during nucleic acid collection tasks in the COVID-19 pandemic and identify its potential antecedents.

METHODS

A cross-sectional design was adopted. A sample of 824 nurses who engaged in nucleic acid collection tasks completed an online self-report questionnaire between 1 March and 31 May 2022. Descriptive and path analyses were utilized to analyse the interrelationships among anxiety, perceived workload, affective commitment, perceived organizational support and work engagement. This study was conducted and reported under the guidelines for Strengthening the Reporting of Observational Studies in Epidemiology.

RESULTS

The results showed that frontline nurses engaged in such tasks reported high levels of anxiety and task load and low levels of work engagement. Path analysis identified anxiety symptoms, perceived workload, perceived organizational support, and affective commitment as associated with work engagement, and among these factors, perceived organizational support and affective commitment played key roles in mediating the relationship of anxiety, workload and work engagement in high-stress working conditions.

CONCLUSIONS

Affective commitment and perceived organizational support were associated with frontline nurses' level of work engagement during the COVID-19 pandemic; these two variables might explain how engagement is generated in high-anxiety and high-workload situations. When healthcare organizations give more attention to frontline nurses' physical and psychological conditions and are able to innovatively motivate affective commitment and facilitate organizational support, nurses' work engagement in high-level tasks may increase, thus enhancing work safety and personal well-being.

Critical consciousness of public health nurses: A descriptive, comparative survey

BACKGROUND

Public Health Nurses (PHN) caring for vulnerable populations amid systemic inequality must navigate complex situations, and consequently they may experience serious moral distress known to be detrimental to PHN wellbeing.

OBJECTIVE

Given PHN awareness of social inequities, the study aimed to determine if PHNs were motivated to enact social change and engage in social and political action to address inequality.

DESIGN AND SAMPLE

A survey of 173 PHNs was conducted in fall 2022. The convenience sample was mainly female (96.5%), White (85%), had associate/bachelor's degrees (71.7%), and worked in governmental public health settings (70.7%).

MEASURE

The study employed the Short Critical Consciousness Scales' subscales: Critical Reflection, Critical Motivation, and Critical Action.

RESULTS

PHNs were highly motivated to address inequities (Critical Motivation = 20.83; SD = 3.16), with similarly high awareness (Critical Reflection = 17.89; SD = 5.18). However, social and political action scores were much lower (Critical Action = 7.13; SD = 2.63). A subgroup of PHNs with strong agreement regarding the impact of poverty were more likely to be younger (p = .039) and work in a community setting (p = .003); with higher scores across subscales (p < .001).

CONCLUSIONS

High critical reflection and motivation among PHNs aligned with literature. Lower Critical Action scores warrant investigation into validity for PHNs, and possible role constraints.

The Impact of Transformational Leadership in the Nursing Work Environment and Patients' Outcomes: A Systematic Review

BACKGROUND

With the increasingly demanding healthcare environment, patient safety issues are only becoming more complex. This urges nursing leaders to adapt and master effective leadership; particularly, transformational leadership (TFL) is shown to scientifically be the most successfully recognized leadership style in healthcare, focusing on relationship building while putting followers in power and emphasizing values and vision.

AIM

To examine how transformational leadership affects nurses' job environment and nursing care provided to the patients and patients' outcomes.

DESIGN

A systematic literature review was conducted. From 71 reviewed, 23 studies were included (studies included questionnaire surveys and one interview, extracting barriers and facilitators, and analyzing using qualitative synthesis).

RESULT

TFL indirectly and directly positively affects nurses' work environment through mediators, including structural empowerment, organizational commitment, and job satisfaction. Nurses perceived that managers' TFL behavior did not attain excellence in any of the included organizations, highlighting the necessity for additional leadership training to enhance the patient safety culture related to the non-reporting of errors and to mitigate the blame culture within the nursing environment.

CONCLUSION

Bringing more focus to leadership education in nursing can make future nursing leaders more effective, which will cultivate efficient teamwork, a quality nursing work environment, and, ultimately, safe and efficient patient outcomes. This study was not registered.

The role of psychosocial risks in burnout, psychosomatic disorders, and job satisfaction: lineal models vs a QCA approach in non-university teachers

This study aims to assess the effect of psychosocial risks and resources on burnout, psychosomatic disorders, and job satisfaction using Hierarchical Regression Modelling (HRM) and Qualitative Comparative Analysis (QCA).

METHOD

The sample consisted of 9020 non-university public education teachers (Mage = 45.33 years, SD = 9.15; 72.5% women).

RESULTS

Demands variables (Workload, Emotional labour, Imbalance, and Interpersonal conflict) were better predictors than resources variables (Job autonomy, Social support, and Resources at work). Resources also significantly improved the model's predictive capacity, except in the case of Indolence. In the QCA results, none of the conditions seems to be necessary. Regarding sufficiency, the combination of the different conditions explains between 44-49% of high levels of Burnout and between 40-47% of low levels of Burnout; between 44-47% of high levels of Psychosomatic disorders and 40-47% of low levels of Psychosomatic disorders; 49% of high Job satisfaction levels and 45-56% of low Job satisfaction levels.

CONCLUSIONS

The results show that QCA models have better explanatory capacity than HRM. Some variables were not significant in HRM, but they were present in combination with other QCA model variables. The findings contribute to understanding how psychosocial risks affect workers' health and job satisfaction.

Using data visualization to characterize whole-person health of public health nurses

OBJECTIVE

To characterize patterns in whole-person health of public health nurses (PHNs).

DESIGN AND SAMPLE

Survey of a convenience sample of PHNs (n = 132) in 2022. PHNs self-identified as female (96.2%), white (86.4%), between the ages 25-44 (54.5%) and 45-64 (40.2%), had bachelor's degrees (65.9%) and incomes of $50-75,000 (30.3%) and $75-100,000/year (29.5%).

MEASUREMENTS

Simplified Omaha System Terms (SOST) within the MyStrengths+MyHealth assessment of whole-person health (strengths, challenges, and needs) across Environmental, Psychosocial, Physiological, and Health-related Behaviors domains.

RESULTS

PHNs had more strengths than challenges; and more challenges than needs. Four patterns were discovered: (1) inverse relationship between strengths and challenges/needs; (2) Many strengths; (3) High needs in Income; (4) Fewest strengths in Sleeping, Emotions, Nutrition, and Exercise. PHNs with Income as a strength (n = 79) had more strengths (t = 5.570, p < .001); fewer challenges (t = -5.270, p < .001) and needs (t = -3.659, p < .001) compared to others (n = 53).

CONCLUSIONS

PHNs had many strengths compared to previous research with other samples, despite concerning patterns of challenges and needs. Most PHN whole-person health patterns aligned with previous literature. Further research is needed to validate and extend these findings toward improving PHN health.

Public health nurses' perceptions and experiences of emergency preparedness, responsiveness, and burnout during the COVID-19 pandemic

OBJECTIVE(S)

To describe PHNs' perceptions and experiences of the COVID-19 pandemic, including training, response activities, and work-related challenges.

DESIGN

This was a qualitative study using interpretive description for analysis.

SAMPLE

PHN participants who worked in public health departments in Wisconsin were recruited using purposive sampling. A total of 15 PHNs participated in the study, including both general and supervisor-level PHNs.

MEASUREMENTS

Data were collected via semi-structured interviews from March to May 2021. Interview questions focused on PHNs' perceptions, experiences, response activities, and burnout in relation to the current pandemic as well as perceptions and experiences of emergency preparedness and response in general.

RESULTS

Five themes emerged in the study. These were: (1) experiences and observations of the COVID-19 pandemic, (2) organizational changes and their impacts, (3) public health emergency preparedness and response, (4) public health emergency response activities, and (5) role strain and burnout.

CONCLUSIONS

Findings presented here have important implications for PHN training and support in emergency preparedness and response. A wide array of strategies focused on developing and supporting the PHN workforce in response to the public health crisis this area need to be implemented at the organizational, community, and policy levels.

'Caring for the helpers': factors associated with professional quality of life among Hong Kong nurses during the fifth wave of the COVID-19 pandemic

BACKGROUND

Western studies have found that nurses are likely to experience both positive and negative emotions in their job, as a helping profession [professional quality of life (ProQoL)] during the coronavirus disease 2019 (COVID-19) pandemic, and that psychosocial and work-related variables (e.g. pandemic-related stressors, interpersonal and organizational support, coping strategies) are associated with such outcomes. However, relevant studies on nurses in the Asian context are limited.

OBJECTIVE

This study examined the psychosocial correlates of three indicators of ProQoL, i.e. compassion satisfaction, secondary traumatic stress (STS), and burnout, among nurses during the fifth wave of the COVID-19 pandemic in Hong Kong.

METHOD

Nurses in Hong Kong (N = 220) working in hospitals and community settings during the COVID-19 pandemic were recruited between 24 May and 27 June 2022 through nursing associations to complete an online survey measuring the aforementioned psychosocial variables.

RESULTS

Hierarchical regression results found that stressors from clinical work environments, insufficient emotional support, and less positive reframing were associated with poorer ProQoL (i.e. lower compassion satisfaction; higher STS and burnout) (β from 0.16, p > .05, to 0.44, p > .001). In addition, COVID-19-related worries/uncertainties and emotional processing were associated with higher STS (β from 0.21 to 0.23, p < .01), whereas insufficient organizational support for communication with the healthcare system was associated with higher burnout (β = 0.12, p < .05).

CONCLUSIONS

Our findings identified the important psychosocial determinants in ProQoL among nurses in Hong Kong and provide recommendations for services supporting the mental health of these nurses. Providing workshops for nurses to train their skills in coping with COVID-19-related uncertainties, worries, and stressors from the clinical work environment, in using adaptive coping strategies (e.g. positive reframing), and in soliciting emotional support from important others could facilitate their ProQoL. Moreover, the provision of organizational support through timely and transparent communication with the healthcare system could reduce STS in nurses.

Workplace Infection Control Measures and Perceived Organizational Support During the COVID-19 Pandemic in Japan: A Prospective Cohort Study

OBJECTIVE

We investigated whether workplace infection control measures during the COVID-19 pandemic could increase perceived organizational support (POS).

METHODS

This prospective cohort study was conducted in Japan from December 2020 to December 2021 using a questionnaire survey. There were 18,560 respondents at follow-up; we investigated 4971 who rated low POS at baseline. The participants were asked a single question about POS and nine about workplace infection control measures. We determined the odds ratios (ORs) of high POS at follow-up using multilevel logistic regression analysis.

RESULTS

The groups of 5 to 6 (OR = 1.29, 95% confidence interval = 1.05-1.57, P = 0.014) and 7 to 9 workplace infection control measures (OR = 1.54, 95% confidence interval, 1.28-1.85, P < 0.001) had significantly higher ORs than the group with 0 to 2 measures.

CONCLUSIONS

Health support for employees through workplace infection control measures can increase POS.

Influencing factors of fatigue among public health nurses during the COVID-19 pandemic: A cross-sectional study

OBJECTIVE

This study investigated the effects of occupational stress, anxiety, depression, and sleep disturbance on the level of fatigue among public health nurses (PHNs).

DESIGN

The study had a cross-sectional, correlational survey design.

MEASURES

A total of 198 PHNs were enrolled from 30 public healthcare centers/offices. Data were collected between May and July 2021 using a structured questionnaire to investigate the general characteristics, occupational stress, anxiety, depression, sleep disturbance, and fatigue of the participants. Descriptive statistics and multiple regressions were used to determine fatigue and its influencing factors among PHNs.

RESULTS

The participants showed high fatigue and occupational stress levels due to a lack of rewards. The percentage of participants with mild-to-severe anxiety and mild-to-severe depression, and those who identified themselves as poor sleepers were 44.9%, 50.5%, and 70.2%, respectively. High levels of sleep disturbance (β = .23, p < .001), occupational stress (β = .21, p < .001), anxiety (β = .20, p = .016), depression (β = .17, p = .043), being younger (β = -.15, p = .004), and being a regular worker (β = .13, p = .017) were influencing factors of fatigue.

CONCLUSIONS

Individual efforts and organizational interventions to enhance sleep quality are needed to relieve fatigue among PHNs. Further, organizational support can be considerate of young nurses and regular workers, and alleviate their occupational stress. Moreover, anxiety and depression should be managed efficiently to reduce fatigue.

Frontline nurses' burnout and its associated factors during the COVID-19 pandemic in South Korea

Background

The Coronavirus disease pandemic is a global health crisis with psychological consequences for healthcare workers.

Purpose

To identify the prevalence and potential factors influencing burnout among frontline nurses in South Korea.

Methods

This cross-sectional study comprised 161 nurses who voluntarily participated in the survey through advertisements at a general hospital. Data on sociodemographic and professional characteristics, insomnia, depression, anxiety, stress, and burnout were collected via an online questionnaire in 2021.

Results

Among the participants, 90 had a high level of burnout. Overall, 59.6 %, 23.0 %, 36.0 %, and 17.4 % of nurses experienced insomnia, depression, anxiety, and stress, respectively. The results showed that the assigned number of patients, insomnia, and depression were the major factors affecting burnout levels of nursing staff.

Conclusions

Frontline nurses were the main force in the fight against public health emergencies. The government and medical institutions must consider professional and psychological factors in ameliorating burnout and safety for nurses.

Job Demands, Resources and Burnout Among Polish Nurses During the Late Wave of COVID-19 Pandemic: The Mediating Role of Emotional Labor

Objective

Burnout has been recognized as a serious health problem. Nurses as a professional group are at a high risk of burnout occurrence, especially when facing burden associated with the COVID-19 pandemic. Despite evidence that higher job demands lead to burnout, there is less known about the indirect effect of job demands and resources on burnout via surface acting. Using the JD-R framework, this study examined how job demands and resources affected burnout among Polish nurses and whether these relationships are mediated by surface acting and moderated by coping with the workload.

Materials and Methods

A sample of 270 nurses from the biggest hospital in Southern Poland filled out an online questionnaire at the time between the fourth and the fifth wave of the COVID-19 pandemic in Poland. The Polish adaptations of Oldenburg Burnout Inventory (OLBI), Organizational Constraints Scale (OCS), Interpersonal Conflict at Work Scale (ICAWS), Areas of Worklife Survey (AWS), and Emotional Labor Scale (ELS) were used. Mediation and moderation analyses were carried out in the SPSS macro-PROCESS.

Results

Surface acting partially mediated the positive association between organizational constraints and interpersonal conflict at work and burnout, as well as the negative association between the perceived organizational support and burnout. Coping with workload moderated the direct effect of organizational constraints on burnout via surface acting.

Conclusion

The findings enrich the knowledge of the mediating and moderating mechanisms to explain the association between job demands, resources and burnout among nurses. There have been proposed interventions concerning increasing organizational support, effective emotional regulation of management education and psychological training regarding adequate coping strategies which could help reduce or prevent the occurrence of burnout in this professional group.

Investigating Frontline Nurse Stress: Perceptions of Job Demands, Organizational Support, and Social Support During the Current COVID-19 Pandemic

Background

While frontline nurses employ coping alternatives to help deal with occupational stress resulting from unprecedented challenges during the COVID-19 pandemic, their access to necessary resources is unclear.

Objective

This study aims to explore nurses' mental health in Alabama hospitals during the COVID-19 outbreak and investigate the impact of organizational and community support on nurse stressor levels, physio-psychosocial responses, and coping strategies employed.

Methods

A cross-sectional survey was developed to bridge our understanding of stress, support, and coping mechanisms and distributed to nurses working with COVID-19-infected patients in hospital settings in Alabama. A total of 232 frontline nurses responded to 79 items in four domains (stressors, physio-psychosocial symptoms, coping, and support) between May 6, 2020, and June 30, 2020. A two-way ANOVA, regression analysis, and mediation of effects were used to analyze the data.

Results

This study found that both social support and use of coping strategies contributed to the reduction of physio-psychosocial symptoms. Differences were found in how older frontline nurses perceived the efficacy of social support and certain coping strategies. This study provides further evidence of the importance of organizational support in addressing the harmful physio-psychosocial symptoms experienced by nurses.

Relationship between emotional labor and sense of career success among community nurses in China, Beijing: A cross-sectional study based on latent class analysis

Background

This study investigated different patterns of emotional labor among community nurses in China and analyzed the relationships between the sense of career success and emotional labor.

Methods

A total of 385 community nurses from Beijing participated in this investigation. Latent class analysis was used to identify meaningful subgroups of participants, and analysis of variance was used to analyze relationships between emotional labor classes and the sense of career success.

Results

Emotional labor among community nursing staff in China was divided into three latent classes: active (n = 90, 25.6%), apathetic (n = 65, 18.5%), and moderate (n = 197, 55.9%). The active emotional labor classes had significantly higher career success (p<0.05). The “gaining recognition” dimension showed significant differences across the three classes.

Conclusion

Our findings suggested managers to implement a variety of measures to strengthen interventions for employees’ emotional labor that are targeted to incentive mechanisms, which will improve nurses’ sense of career success.