Impact of Workplace Climate on Burnout Among Critical Care Nurses in the Veterans Health Administration

Job satisfaction and burnout syndrome among intensive-care unit nurses: A systematic review and meta-analysis

INTRODUCTION

The severe conditions often experienced in an intensive care unit, combined with poor working conditions, increase stress and therefore decrease job satisfaction. Sustained stress in the workplace leads to the development of burnout, a syndrome characterised by three dimensions: emotional exhaustion, depersonalisation and perceived lack of personal fulfilment.

OBJECTIVE

To analyse the relationship between burnout syndrome and job satisfaction among ICU personnel.

DATA SOURCES

The PubMed, CINAHL and Scopus databases were used.

STUDY DESIGN

A systematic review and meta-analysis. The study sample consisted of 18 quantitative primary studies conducted in the last five years. Validated questionnaires were used to assess burnout in ICU healthcare workers, the most commonly used being the Maslach Burnout Inventory.

EXTRACTION METHODS

The search equation applied was: "job satisfaction AND nurs* AND burnout AND (ICU OR intensive care units)". The search was performed in October 2022.

PRINCIPAL FINDINGS

The search returned 514 results. Only 73 articles met the eligibility criteria. After reading the title and abstract, 20 articles were selected. After reading the full texts, 12 articles remained and after the reverse search, 18 articles were finally selected. The studies reported a 50% prevalence of burnout, all three dimensions of which were heightened by the COVID-19 pandemic. Analysis of the study findings revealed an inverse association between burnout and job satisfaction.

CONCLUSIONS

Job dissatisfaction of ICU nurses depends on lack of experience, working conditions or working environment among others. ICU nurses with lower job satisfaction have higher levels of burnout.

IMPLICATIONS FOR CLINICAL PRACTICE

This meta-analysis shows the potential value of job satisfaction on improving health outcomes related to burnout syndrome for nursing professional in Intensive Care Units. Different factors that could increase job satisfaction and consequently protect them from suffering high levels of burnout, such as salary, permanence in the service, mental health care are the responsibility of the hospital supervisor and, finally, of the own Health System. Knowledge of a risk profile based on the factors influencing job dissatisfaction would enable the implementation of effective workplace interventions to reduce or prevent the risk of burnout. Health policies should focus on protecting the worker, so in addition to improving working conditions, it would be interesting to promote coping skills in order to improve the quality of care and patient safety.

Factors determining safety culture in hospitals: a scoping review

OBJECTIVE

To evaluate and synthesise the factors determining patient safety culture in hospitals.

METHODS

The scoping review protocol was based on the criteria of the Joanna Briggs Institute. Eligibility criteria were as follows: (1) empirical study published in a peer-reviewed journal; (2) used methods or tools to assess, study or measure safety culture or climate; (3) data collected in the hospital setting and (4) studies published in English. Relevant literature was located using PubMed, CINAHL, Web of Science and PsycINFO databases. Quantitative and qualitative analyses were performed using RStudio and the R interface for multidimensional analysis of texts and questionnaires (IRaMuTeQ).

RESULTS

A total of 248 primary studies were included. The most used instruments for assessing safety culture were the Hospital Survey on Patient Safety Culture (n=104) and the Safety Attitudes Questionnaire (n=63). The Maslach Burnout Inventory (n=13) and Culture Assessment Scales based on patient perception (n=9) were used in association with cultural instruments. Sixty-six articles were included in the qualitative analysis. In word cloud and similarity analyses, the words 'communication' and 'leadership' were most prominent. Regarding the descending hierarchical classification analysis, the content was categorised into two main classes, one of which was subdivided into five subclasses: class 1a: job satisfaction and leadership (15.56%), class 1b: error response (22.22%), class 1c: psychological and empowerment nurses (20.00%), class 1d: trust culture (22.22%) and class 2: innovation worker (20.00%).

CONCLUSION

The instruments presented elements that remained indispensable for assessing the safety culture, such as leadership commitment, open communication and learning from mistakes. There was also a tendency for research to assess patient and family engagement, psychological safety, nurses' engagement in decision-making and innovation.

Health status, resources, and job demands in geriatric nursing staff: A cross-sectional study on determinants and relationships

BACKGROUND

According to current estimates, the number of people needing care will double in the next 40 years. It is expected that between 130,000 and 190,000 additional nurses will be needed by 2030 in Germany. Physical and psychological burdens associated with nursing in long-term care facilities can develop into serious health risk factors and significantly impact occupational factors such as absenteeism, especially when linked to difficult working conditions. However, demands and resources specific to the nursing profession have not been analyzed extensively to preserve and promote nurses' workability and health adequately.

OBJECTIVE

Our study aimed to examine the extent to which perceived health among geriatric nursing staff in Germany is predicted by personal resources, job demands, and job resources. In addition, we analyzed the impact of different behavior and experience patterns on these relationships.

DESIGN, SETTING, AND PARTICIPANTS

An observational study was conducted between August 2018 and February 2020 in 48 nursing home facilities with 854 staff members in Germany as part of the project 'PROCARE - Prevention and occupational health in long-term care'.

METHODS

The survey contained instruments that measure workplace exposure, musculoskeletal complaints, physical and mental well-being, chronic stress, and work-related behavior and experience patterns. In addition, health-related information on physical activity and nutrition was collected. Data were analyzed using structural equation modeling.

RESULTS

The combined physical and mental workload for geriatric nurses is very high, with 75 % showing chronic stress. In the overall model, job and personal resources have a stronger association with mental health than physical health, while job demands have an equal impact on mental and physical health. Coping behavior also plays an important key role that should be assessed and considered. A behavior and experience risk pattern (health-endangering) is more strongly associated with a lower health status than a health-promoting behavior pattern. Results of the multigroup test showed that work-related behavior and experience patterns significantly moderate the relationship between physical health and mental health (χ2 = 392/p ≤ .001/df = 256/RMSEA = 0.028/CFI = 0.958/TLI = 0.931). Only 43 % show a health-friendly coping pattern.

CONCLUSIONS

Our findings underline the importance of holistic health promotion, which not only aims at changes at the behavioral level and the development of coping strategies but also takes on the task of reducing the workload and including measures to improve the working climate.

TRIAL REGISTRATION NUMBER

DRKS.de (DRKS00015241); August 9, 2018.

TWEETABLE ABSTRACT

Healthier coping patterns can benefit geriatric nurses' health. However, this is not a substitute for improving working conditions.

Factors affecting the implementation of employee whole health in the veterans health administration: a qualitative evaluation

BACKGROUND

There is increasing recognition of the need to focus on the health and well-being of healthcare employees given high rates of burnout and turnover. Employee wellness programs are effective at addressing these issues; however, participation in these programs is often a challenge and requires large scale organizational transformation. The Veterans Health Administration (VA) has begun to roll out their own employee wellness program-Employee Whole Health (EWH)-focused on the holistic needs of all employees. This evaluation's goal was to use the Lean Enterprise Transformation (LET) model for organizational transformation to identify key factors-facilitators and barriers-affecting the implementation of VA EWH.

METHODS

This cross-sectional qualitative evaluation based on the action research model reflects on the organizational implementation of EWH. Semi-structured 60-minute phone interviews were conducted in February-April 2021 with 27 key informants (e.g., EWH coordinator, wellness/occupational health staff) knowledgeable about EWH implementation across 10 VA medical centers. Operational partner provided a list of potential participants, eligible because of their involvement in EWH implementation at their site. The interview guide was informed by the LET model. Interviews were recorded and professionally transcribed. Constant comparative review with a combination of a priori coding based on the model and emergent thematic analysis was used to identify themes from transcripts. Matrix analysis and rapid turnaround qualitative methods were used to identify cross-site factors to EWH implementation.

RESULTS

Eight common factors in the conceptual model were found to facilitate and/or hinder EWH implementation efforts: [1] EWH initiatives, [2] multilevel leadership support, [3] alignment, [4] integration, [5] employee engagement, [6] communication, [7] staffing, and [8] culture. An emergent factor was [9] the impact of the COVID-19 pandemic on EWH implementation.

CONCLUSIONS

As VA expands its EWH cultural transformation nationwide, evaluation findings can (a) enable existing programs to address known implementation barriers, and (b) inform new sites to capitalize on known facilitators, anticipate and address barriers, and leverage evaluation recommendations through concerted implementation at the organization, process, and employee levels to jump-start their EWH program implementation.

The Impact of the Working Hours Among Malaysian Nurses on Their Ill-Being, Intention to Leave, and the Perceived Quality of Care: A Cross-Sectional Study During the COVID-19 Pandemic

Purpose

This study explores the effect of working duration on nurses and their ill-being (ie, anxiety, depression, fatigue, and sleepiness), intention to leave, and the quality of nursing care.

Methods

A questionnaire survey was employed for a convenience sample of 400 nurses at Malacca General Hospital in Malaysia who voluntarily participated in this cross-sectional study. The Statistical Package for the Social Sciences (SPSS) was used to treat and analyze the data. Descriptive statistics were generated, and Post Hoc analyses and ANOVA tests were conducted.

Results

Findings indicated that working hours duration was significantly associated with nurses' anxiety (F (4, 394) = 10.362, p <0.001), depression (F (4, 395) = 23.041, p< 0.001), fatigue (F (4, 395) = 24.232, p< 0.001), sleepiness (F (4, 395) = 4.324, p < 0.002), quality of nursing care (F (4, 395) = 16.21, p <0.001) and intention leave their job, (F (4, 395) = 50.29, p <0.001). The results also revealed that working more than 14 hours was negatively associated with their perceived quality of nursing care and positively associated with their perceived ill-being and intention to leave.

Conclusion

Shift length is an important issue, and nursing managers must consider shift length as it can adversely correlate with the nurses' perceptions of work and life.

Well-Being and Professional Efficacy Among Health Care Professionals: The Role of Resilience Through the Mediation of Ethical Vision of Patient Care and the Moderation of Managerial Support

Drawing on the Conservation of Resources theory, this study analyzes whether resilience could be related to healthcare providers' wellbeing and professional self-efficacy, both directly and indirectly, as mediated by ethical vision of patient care and moderated by managerial support in dealing with ethical issues. Overall, 315 Italian healthcare professionals employed in neuro-rehabilitation medicine or palliative care specialties participated in this multi-centered cross-sectional study. The following variables were investigated: resilience (Connor-Davidson Resilience Scale), wellbeing (Maugeri Stress Index-Reduced), professional self-efficacy (Maslach Burnout Inventory-General Survey), ethical vision of patient care and managerial support in dealing with ethical issues (Italian version of the Hospital Ethical Climate Survey). Overall, resilience was positively associated with healthcare providers' wellbeing and professional self-efficacy, directly and indirectly, as mediated by ethical vision of patient care. Highly resilient healthcare professionals who perceived the presence of a positive ethical vision of patient care in their workplace were more likely to experience greater wellbeing when managerial support in dealing with ethical issues was high (vs. low). Thus, these findings provide suggestions for tailored interventions sustaining healthcare professionals along their daily activity characterized by high-demanding and challenging situations.

Healthcare providers' intention to leave their jobs during COVID-19 pandemic: A cross-sectional study

Background and Aims

During the coronavirus pandemic (COVID-19), healthcare providers confronted risks of disease transmission to themselves and their family members, resulting in physical and psychological burdens. This might affect their decisions to leave their jobs temporarily or permanently, fearing infection and protecting their families. This study examined the factors related to the intention to leave a job among healthcare providers during the COVID-19 pandemic in Jordan.

Methods

A cross-sectional correlational design was used to collect data using a convenience sample of 557 healthcare providers working in different sectors across Jordan. Data were collected using a self-administered questionnaire about the intention to leave jobs during the pandemic.

Results

The sample included 368 females (63.8%) and 209 males (36.6%) participants. The mean age of participants was 30.8 years (SD = 6.65). Differences found in intention to leave job during COVID-19 in relation to age (t = 2.60, p < 0.05), gender (X 2 = 4.25, p < 0.001), and marital status (X 2 = 18.2, p < 0.001). Participants with a high risk of exposure to COVID-19 and who experienced higher workloads had higher scores of intention to leave their job during COVID-19, while being married had lower scores.

Conclusions

Policy-makers need to pay attention to young and single healthcare providers during the COVID-19 pandemic to prevent them leave their job. Crucial guidelines for managing workload during the COVID-19 pandemic are needed. Policy-makers during pandemics have to protect healthcare providers who feel they are at high risk of infection.

How Supportive Ethical Relationships Are Negatively Related to Palliative Care Professionals' Negative Affectivity and Moral Distress: A Portuguese Sample

In the modern healthcare landscape, moral distress has become an increasingly common phenomenon among healthcare professionals. This condition is particularly prevalent among palliative care professionals who are confronted with bioethical issues in their daily practice. Although some studies described the effects of poor ethical climate and negative affectivity on moral distress, how these variables could be incorporated into a single model is still unclear. Thus, this study aims to investigate whether ethical relationships with the hospital could be related to the intensity and frequency of moral distress, both directly and as mediated by professionals' negative affectivity. Sixty-one Portuguese palliative care professionals completed web-based self-report questionnaires. After exploring descriptive statistics, mediation analyses were performed using the partial least squares method. The results indicated that the presence of positive relationships with the hospital reduced the professionals' negative affectivity levels. This, in turn, led palliative care professionals to experience a lower frequency and intensity of moral distress. Being a physician was positively associated with negative affectivity but not with the frequency of moral distress. Considering the protective role of ethical relationships with hospitals, health organizations could consider implementing interventions to improve hospitals' ethical climate and provide staff with ethics training programs.

Nursing Moral Distress and Intent to Leave Employment During the COVID-19 Pandemic

BACKGROUND

Complexity in nursing practice creates an intense and stressful environment that may lead to moral distress (MD) and registered nurses (RNs) seeking other employment.

LOCAL PROBLEM

In 2020, the RN turnover rate was 8%, with postpandemic turnover projected to reach 13%.

METHODS

The Measure of Moral Distress for Health Care Professionals (MMD-HP) was used to measure the frequency and level of RNs' MD.

RESULTS

t tests showed significant differences for 16 of 27 MMD-HP items in RN intent to leave. RNs had 2.9 times the odds of intent to leave (P = .019) due to perceived issues with patient quality and safety and 9.1 times the odds of intent to leave (P < .001) due to perceived issues with the work environment. Results explained 40.3% of outcome variance.

CONCLUSIONS

MD related to work environment or patient quality and safety were significant factors in RN intent to leave their position.

Factors Influencing Role Ambiguity and Role Conflict Among Intensive Care Unit Nurses Providing End of Life Care

AIM

The aim of this study was to determine the relationship of compassion satisfaction, compassion fatigue, and death anxiety with role ambiguity and role conflict in intensive care unit (ICU) nurses providing care at end of life.

BACKGROUND

Understanding the factors that impact care for patients and families at the end of life is important for nursing practice and nursing leaders.

METHODS

A quantitative nonexperimental correlation design was used, with 216 critical care nurses recruited using an Internet-based website. Data were analyzed using, Pearson product-moment correlation, χ2 test of independence, and the independent-samples t test or analysis of variance as appropriate.

RESULTS

Role ambiguity and role conflict were negatively related to compassion satisfaction and were positively related to compassion fatigue and death anxiety. There was no relationship between increased years of ICU experience and role ambiguity and role conflict.

CONCLUSION

Compassion satisfaction is a significant predictor for role ambiguity, whereas burnout is best predicted by role conflict for ICU nurses providing end of life care.

Critical Care Nurse Burnout in Veterans Health Administration: Relation to Clinician and Patient Outcomes

BACKGROUND

Critical care nurses have a burnout rate among the highest of any nursing field. Nurse burnout may impact care quality. Few studies have considered how temporal patterns may influence outcomes.

OBJECTIVE

To test a longitudinal model of burnout clusters and associations with patient and clinician outcomes.

METHODS

An observational study analyzed data from annual employee surveys and administrative data on patient outcomes at 111 Veterans Health Administration intensive care units from 2013 through 2017. Site-level burnout rates among critical care nurses were calculated from survey responses about emotional exhaustion and depersonalization. Latent trajectory analysis was applied to identify clusters of facilities with similar burnout patterns over 5 years. Regression analysis was used to analyze patient and employee outcomes by burnout cluster and organizational context measures. Outcomes of interest included patient outcomes (30-day standardized mortality rate and observed minus expected length of stay) for 2016 and 2017 and clinician outcomes (intention to leave and employee satisfaction) from 2013 through 2017.

RESULTS

Longitudinal analysis revealed 3 burnout clusters among the 111 sites: low (n = 37), medium (n = 68), and high (n = 6) burnout. Compared with sites in the low-burnout cluster, those in the high-burnout cluster had longer patient stays, higher employee turnover intention, and lower employee satisfaction in bivariate models but not in multivariate models.

CONCLUSIONS

In this multiyear, multisite study, critical care nurse burnout was associated with key clinician and patient outcomes. Efforts to address burnout among nurses may improve patient and employee outcomes.

Mattering perception, work engagement and its relation to burnout amongst nurses during coronavirus outbreak

AIM

To assess the mattering perception, feelings of burnout and work engagement amongst nurses during coronavirus outbreak.

DESIGN

Cross-sectional research design.

METHODS

It conducted at Zagazig fever hospital and chest hospital on 280 nurses. A self-administered questionnaire containing four parts; characteristics, mattering at Work Scale, Burnout scale and Engagement scale.

RESULTS

The present study reported that more than half of studied nurses had moderate mattering level and more than one-quarter of them had low mattering. More than two-fifth of studied nurses had moderate level and slight less than one-third of them had low engagement. More than two-fifth of studied nurses had moderate level of burnout, whilst slight less than one-third of them had high burnout, and one-quarter of them had low burnout.

COVID-19: The Lived Experience of Critical Care Nurses

OBJECTIVE

The goal of this qualitative phenomenological study was to explore in-depth, critical care nurses' (CCNs) lived experience while caring for coronavirus disease 2019 (COVID-19) patients during the pandemic.

BACKGROUND

CCNs play an important role during pandemics characterized by highly contagious, life-threatening disease. Understanding the experience of CCNs during a pandemic is particularly important because of the high rate of burnout within this group, as well as a shortage of these caregivers across the globe.

METHODS

Using Heidegger's interpretive phenomenological approach, interviews were conducted with 10 CCNs caring for COVID-19 patients. The goal of the interviews was to access a deep layer of understanding regarding participants' lived experience.

RESULTS

Themes of role frustration, emotional and physical exhaustion, and the importance of presence were revealed.

CONCLUSION

Themes revealed suggest a number of actions hospital administrators could take to support CCNs as they experience the challenges of a pandemic.

Early career midwives' perception of their teamwork skills following a specifically designed, whole-of-degree educational strategy utilising groupwork assessments

OBJECTIVE

The aim of this study was to investigate whether a specifically designed whole-ofdegree strategy utilising groupwork assessments was effective in facilitating the development of early career midwives' teamwork skills.

DESIGN AND METHODS

A qualitative study using in-depth, semi-structured interviews was undertaken with early career midwives who had graduated within the previous two years. This study is the final cycle of a larger participatory action research project. Qualitative data was analysed using thematic analysis.

PARTICIPANTS

Nineteen early career midwives from one Australian university participated. Their preregistration education was via a Bachelor of Midwifery. Their education included a whole-of-degree educational strategy to facilitate the development of teamwork skills.

FINDINGS

One overarching theme "Becoming an Effective Team Member' and three sub-themes: 'Learning and developing Teamwork Skills'; 'More secure and confident' and 'Self-Assurance in interprofessional interactions' were identified in the interview data. Despite their junior status, the midwives demonstrated the knowledge, skills, and attitudes of an effective team member. Their social and emotional skills appeared well developed and they felt confident interacting with other health care workers in a professional manner.

KEY CONCLUSIONS

Early career midwives who were taught and practiced teamwork skills throughout their degree, appear to have developed the social and emotional competencies required for effective teamwork.

IMPLICATIONS FOR PRACTICE

The capacity for effective teamwork of this small group of early career midwives has the potential to improve the quality and safety of their care for childbearing women. Learning teamwork skills in the educational setting appears to have generated skills focused on conflict resolution, emotional self-regulation and social and emotional competency in these new midwives. These are favourable skills in the emotionallycharged environment of maternity care, where inter-collegial bullying is present and where new midwives can experience poor psychological wellbeing. Health care employers want new graduate health professionals to be work ready and to have the skills necessary to be effective team members. The program undertaken by these new graduates may be of assistance in developing these capabilities in other health students.

THE KNOWN

Teamwork skills are an intrinsic part of the day-to-day activities of maternity services, influencing the workplace culture, retention of midwives and the quality and safety of care. Poor teamwork is associated with clinical errors, bullying and high turnover of staff.

THE NEW

Early career midwives who were taught teamwork skills and practice these skills using their groupwork assignments throughout their undergraduate degree appear to demonstrate the social and emotional competencies required for effective teamwork.

THE IMPLICATIONS

Implementing a whole-of-degree program to develop teamwork skills in undergraduate midwifery students may improve early career midwives' social and emotional competencies and interactions with other health professionals. Learning teamwork skills in the educational setting may generate skills in the new midwife that focus on conflict resolution, emotional self-regulation, and social and emotional competency. These are favourable skills in the emotionally charged environment of maternity care, where inter-collegial bullying is present and where new midwives can experience poor psychological wellbeing.

Forty-Fourth ASPEN Presidential Address: The 2020 Overture-A New Tune for the Future

The provision of safe nutrition care to patients is the fundamental vision of the American Society for Parenteral and Enteral Nutrition (ASPEN). Yet we are facing important challenges in our field and society, requiring us to reflect, rethink, and adjust to make new breakthroughs to meet the needs for the future. In developing new plans to address these challenges, we must focus on 2 critical elements: people and the scientific process. Government and organizations cannot carry on their missions without people. But with the challenges of healthcare finance, biotechnology disruption, the desire to facilitate knowledge transfer and now the impact of the global pandemic, we need to develop a forward-thinking and sustainable approach to connect people and foster continued learning. Burnout is a recognized occupational problem that affects providers and researchers across all disciplines. The coronavirus disease 2019 pandemic has amplified the challenges associated with burnout. Supporting the needs and promoting the well-being of people, therefore, are critical to move forward successfully. At the same time, the scientific advances in our field rely on sound scientific principles and integrity. Information overload, pressure to produce immediate outcomes (such as cost-saving initiatives), and misinformation can compromise the scientific process and research evidence. The two common missteps that affect researchers, clinicians, and administrators include premature factulation and binary thinking. We will discuss how these missteps can occur and the approaches to minimize their influence in making sound decisions and policies to meet the future's needs.