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

A narrative review of the well-being and burnout of U.S. community pharmacists

OBJECTIVES

The purpose of this narrative review is to summarize the literature on well-being and burnout among community pharmacists in the U.S. and provide recommendations for future research.

METHODS

Relevant literature was identified by searching PubMed for combinations of keywords such as "burnout" and "well-being" combined with "pharmacists." Titles and abstracts were reviewed for relevancy, and full text articles were reviewed when applicable.

RESULTS

While burnout is defined by its 3 core symptoms of emotional exhaustion, depersonalization, and low personal accomplishment, well-being is more challenging to define and measure, which has led to it being less studied. Community pharmacists faced high rates of burnout, low quality of life (QOL), and extreme fatigue prior to the COVID-19 pandemic, a situation that has likely only worsened. Factors such as workload, the type of community pharmacy, the level of education or training of the pharmacist, and stress may be some of the contributors to high rates of burnout. Clinician burnout may be related to high rates of mental health disorders seen in pharmacists, may impact patient safety and satisfaction, and may affect productivity and costs to employers and the healthcare system overall. There has been no research into interventions or strategies to support well-being and reduce burnout among community pharmacists, but having a workplace that is perceived as supporting well-being may have some impact. Recommendations for future research include the following: (1) define well-being, (2) explore why various factors support well-being or contribute to burnout, (3) determine the impact of community pharmacists experiencing well-being or burnout, and (4) develop strategies to support well-being and reduce burnout that are specific to community pharmacy.

CONCLUSION

There is a sparsity of evidence regarding community pharmacist well-being and burnout. Further research is needed to generate the evidence needed to support interventions that are specific to the unique work setting of community pharmacists.

The Burnout PRedictiOn Using Wearable aNd ArtIficial IntelligEnce (BROWNIE) study: a decentralized digital health protocol to predict burnout in registered nurses

BACKGROUND

When job demand exceeds job resources, burnout occurs. Burnout in healthcare workers extends beyond negatively affecting their functioning and physical and mental health; it also has been associated with poor medical outcomes for patients. Data-driven technology holds promise for the prediction of occupational burnout before it occurs. Early warning signs of burnout would facilitate preemptive institutional responses for preventing individual, organizational, and public health consequences of occupational burnout. This protocol describes the design and methodology for the decentralized Burnout PRedictiOn Using Wearable aNd ArtIficial IntelligEnce (BROWNIE) Study. This study aims to develop predictive models of occupational burnout and estimate burnout-associated costs using consumer-grade wearable smartwatches and systems-level data.

METHODS

A total of 360 registered nurses (RNs) will be recruited in 3 cohorts. These cohorts will serve as training, testing, and validation datasets for developing predictive models. Subjects will consent to one year of participation, including the daily use of a commodity smartwatch that collects heart rate, step count, and sleep data. Subjects will also complete online baseline and quarterly surveys assessing psychological, workplace, and sociodemographic factors. Routine administrative systems-level data on nursing care outcomes will be abstracted weekly.

DISCUSSION

The BROWNIE study was designed to be decentralized and asynchronous to minimize any additional burden on RNs and to ensure that night shift RNs would have equal accessibility to study resources and procedures. The protocol employs novel engagement strategies with participants to maintain compliance and reduce attrition to address the historical challenges of research using wearable devices.

TRIAL REGISTRATION

NCT05481138.

On-call absences and academic recognition: A retrospective cohort analysis

BACKGROUND

Resident call schedules require careful planning and are vulnerable to unanticipated absences from unpredictable factors. We tested whether unplanned absences from resident call schedules were associated with the likelihood of subsequent academic recognition.

METHODS

We examined unplanned absences from call shifts for internal medicine residents at the University of Toronto from 2014 to 2022 (8 years). We identified institutional awards granted at the end of the academic year as an indicator of academic recognition. We defined the resident-year as the unit-of-analysis that started in July and ended in June of the subsequent year. Secondary analyses examined the association between unplanned absences and the likelihood of academic recognition in later years.

RESULTS

We identified 1668 resident-years of training in internal medicine. In total, 579 (35%) had an unplanned absence, and the remaining 1089 (65%) had no unplanned absence. Baseline characteristics were similar between the two groups of residents. In total, 301 awards were received for academic recognition. The likelihood of receiving an award at the end of the year was 31% lower for residents who had any unplanned absence compared with those who had no absence (adjusted odds ratio = 0.69, 95% confidence interval 0.51-0.93, p = 0.015). The likelihood of receiving an award was further decreased for residents with multiple unplanned absences compared with those with none (odds ratio 0.54, 95% confidence interval 0.33-0.83, p = 0.008). An absence during the first year of residency was not significantly associated with the likelihood of academic recognition in later years of training (odds ratio 0.62, 95% confidence interval 0.36-1.04, p = 0.081).

CONCLUSIONS

The results of this analysis suggest unplanned absences from scheduled call shifts may be associated with a decreased likelihood of academic recognition for internal medicine residents. This association could reflect countless confounders or the prevailing culture of medicine.

Job burnout among primary healthcare workers during COVID-19 pandemic: cross-sectional study in China

Objective

This study evaluated job burnout among primary healthcare workers (PHCWs) in China during the COVID-19 pandemic, explored its influencing factors, and examined PHCWs' preferences for reducing job burnout.

Method

We conducted a multicenter cross-sectional study in Heilongjiang, Sichuan, Anhui, Gansu, and Shandong Provinces. An electronic questionnaire survey was conducted through convenience sampling in communities from May to July 2022. We collected sociodemographic characteristics, job burnout level, job satisfaction, and preferred ways to reduce job burnout among PHCWs.

Results

The job burnout rate among PHCWs in China was 59.87% (937/1565). Scores for each dimension of job burnout were lower among PHCWs who had a better work environment (emotional exhaustion OR: 0.60; depersonalization OR: 0.73; personal accomplishment OR: 0.76) and higher professional pride (emotional exhaustion OR: 0.63; depersonalization OR: 0.70; personal accomplishment OR: 0.44). PHCWs with higher work intensity (emotional exhaustion OR: 2.37; depersonalization OR: 1.34; personal accomplishment OR: 1.19) had higher scores in all job burnout dimensions. Improving work environments and raising salaries were the preferred ways for PHCWs to reduce job burnout.

Conclusion

Strategies should be developed to improve job satisfaction among PHCWs, enhance their professional identity, and alleviate burnout to ensure the effective operation of the healthcare system, especially during periods of overwork.

The effectiveness of mindfulness training in improving medical students' stress, depression, and anxiety

INTRODUCTION

There is growing interest in Mindfulness-based Stress Reduction (MBSR) program to combat mental distress in medical students. In Saudi Arabia, literature is insufficient about MBSR and its effectiveness. This study aims to measure the effectiveness of MBSR in improving mindful state, stress, anxiety, and depression in medical students. Also, the study explores the association between the attendance rate of MBSR sessions and its effectiveness. Lastly, the study examines gender differences in response to MBSR.

METHODS

This is a stratified randomized controlled study of 84 medical students from two medical schools in Riyadh, Saudi Arabia. They were recruited voluntarily from November 2018 to April 2021, and allocated to MBSR and waitlist groups using a stratified randomization method based on gender. MBSR group received eight weeks of sessions through audiovisual materials. An online survey utilizing validated questionnaires assessing stress, mindfulness, anxiety, and depression was used to evaluate both groups pre-program (time 0), post-program (time 1), and three months later (time 2).

RESULTS

Seventy-one participants completed the post-test (time 1). There were no differences between study groups at time 0 and 1. However, in 41 subjects who completed the follow-up test (time 2), the anxiety dropped significantly in MBSR group (mean difference (MD), -3.935; 95% CI, -7.580 to -0.290). Furthermore, attending more MBSR sessions was inversely correlated with depression (r, -0.556; P, 0.002), and anxiety (r, -0.630; P, 0.000). Compared to their baseline, males in MBSR group improved in stress (MD, 3.08; 95% CI, 0.30 to 5.86), anxiety (MD, 4.91; 95% CI, 3.32 to 6.50), and mindfulness (MD, -0.58; 95% CI, -1.01 to -0.15), while females improved in stress (MD, 2.64; 95% CI, 0.02 to 5.26).

CONCLUSION

Despite the study being interrupted by the stressful COVID-19 outbreak, the findings suggest that MBSR improved psychological outcomes when participants commit to the program.

Burnout Rates Among General Orthopedic Surgeons and Subspecialists: A Pilot Study

Burnout among physicians is a syndrome of emotional exhaustion, de-personalization, and reduced sense of personal accomplishment that can negatively affect personal relationships, physician well-being, and patient outcomes. Although burnout rates of up to 50% to 60% among orthopedic surgeons have been reported, no studies have evaluated burnout among orthopedic generalists and subspecialists. The primary goal of this study was to examine the prevalence of burnout among orthopedic disciplines. We conducted a multicenter study from March 2019 through December 2019 involving 149 orthopedists. An abbreviated Maslach Burnout Inventory-Human Services Survey was used to measure burnout. Demographic information, personal characteristics, professional characteristics, family life and spousal support, and depression were also assessed. The mean rate of burnout among all respondents was 62%, whereas 16.77% screened positive for depression. Subspecialties with the highest rates of burnout were oncology (100%), sports medicine (68%), and trauma (63%). Similarly, trauma (50.00%), oncology (40.00%), and general orthopedics (20.00%) had the highest positive depression screening rates. In contrast, shoulder and elbow (50%), pediatric (52%), and foot and ankle (54%) specialists had the lowest rates of burnout, whereas shoulder and elbow (0.00%), spine (0.00%), and sports medicine (6.50%) specialists had the lowest rates of positive depression screening. Older age, higher debt load, and oncology subspecialty were associated with increased burnout risk. This study sought to determine burnout rates within each orthopedic discipline, with a secondary aim of disclosing contributing factors. Trauma and oncology had the highest rates of burnout and positive depression screening. Because this study represents a small orthopedic cohort, larger studies are needed to appropriately manage burnout in the future. [Orthopedics. 2022;45(6):333-339.].

Burnout among physicians and caregivers in oncology: the Moroccan experience

Purpose

Caregivers in radiation oncology are exposed to a high risk of burnout which sometimes causes serious consequences for their health, which can in turn affect patient care. In this study, we investigated the prevalence of burnout and its psychological impact on health professionals and determined the factors that predispose to the risk of burnout.

Methods and materials

A cross-sectional survey was conducted with descriptive and analytical purposes among the different teams within the oncology and radiotherapy departments in different hospitals (CHU and regional hospitals) in Morocco, through an online self-questionnaire composed of sociodemographic data, professional data, working conditions, an assessment of interfering factors, the Maslach Burnout Inventory (MBI), the Generalised Anxiety Disorder-7 (GAD-7) scale and the Patient Health Questionnaire-9 (PHQ-9) scale.

Results

One hundred and eighteen caregivers participated in this evaluation. 62.7% were physicians, 75.4% worked in university hospitals and 53.4% were in radiotherapy departments. Analysis of the three dimensions of the Maslach Burnout Inventory - Human Services Survey (MBI-HSS) score found high scores in the dimensions of emotional exhaustion (81.4%) and depersonalisation (79.7%), and low scores in decreased personal accomplishment (46.6%). The evaluation of the impacts of burnout in the latter found a mean of the Patient Health Questionnaire-9 (PHQ-9) at 12.45 + 7.84 and the mean of the GAD-7 at 9.73 + 5.98.

Conclusion

Our results are in line with those found in the literature, hence the need for screening and active prevention of burnout among radiation oncology caregivers.

Associations of pediatric nurse burnout with involvement in quality improvement

PURPOSE

Burnout among nurses negatively impacts patient care experiences and safety. Inpatient pediatric nurses are high-risk for burnout due to high patient volumes, inadequate staffing, and needing to balance the demands of patients, families and team members. We examined the associations of inpatient pediatric nurse burnout with their perspectives on the importance of quality at the hospital, patient experience measurement, quality improvement (QI), unit culture, and staffing.

METHODS

We conducted a cross-sectional study at an urban children's hospital. We surveyed pediatric nurses about their perspectives including the single-item Maslach Burnout Inventory. We fit separate regression models, controlling for role, location and unit, predicting outcome measures from the dichotomized burnout scale.

RESULTS

Twenty-seven percent of pediatric nurses reported burnout. Nurses who had more confidence in patient experience measurement, received frequent patient experience performance reports, felt included in QI, and experienced QI efforts as integrated into patient care reported not being burned out (compared to those reporting burnout; all p-values<0.05). More open communication among nurses (e.g., about possible problems with care) and unit-level teamwork were also associated with not being burned out, whereas a larger QI workload was associated with burnout (p-values<0.05).

CONCLUSIONS

Open communication among nurses and nurses being more involved and valued in QI efforts were related to not being burned out. Research is needed to further examine aspects of QI involvement that reduce burnout.

PRACTICE IMPLICATIONS

Supporting open communication among pediatric nurses, engaging them in QI and integrating QI into patient care while minimizing QI workload may decrease burnout.

How Time Pressure Matter University Faculties' Job Stress and Well-Being? The Perspective of the Job Demand Theory

The work environment of employees has been greatly affected by the COVID-19 pandemic, and many limitations and risks can be seen until now. In addition to employees in firms, the faculty in colleges and universities also suffer from pressure and face challenges. For the purpose of performance assessment and promotion, the faculty not only needs to teach students, but also assumes the time pressure from academic research. This study discusses the process in which the faculty's subjective well-being is affected, in an effort to learn about the job demands of the faculty under the work environment with a high level of time pressure, and the effect of these time-related job demands on their psychological health. In this study, 347 valid questionnaires were collected from universities in coastal areas of the Chinese mainland. The results show that time-related job demands have a positive impact on time pressure; time pressure has a negative impact on subjective well-being; and time-related self-efficacy can significantly mediate the relationship among time-related job demands, time pressure, and subjective well-being. On this basis, this study proposes its theoretical and practical implications.

Mental Health Problems, Burnout and Resilience in Community Pharmacists during the COVID-19 Pandemic: a Cross-Sectional Study

Background

Methods

Results

Conclusions

Creating the path for quality of work life: A study on nurse performance

Since March 2020, it is known that Indonesia has experienced the impact of the Corona Virus Disease 2019 (Covid-19) Pandemic, and making health workers at the forefront of potential exposure to the Covid-19 virus because they have to deal with Covid-19 patients every day during the pandemic. The purpose of this study is to focus on developing an empirical model to increase job performance in the hospital to create the right quality of work and still make the organization grow well sustainably. This study will use assistance of quality of work life, organizational commitment, job satisfaction, and psychological empowerment in creating an increase in job performance needed by nurses at the Type B Hospital in Jakarta. This study uses a quantitative approach through a questionnaire survey method conducted on nurses at 36 Type B Hospital in Jakarta, totalling 400 respondents. The sample used in this study was obtained through a purposive sampling technique with the criteria of a service period of more than 2 years. Then the data were analysed using the Structural Equation Model (SEM). Though quality of work life is found to significantly affect organizational commitment, job satisfaction and psychological empowerment, its effect on job performance found to be insignificant. Further findings will be discussed further.

Psychological wellbeing and the association with burnout in a cohort of healthcare workers during the COVID-19 pandemic

Burnout, depression, and anxiety are prevalent among healthcare workers (HCWs) during the COVID-19 pandemic and have been previously shown to contribute to poor health outcomes and reduced quality of care. Positive psychological constructs such as positive affect and meaning and purpose are related to resilience in the face of significant stress. No studies have examined these associations among a cohort of HCWs during this pandemic. The purpose of this study was to examine the association of depression, anxiety, positive affect, and meaning and purpose with burnout among HCWs during the COVID-19 pandemic. We utilized data from a cross-sectional survey conducted between September 29-December 8, 2021, among a cohort of 2,411 HCWs from a large, tertiary academic health care system in the Chicago area. We employed the Patient-Reported Outcomes Measurement Information System (PROMIS) measures for depression, anxiety, positive affect, and meaning and purpose and burnout was measured by the Oldenburg Burnout Inventory (OLBI). The majority (80.88%) of HCWs in this study identified as White, Non-Hispanic race/ethnicity, female sex (82.37%), and roughly one third were between ages 30-39 years old (30.98%). Registered nurses (26.96%) accounted for the largest single occupation group. The mean burnout score was 36.87 (SD = 7.65), with 53.38% of participants classified as having burnout, and registered nurses demonstrating the highest proportions of burnout (63.54%). Higher depression (coef = 0.15, SE = 0.03, p < 0.001) and anxiety (coef = 0.25, SE = 0.02, p < 0.001) scores were associated with higher burnout in multivariable linear regression models. Increased positive affect (coef= -0.19, SE= 0.02, p < 0.001) and meaning and purpose (coef= -0.12, SE= 0.01, p < 0.001) scores were significantly associated with reduced burnout. Positive affect and meaning and purpose were inversely associated with burnout among a cohort of HCWs during the COVID-19 pandemic. Previous studies of positive affect and meaning and purpose suggest the potential buffering effect that these indices may have on burnout. Future research is needed to examine the effect of positive affect and meaning and purpose on mitigating the negative impacts of burnout, depression, and anxiety among HCWs as they cope with the stress of the COVID-19 pandemic and beyond.

Work-Related Factors Associated With Burnout Among Peruvian Nurses

Introduction:

Commonly, burnout in nurses has influenced their performance. The contribution of this study allows to broaden the knowledge of the performance-burnout relationship and identifies the work performance in nurses as a precursor of burnout.

Objective:

The study aimed to examine the factors of work performance of nursing staff that influence burnout.

Methods:

A descriptive cross-sectional design was used and a total of 340 nurses from the department of Puno in Peru participated. Demographic, job performance, and burnout data were collected.

Results:

Job performance factors, such as counterproductive behavior, positively influenced burnout, while task and context performance negatively influenced burnout. These variables explained 28.54% of the variance of burnout among nurses.

Conclusion:

Job performance factors have a significant impact on burnout. To reduce burnout, workforce resources that motivate, engage, and monitor nurse performance must be identified individually or organizationally. There is a need to develop training that promotes the improvement of emotional skills for better performance and the reduction of professional burnout.

A Longitudinal Study on the Changes in Mental Health of Healthcare Workers during the COVID-19 Pandemic

Objective: This study examines Argentinean health care workers in order to 1) test self-perceived job performance levels and the presence of psychological symptoms compatible with common mental disorders, and 2) examine within-person changes in general discomfort and psychological distress, adjusting for demographic factors, region, and health-related factors during two time points of the COVID-19 pandemic.Method: This longitudinal study comprised 305 healthcare workers who completed a survey at two time points approximately 4 months apart. We used the General Health Questionnaire and the Kessler Psychological Distress Scale to measure mental health outcomes. To address the first aim we calculated differences (Student's t test for paired samples) and correlations (Pearson's r coefficient). To address the second aim we used fixed effects model by means of a multilevel approach, a linear model that considers dependency in the data.Results: Self-perceived job performance deteriorated across time. From the first measurement to the four-month follow-up, more health care workers presented common mental disorders (40% vs 45.57%), depression, and/or anxiety (52.46% vs 62.62%). A meaningful worsening of mental health was observed in healthcare workers who expressed concern about being infected with COVID-19, whether asymptomatic (greater general discomfort and psychological distress) or symptomatic (greater general discomfort). Likewise, there were significant interactions between a history of mental disorder and concern about COVID-19 infection.Conclusions: Among healthcare workers, the uncertainty about the COVID-19 infection may have larger negative mental health impacts than actually being infected.

Cross-sectional study to evaluate burnout among pharmacy staff in Saudi Arabia during COVID-19 pandemic

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Methods

Results

Conclusions

The Effectiveness and Safety of Mind-Body Modalities for Mental Health of Nurses in Hospital Setting: A Systematic Review

The mental health of nurses including burnout is an important issue. The purpose of this systematic review was to evaluate whether mind-body modalities improve burnout and other mental health aspects of nurses. A comprehensive search was conducted using six electronic databases. Randomized controlled trials using mind-body modalities on the mental health of nurses, up to January 2021, were included. The methodological quality of the included studies was assessed using the Cochrane Risk of Bias tool. Seventeen studies were included in the review. Data on mindfulness-based interventions (MBIs) and yoga were available for burnout, and there was no evidence that multimodal resilience programs including MBIs statistically significantly improved burnout levels compared to no intervention or active control groups. However, one study reported that yoga could significantly improve emotional exhaustion and depersonalization, which are subscales of burnout, compared to usual care. In addition, the effects of MBIs, relaxation, yoga, and music on various mental health outcomes and stress-related symptoms have been reported. In conclusion, there was some evidence that yoga was helpful for improvement in burnout of nurses. However, due to the heterogeneity of interventions and outcomes of the studies included, further high-quality clinical trials are needed on this topic in the future.

Burnout and Oncology: an irreparable paradigm or a manageable condition? Prevention strategies to reduce Burnout in Oncology Health Care Professionals

BACKGROUND

Burnout is a stress-induced occupational related syndrome, characterized by Emotional Exhaustion (EE), feeling of depersonalization (DP) and low sense of professional accomplishment (PA). The aim of this study is to analyse the effectiveness of interventions in decreasing health professionals Burnout as well as work and life-style risk factors.  Methods: A survey in Medical Oncology Department in the University Hospital of Parma was conducted using the validated Maslach Burnout Inventory (MBI) and two additional questionnaires exploring lifestyle and work factors. An 8-months intervention involved fortnight meetings by facilitators, incorporated elements of reflection, shared experiences and managing emotions. Six months after the end of the intervention a second survey was performed among the participants using MBI and the same questionnaires mentioned above.  Results: EE resulted the most problematic score in Day Hospital: after the 8-month intervention we described a significant decreasing in EE score especially for Day Hospital operators (from 16.7 to 10.9) and a considerable reduction in DP score. In the Oncology Ward a correlation between lack of collaboration among different health categories and DE score was detected; in the Day Hospital the absence of solid working teams was related to higher EE scores.  Conclusion: The Oncology professional health care personnel are at the greatest risk of Burnout. Our study in Oncology Department shows that specific intervention should be used to prevent and reduce Burnout. Effective personal health care strategies should be incorporated into routine oncology care to prevent and treat Burnout.

The Effects of Mindfulness Meditation on Stress and Burnout in Nurses

Background: Occupational burnout related to stress in the workplace is experienced by nurses who are regularly confronted with trauma, suffering, and high workloads. Burnout can negatively impact patient care and have detrimental effects on nurses' physical and mental health. Mindfulness-based stress reduction programs have been researched as a potential holistic intervention for reducing stress and burnout in nurses through cultivating present awareness, emotional regulation, and positive thinking. Purpose: This critical review of the literature explores current knowledge on the effectiveness of mindfulness meditation on stress and burnout in nurses, examines gaps in the current literature, and provides recommendations for future research on this topic. Methods: Search terms included mindfulness, meditation, mindfulness-based stress reduction , occupational stress, stress, burnout, and nurs*. Peer-reviewed research directly related to the impact of mindfulness-based stress reduction on nurses experiencing stress and/or burnout was reviewed. Findings: Findings reveal evidence that mindfulness meditation is effective in decreasing stress and burnout in nurses. Mindfulness-based interventions have been shown to significantly decrease stress, improve all aspects of burnout, and increase self-compassion and compassion satisfaction in practicing nurses. Conclusions: Mindfulness meditation has the potential to decrease stress and burnout in nurses by decreasing self-judgment and overidentification with experience, and by increasing resiliency, compassion, and emotional regulation.

Burnout and self-regulation failure: A diary study of self-undermining and job crafting among nurses

AIM

The objective was to test how nurse burnout impairs day-to-day adaptive self-regulation strategies that link levels of regulatory resources with employee job performance.

BACKGROUND

Regulatory resources help employees manage their thoughts, feelings, and behaviours on a daily basis. On days when these resources are low, employees may engage in maladaptive self-regulation: more self-undermining (i.e. creating additional obstacles) and less job crafting (i.e. optimizing job demands and resources), which debilitates their work performance. We expected that self-regulation is impaired especially when individuals exhibit low motivation and low ability to regulate their behaviour, that is, when they experience elevated burnout.

DESIGN

This research used a daily diary design. Nurses responded to a general survey and then completed daily diary surveys in three different moments: before, during and after work for 10 consecutive workdays (total reports N = 732).

METHOD

A sample of 81 nurses from Polish hospitals and primary healthcare centres completed self-reported questionnaires between January and March 2018. Hypotheses were tested using multilevel modelling in Mplus.

RESULTS

Momentary self-regulatory capacity before work was negatively related to self-undermining and positively related to job crafting, and it indirectly predicted daily job performance. As hypothesized, these indirect relationships were moderated by general, chronic burnout. We found that only for employees with low levels of burnout, daily self-regulation was linked with better functioning via increased job crafting and decreased self-undermining.

CONCLUSION

Chronic burnout disturbs day-to-day behaviour regulation. Individuals with elevated burnout symptoms have difficulty to translate momentary boosts in regulatory resources into adaptive strategies that are linked with higher performance.

IMPACT

Our findings call for better recovery programmes, strategic Human Resource Management practices aimed at reducing factors that deplete daily self-regulatory resources, and finally top-down interventions preventing burnout among employees in the healthcare system.

Relationship between nurse burnout, patient and organizational outcomes: Systematic review

BACKGROUND

Burnout, characterized by emotional exhaustion, depersonalization, and decreased personal accomplishments, poses a significant burden on individual nurses' health and mental wellbeing. As growing evidence highlights the adverse consequences of burnout for clinicians, patients, and organizations, it is imperative to examine nurse burnout in the healthcare system.

OBJECTIVE

The purpose of this review is to systematically and critically appraise the current literature to examine the associations between nurse burnout and patient and hospital organizational outcomes.

DESIGN AND DATA SOURCES

A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses was conducted. PubMed, CINAHL, PsychInfo, Scopus, and Embase were the search engines used. The inclusion criteria were any primary studies examining burnout among nurses working in hospitals as an independent variable, in peer-reviewed journals, and written in English. The search was performed from October 2018 to January 2019 and updated in January and October 2020.

RESULTS

A total of 20 studies were included in the review. The organizational-related outcomes associated with nurse burnout were (1) patient safety, (2) quality of care, (3) nurses' organizational commitment, (4) nurse productivity, and (5) patient satisfaction. For these themes, nurse burnout was consistently inversely associated with outcome measures.

CONCLUSIONS

Nurse burnout is an occupational hazard affecting nurses, patients, organizations, and society at large. Nurse burnout is associated with worsening safety and quality of care, decreased patient satisfaction, and nurses' organizational commitment and productivity. Traditionally, burnout is viewed as an individual issue. However, reframing burnout as an organizational and collective phenomenon affords the broader perspective necessary to address nurse burnout. Tweetable abstract: Not only nurse burnout associated w/ worsening safety & quality of care, but also w/ nurses' organizational commitment and productivity. Reframing burnout, as an organizational & collective phenomenon is necessary.

Exploring the effort-reward structure of university work focusing on perceived overall stress, self-reported health, and musculoskeletal disorders

Background: The effort-reward imbalance (ERI) model by Siegrist encouraged numerous scientific investigations that reported particular ties between psychosocial risks and poor self-reported health (SRH), while psychosocial work-related stress has also been linked to musculoskeletal disorders (MSDs). The aim of this study was to examine the health status and the perceived levels of occupational stress of university employees and to analyse the findings according to the employees’ effort and reward structure of work, perceived overall stress, SRH and the presence of MSDs.

Design and methods: 398 employees – including healthcare professionals, academic personnel and workers with administrative or other jobs – employed at the University of Szeged, Faculty of Medicine were investigated with a self-administered questionnaire including the Effort-Reward Imbalance Questionnaire (ERIQ) and Perceived Stress Scale 4 (PSS-4).

Results: More than half of the investigated subjects (54.8%) reported some forms of MSDs. Low self-reported health (P<0.001) and presence of MSDs (P=0.015) were significantly associated with the level of perceived stress and effort-reward imbalance (ERI), moreover increased level of perceived stress was independently associated with the likelihood of MSDs (AOR=1.13) and low self-reported health (AOR=1.30). ERI well predicted low self-reported health (AOR=2.05) as well. Increased level of perceived stress positively correlated with high workrelated effort (r=0.247, P<0.001) and over-commitment (r=0.387, P<0.001) while with work-related reward (r=−0.181, P=0.011) perceived stress showed a negative connection.

Conclusion: Our results suggest that addressing the burden of effort-reward imbalance and MSDs would likely lessen employees’ perceived level of overall stress and affect their self-reported overall state of health.

Exploring the Impact of Primary Care Physician Burnout and Well-Being on Patient Care: A Focus Group Study

OBJECTIVES

The aims of the study were (1) to explore whether primary care physicians (general practitioners [GPs]) perceive burnout and well-being to impact on the quality and safety of patient care and (2) to determine potential mechanisms behind these associations.

METHOD

Five focus groups with 25 practicing GPs were conducted in England, either in the participants' practice or in a private meeting room outside of their workplace.An interview schedule with prompts was followed with questions asking how participants perceive GP burnout and poor well-being could impact on patient care delivery. Audio recordings were transcribed verbatim and analyzed using thematic analysis.

RESULTS

General practitioners believed that poor well-being and burnout affect the quality of care patients receive through reducing doctors' abilities to empathize, to display positive attitudes and listening skills, and by increasing the number of inappropriate referrals made. Participants also voiced that burnout and poor well-being can have negative consequences for patient safety, through a variety of mechanisms including reduced cognitive functioning and decision-making abilities, a lack of headspace, and fatigue. Furthermore, it was suggested that the relationship between well-being/burnout and mistakes is likely to be circular.

CONCLUSIONS

Further research is needed to ascertain the validity of these perceptions. If found, physicians, healthcare organizations, and policy makers should examine how they can improve physician well-being and prevent burnout, because this may be a route to ensure high-quality and safe patient care.

Examining correlates of organizational citizenship behavior and counterproductive work behavior in a collectivist culture: the case of Arab teachers in Israel

Purpose

This study aims to examine the relationships between personal (emotional intelligence, Dark Triad (DT), core self-evaluation and burnout) and situational variables (organizational justice) and organizational citizenship behavior (OCB) (supervisor report) and counterproductive work behavior (CWB) (self-report).

Design/methodology/approach

In total, 680 questionnaires were distributed to teachers in 20 Arab elementary schools in Northern Israel. Usable questionnaires were returned by 509 teachers (75%). The questionnaires covered emotional intelligence, DT, core self-evaluation, organizational justice, burnout, CWB and demographic characteristics. Their principals filled out questionnaires on the teachers’ in-role performance and OCB.

Findings

Results showed that CWB was mostly related to higher levels of psychopathy, lower levels of emotional intelligence (ability to use emotions) and higher levels of burnout (emotional exhaustion). OCB was related to higher levels of procedural justice, lower levels of burnout and higher levels of emotional intelligence.

Practical implications

Organizations should consider ways to reduce burnout, which may reduce CWB and increase perceptions of justice, thereby promoting OCB.

Originality/value

Two novel aspects are noteworthy. First, this study simultaneously examines both CWB and OCB to clarify the similarities and differences between them. Second, few studies have examined the correlates of CWB and OCB in Arab culture.

Psychometric Properties of the Korean Version of the Mental Health Professionals Stress Scale

Background: Job stress of mental health professionals can have a negative impact on them, particularly their psychological health and mortality, and may also affect organizations' and institutions' ability to provide quality mental health services to patients. Aim: This study aimed to: (1) investigate the validity and reliability of the Korean Mental Health Professionals Stress Scale (K-MHPSS), (2) develop K-MHPSS cut-off points to measure clinical depression and anxiety, and (3) examine whether specific stressors vary by area of expertise. Methodology: Data were collected via an online survey over 3 months, from August to October 2020. An online survey using a survey website was administered to volunteers who accessed the link and consented to participate. Data from 558 participants (200 clinical psychologists, 157 nurses, and 201 social workers) were included in the final analysis. Confirmatory and exploratory factor analyses were conducted to examine the factor structure of the K-MHPSS; concurrent validity of the scale was determined by analyzing correlation; internal consistency was determined by Cronbach's alpha coefficient. In addition, ROC curve analysis and Youden's index were used to estimate optimal cut-off points for K-MHPSS; one-way ANOVA was performed to investigate the difference among the three groups. Results: The seven-factor model of the original scale did not be replicated by Korean mental health professionals. The K-MHPSS had the best fit with the six-factor model, which consists of 34 items. Concurrent validity was confirmed, and overall reliability was found to be good. The K-MHPSS cut-off points for depression and anxiety appeared to slightly different by professional groups. Furthermore, nurses and social workers showed significantly higher total scores compared to clinical psychologists, and there are significant differences in subscale scores among professionals. Conclusion: The Korean version of the MHPSS has appropriate psychometric properties and can be used to assess the occupational stress of mental health professionals. It can also serve as a reference point for screening clinical level of depression and anxiety in mental health professionals.

Are You Tired of Working amid the Pandemic? The Role of Professional Identity and Job Satisfaction against Job Burnout

With the outbreak of novel coronavirus in 2019, most universities changed from traditional offline teaching to online teaching, which brought about a large amount of problems, including teachers' physical and mental problems. Because of teaching on the computer screen for a long period of time, the teacher lacks communication and can act casually. With long-term accumulation, the problem of teachers' job burnout has become increasingly serious. The main purpose of this study was to examine the influence of professional identity on job burnout during the period of the novel coronavirus. At the same time, this study also discussed the moderating effect of job satisfaction on professional identity and job burnout, and its relationship between job satisfaction and job burnout. During the peak period of the COVID-19 epidemic, we conducted an online survey-483 Chinese university teachers with online teaching experience completed the Teacher Professional Identity Scale, Job Satisfaction Scale, and Job Burnout Scale. The results of this study found professional identity and job satisfaction of university teachers to be significantly negative predictors of job burnout, with job satisfaction playing a moderating role between professional identity and job burnout. This study also confirmed that professional identity and job satisfaction are important factors affecting job burnout of university teachers. Therefore, this study proposed that schools should adopt more effective strategies to improve university teachers' professional identity and job satisfaction in order to reduce the practical problems of job burnout, ensure the effectiveness of online teaching, and maintain the sustainable development during the epidemic.

Burnout in Healthcare Workers: Prevalence, Impact and Preventative Strategies

Approximately, one in three physicians is experiencing burnout at any given time. This may not only interfere with own wellbeing but also with the quality of delivered care. This narrative review discusses several aspects of the burnout syndrome: prevalence, symptoms, etiopathogenesis, diagnosis, impact, and strategies on how to deal with the problem.

Perspectives of VA Primary Care Clinicians Toward Electronic Consultation-Related Workload Burden: A Qualitative Analysis

IMPORTANCE

Electronic consultation (e-consultation) is increasingly being adopted to expand access to specialty care and reduce health care costs. Little is known about clinicians' perceptions of using e-consultations, which may be associated with program adoption.

OBJECTIVE

To identify perceptions of primary care clinicians in the US Veterans Health Administration (VHA) system about e-consultation and workload.

DESIGN, SETTING, AND PARTICIPANTS

A qualitative study using semistructured interviews was conducted from September 2017 through March 2018 in a national sample of VHA primary care clinics in the US. Participants were primary care clinicians who had at least 300 total patient encounters from July 2016 to June 2017, including at least 1 e-consultation request. A convenience sample of participants was recruited using email invitations. Deductive and inductive content analysis were used to identify themes. Data were analyzed from October 2017 to April 2018.

EXPOSURES

Use of e-consultation.

MAIN OUTCOMES AND MEASURES

Primary care clinician perspectives regarding e-consultation and their workload.

RESULTS

A total of 34 primary care clinicians enrolled working across 27 VHA clinical sites were included; 9 (26%) were between ages 40-49 years; 23 (68%) were female. Three themes were identified. First, the process of entering, tracking, and following up on e-consultations added a time burden to primary care clinicians. Second, e-consultation was perceived to shift diagnostic and follow-up responsibilities from specialists to primary care clinicians. Third, e-consultations were thought to improve the timeliness and quality of care provided despite a perceived increase in workload.

CONCLUSIONS AND RELEVANCE

In this study, participants perceived e-consultation as valuable for patient care but also as an increase in their workload. Further work is warranted to quantify the workload increase on clinician burnout, job satisfaction, and turnover.

Differences in the effects of organisational climate on burnout according to nurses' level of experience

AIM

To elucidate the orientation of burnout prevention in line with the experience level of nurses by examining the impact of organisational climate on burnout by nursing experience level.

BACKGROUND

While the relationship between a nurse and the organisation where they work changes depending on the nurse's experience level, there is a dearth of research that takes into account the nursing experience level in exploring the relationship between organisational climate and burnout.

METHOD

A cross-sectional questionnaire survey was conducted with 1,102 nurses. Nursing experience was divided into six levels. Two scales for organisational climate and the Maslach burnout inventory were used.

RESULTS

There were effects between the organisational climate and exhaustion/depersonalization, depending on the experience level. Novices with low scores for head nurses' considerations towards staff felt the highest level of emotional exhaustion. For advanced beginners, a sense of control significantly determined emotional exhaustion.

CONCLUSIONS

There was a difference in the relationship between organisational climate and burnout in experience level, suggesting different intervention directions.

IMPLICATIONS FOR NURSING MANAGEMENT

There is a direction of intervention suitable for each experience level, suggesting the need to respond to each accordingly.

Relationship Between Burnout and Professional Behaviors and Beliefs Among US Nurses

OBJECTIVE

To evaluate the relationship between burnout and professional behaviors and beliefs among US nurses.

METHODS

We used data from 2256 nurses who completed a survey that included the Maslach Burnout Inventory and items exploring their professional conduct (documented something they had not done so they could "close out" an encounter in the EHR or part of the assessment not completed, requested continuing education credit for an activity not attended) and beliefs about reporting impaired colleagues.

RESULTS

On multivariable analysis, burnout was independently associated with higher odds of reporting 1 or more unprofessional behaviors in the last year and not believing nurses have a duty to report impairment among colleagues due to substance use or mental health problems.

CONCLUSIONS

Occupational burnout is associated with self-reported unprofessional behaviors and less favorable beliefs about reporting impaired colleagues among nurses.

A blueprint for leadership during COVID-19

Minimizing burnout and moral distress among the nursing workforce.

Using system dynamics modelling to show the effect of nurse workload on nurses' health and quality of care

The objective of the current study is to explore System Dynamics modelling to quantify and understand the effects of nursing workload on nurse burnout, absenteeism, and quality of patient care. A literature search was performed to identify the causal relationships between factors related to the problem and build a conceptual causal loop diagram. Each of these factors was then operationalised and a simulation model was built using quantitative empirical data from the literature, supplemented with expert input. The model results showed that long nurse shifts and work weeks double nurse fatigue levels, while increasing burnout by up to 6 times, absenteeism by up to 5 times, and medical errors for the patients increasing by up to 150%. The study demonstrates a novel application of System Dynamics in healthcare to examine the impact of management strategies and healthcare system design on nurses' wellbeing and on care quality. Practitioner summary: System Dynamics Modelling allows for the integration of available scientific evidence and expertise to reveal the relationship between nurse workload, burnout and care quality in terms of medical errors. Such models can reveal possible responses from proposed policy or system design changes that could not be quantified with conventional approaches. Abbreviations: HF: human factors; SD: system dynamics; CLD: causal loop diagram; OFAT: one factor at a time.

Burnout in nursing: a theoretical review

BACKGROUND

Workforce studies often identify burnout as a nursing 'outcome'. Yet, burnout itself-what constitutes it, what factors contribute to its development, and what the wider consequences are for individuals, organisations, or their patients-is rarely made explicit. We aimed to provide a comprehensive summary of research that examines theorised relationships between burnout and other variables, in order to determine what is known (and not known) about the causes and consequences of burnout in nursing, and how this relates to theories of burnout.

METHODS

We searched MEDLINE, CINAHL, and PsycINFO. We included quantitative primary empirical studies (published in English) which examined associations between burnout and work-related factors in the nursing workforce.

RESULTS

Ninety-one papers were identified. The majority (n = 87) were cross-sectional studies; 39 studies used all three subscales of the Maslach Burnout Inventory (MBI) Scale to measure burnout. As hypothesised by Maslach, we identified high workload, value incongruence, low control over the job, low decision latitude, poor social climate/social support, and low rewards as predictors of burnout. Maslach suggested that turnover, sickness absence, and general health were effects of burnout; however, we identified relationships only with general health and sickness absence. Other factors that were classified as predictors of burnout in the nursing literature were low/inadequate nurse staffing levels, ≥ 12-h shifts, low schedule flexibility, time pressure, high job and psychological demands, low task variety, role conflict, low autonomy, negative nurse-physician relationship, poor supervisor/leader support, poor leadership, negative team relationship, and job insecurity. Among the outcomes of burnout, we found reduced job performance, poor quality of care, poor patient safety, adverse events, patient negative experience, medication errors, infections, patient falls, and intention to leave.

CONCLUSIONS

The patterns identified by these studies consistently show that adverse job characteristics-high workload, low staffing levels, long shifts, and low control-are associated with burnout in nursing. The potential consequences for staff and patients are severe. The literature on burnout in nursing partly supports Maslach's theory, but some areas are insufficiently tested, in particular, the association between burnout and turnover, and relationships were found for some MBI dimensions only.

Professional quality of life and burnout amongst radiation oncologists: The impact of alexithymia and empathy

BACKGROUND AND PURPOSE

Different factors may influence the professional quality of life of oncology professionals. Among them, personality traits, as alexithymia and empathy, are underinvestigated. Alexithymia is about deficits in emotion processing and awareness. Empathy is the ability to understand another's 'state of mind'/emotion. The PROject on BurnOut in RadiatioN Oncology (PRO BONO) assesses professional quality of life, including burnout, in the field of radiation oncology and investigates alexithymia and empathy as contributing factors.

MATERIAL AND METHODS

An online survey was conducted amongst ESTRO members. Participants completed 3 validated questionnaires for alexithymia, empathy and professional quality of life: (a) Toronto Alexithymia Scale; (b) Interpersonal Reactivity Index; (c) Professional Quality of Life Scale. The present analysis, focusing on radiation/clinical oncologists, evaluates Compassion Satisfaction (CS), Secondary Traumatic Stress (STS) and Burnout and correlates them with alexithymia and empathy (empathic concern, perspective taking and personal distress) with generalized linear modeling. Significant covariates on univariate linear regression analysis were included in the multivariate linear regression model.

RESULTS

A total of 825 radiation oncologists completed all questionnaires. A higher level of alexithymia was associated to decreased CS (β: -0.101; SE: 0.018; p < 0.001), increased STS (β: 0.228; SE: 0.018; p < 0.001) and burnout (β: 0.177; SE: 0.016; p < 0.001). A higher empathic concern was significantly associated to increased CS (β: 0.1.287; SE: 0.305; p = 0.001), STS (β: 0.114; SE: 0.296; p < 0.001), with no effect on burnout. Personal distress was associated to decreased CS (β: -1.423; SE: 0.275; p < 0.001), increased STS (β: 1.871; SE: 0.283; p < 0.001) and burnout (β: 1.504; SE: 0.245; p < 0.001).

CONCLUSIONS

Alexithymic personality trait increased burnout risk, with less professional satisfaction. Empathic concern was associated to increased stress, without leading to burnout, resulting in higher professional fulfillment. These results may be used to benchmark preventing strategies, such as work-hour restrictions, peer support, debriefing sessions, and leadership initiatives for professionals at risk.

Relationship Between Organizational Leadership and Health Care Employee Burnout and Satisfaction

OBJECTIVE

To explore the relationship between immediate supervisor leadership behaviors and burnout and professional satisfaction of health care employees.

PARTICIPANTS AND METHODS

From October 2 to 20, 2017, we surveyed nonphysician health care employees. The survey included 2 items from the Maslach Burnout Inventory and items on their immediate supervisor leadership behaviors. Logistic regression was performed to evaluate the relationship between the leadership score and the prevalence of burnout and satisfaction after adjusting for age, sex, duration of employment, and job category. Sensitivity analysis was performed using mixed models with a random intercept for work unit to assess the impact of the correlation within work units on burnout and satisfaction with the organization.

RESULTS

Of the 57,414 employees surveyed, 39,896 (69.5%) responded and answered the leadership questions. Supervisor scores in each dimension and composite leadership scores correlated with burnout and satisfaction of employees (P<.001 for all). In logistic regression, each 1-point increase in leadership score was associated with a 7% decrease in odds of burnout and an 11% increase in odds of satisfaction (P<.001 for both) of employees. The mean composite leadership score rating of each immediate supervisor correlated with rate of burnout (r=-0.247; P<.001) and the satisfaction with the organization (r=0.416; P<.001) at the work unit level.

CONCLUSION

Leadership qualities of immediate supervisors relate to burnout and satisfaction of nonphysician health care employees working in a large organization. Further studies are needed to determine whether strategies to monitor and improve supervisor leadership scores result in reduction in burnout and improved satisfaction among health care employees.

A cross-sectional study exploring the relationship between burnout, absenteeism, and job performance among American nurses

Background

Studies suggest a high prevalence of burnout among nurses. The aim of this study was to evaluate the relationship between burnout among nurses and absenteeism and work performance.

Methods

A national sample of U.S. nurses was sent an anonymous, cross-sectional survey in 2016. The survey included items about demographics, fatigue, and validated instruments to measure burnout, absenteeism, and poor work performance in the last month.

Results

Of the 3098 nurses who received the survey, 812 (26.2%) responded. The mean age was 52.3 years (SD 12.5), nearly all were women (94.5%) and most were married (61.9%) and had a child (75.2%). Participating nurses had a mean of 25.7 (SD 13.9) years of experience working as nurse and most held a baccalaureate (38.2%) or masters of science (37.1%) degree in nursing. A quarter worked in the inpatient setting (25.5%) and the average hours worked per week was 41.3 (SD 14.1). Overall, 35.3% had symptoms of burnout, 30.7% had symptoms of depression, 8.3% had been absent 1 or more days in the last month due to personal health, and 43.8% had poor work performance in the last month. Nurses who had burnout were more likely to have been absent 1 or more days in the last month (OR 1.85, 95% CI 1.25–2.72) and have poor work performance (referent: high performer; medium performer, OR 2.68,95% CI 1.82–3.99; poor performer, OR 5.01, 95% CI 3.09–8.14). After adjusting for age, sex, relationship and parental status, highest academic degree, practice setting, burnout, depression, and satisfaction with work-life integration, nurses who were more fatigued (for each point worsening, OR 1.22, 95% CI 1.10–1.37) were more likely to have had absenteeism while those who worked more hours (for each additional hour OR 0.98, 95% CI 0.96–1.00) were less likely to have had absenteeism. Factors independently associated with poor work performance included burnout (OR 2.15, 95% CI 1.43–3.24) and fatigue (for each point of worsening, OR 1.22, 95% CI 1.12–1.33).

Conclusions

These findings suggest burnout is prevalent among nurses and likely impacts work performance.

Burnout among healthcare providers in the complex environment of the Middle East: a systematic review

BACKGROUND

Burnout is a syndrome characterized by emotional exhaustion, increased depersonalization, and a diminished sense of personal accomplishment due to chronic emotional stress at work. Burnout impacts job satisfaction, job performance, vulnerability to illnesses, and interpersonal relationships. There is a gap in the systematic data on the burden of burnout among healthcare professionals from different sectors of healthcare in Middle Eastern countries. Our objective was to examine the burden of burnout among healthcare providers in the Middle East, how it was assessed, which sectors were included, and what interventions have been used.

METHODS

Articles were found through a systematic review of search results including PubMed, Web of Science (Thomson Reuters), and PsycINFO (EBSCO) using search terms reflecting burnout in Middle Eastern countries among populations of healthcare providers. Studies were included if they examined a quantitative measure of burnout among healthcare providers in the Middle East.

RESULTS

There were 138 articles that met our inclusion criteria for this systematic review. Studies focused on burnout in the Middle East among physicians (N = 54 articles), nurses (N = 55), combined populations of healthcare workers (N = 22), and medical students (N = 7). The Maslach Burnout Inventory was the most common tool to measure burnout. Burnout is common among physicians, nurses, and other healthcare professionals, with prevalence estimates predominantly ranging between 40 and 60%. Burnout among healthcare providers in the Middle East is associated with characteristics of their work environments, exposure to violence and terror, and emotional distress and low social support.

CONCLUSIONS

Burnout is highly prevalent among healthcare providers across countries in the Middle East. Previous studies examining burnout in this region have limitations in their methodology. More thoroughly developed epidemiologic studies of burnout are necessary. Health system strengthening is needed in a region that has endured years of ongoing conflict, and there is an urgency to design and implement programs that tackle burnout among health professionals.

The relationship between work-related psychosocial factors and burnout among Iranian nurses: Job Demand-Control-Support model

Background:

Nursing work environment consists of a number of work-related psychosocial risk factors such as excessive workloads, lack of social support, emotional demands, job insecurity and confronting with challenging situations all of which may induce burnout. The aim of the current study was to investigate the relationship between work-related psychosocial factors and burnout among Iranian nurses.

Methods:

A cross-sectional study was carried out among 522 nurses. The data related to work-related psychosocial factors and burnout was gathered using Job Content Questionnaire (JCQ) and Maslach Burnout Inventory (MBI), respectively. Pearson’s correlation coefficients were used to examine the relationship between work-related psychosocial factors and burnout.

Results:

Mean scores of the dimensions of burnout for emotional exhaustion, depersonalization, and reduced personal accomplishment were 13.6 (SD=8.6), 18.42 (SD=7.1), and 28.45 (SD= 9.15), respectively. Psychological and physical job demands were positively correlated with different dimensions of burnout while social support and job control showed negative correlation with them.

Conclusion:

Appropriate interventions on reducing job demands both psychologically and physically and increasing social support and job control are suggested in prevention of burnout among the studied nurses.

Burnout Syndrome in Physicians-Psychological Assessment and Biomarker Research

Background and objectives: Burnout is a syndrome typically occurring in work environments with continuous and chronic stress. Physicians are at increased risk for burnout, as a result of 24-h work, delayed work–life balance gratification, and the challenges associated with patient care. The aim of the present study was to evaluate the psychological parameters of burnout symptoms in relation to biomarkers of stress among physicians with different medical specialties. Materials and methods: A total of 303 physicians were contacted as potential participants. A comparison group of 111 individuals working outside medicine was used as a control to verify the results. The physicians were specialists in internal medicine, general surgery, pathology, and primary care. Serum cortisol, salivary cortisol, adrenocorticotropic hormone (ACTH), insulin (IRI), and prolactin levels were analyzed by chemiluminescence enzyme immunoassay (Access 2, Beckman Coulter). Fasting glucose in serum and glycated hemoglobin (HbA1C) in whole blood were measured using the automatic analyzer AU 480 Beckman Coulter system. Symptoms of burnout were measured with the Maslach Burnout Inventory (MBI). Results: The group with burnout presented significantly higher levels of serum and saliva cortisol, ACTH, prolactin, fasting glucose, and HbA1C compared with the control group. The correlation analysis between biomarkers showed a positive correlation with moderate strength between serum and saliva cortisol (r = 0.516, p = 0.01),as well as serum and saliva cortisol with ACTH (r = 0.418; r = 0.412, p = 0.01) and HbA1C (r = 0.382; r = 0.395, p = 0.01). A weak positive correlation was found between serum and saliva cortisol with prolactin (r = 0.236; r = 0.267, p < 0.01) and glucose (r = 0.271; r = 0.297, p < 0.01). In the multiple logistic regression model, saliva cortisol, HbA1C, and age were significantly associated with burnout (chi-square = 16.848, p < 0.032). Conclusion: Our findings demonstrated the interest of exploring biomarkers of stress related to burnout in health professionals.

Can mindfulness in health care professionals improve patient care? An integrative review and proposed model

Mindfulness in health care professionals (HCPs) is often discussed as a tool for improving patient care outcomes, yet there has not been a critical evaluation of the evidence, despite a growing body of research on mindfulness-based interventions (MBIs). Numerous mechanisms exist by which mindfulness in HCPs may have an effect on patient care, and the field lacks an integrated model to guide future investigations into how MBIs may exert effects. The primary goals of this integrative review are to evaluate the evidence for the impact of MBIs in HCPs on patient care outcomes and to propose a causal model to guide future research. Databases were systematically searched for eligible studies investigating either an MBI or a measure of dispositional mindfulness in HCPs on patient care outcomes. Studies were critically evaluated using a previously developed tool. Twenty-six studies were identified (N = 1,277), which provide strong support for effects of mindfulness on HCP-reported patient care. Moderate support was found for patient safety, patient treatment outcomes, and patient-centered care. There was overall weak evidence to support a relationship between HCP-mindfulness on patient satisfaction. Mindfulness in HCPs may be related to several aspects of patient care.

The Reciprocal Relationship Between Resources and Psychological Distress Among Unemployed Job Seekers

This study sets out to investigate the reciprocal relationship between resources and psychological distress in a sample of unemployed job seekers shortly after dismissal. This idea of reciprocal relationships is inspired by general resource-based theories, the conservation of resources theory, and the broaden and build theory in particular. We selected perceived availability of networks as a social resource and reemployment efficacy as a personal resource, and we distinguished between negative and absence of positive affect as indicators of psychological distress. We analyzed data of 610 unemployed job seekers who participated twice in a survey with a time lag of 6 months and using structural equation modeling. Results showed that negative affect (but not absence of positive affect) depleted both perceived availability of networks and reemployment efficacy. The path from resources to psychological distress was not significant. We discuss potential implications for research and practice.

Hoarding symptoms and workplace impairment

OBJECTIVES

A prior study found that over 50% of treatment-seeking individuals who hoard incur at least one psychiatric work impairment day (i.e., they are unable to work or are less effective at work due to poor mental health) each month. The aim of the current study was to assess work-related variables associated with workplace impairment in a non-treatment-seeking sample.

DESIGN

Cross-sectional. Self-report questionnaires were administered via Amazon's Mechanical Turk.

METHODS

One hundred and eighty-five employed individuals who reported elevated hoarding symptoms completed questionnaires regarding hoarding symptoms, work engagement, psychiatric work impairment, work control, attention and concentration difficulties at work, and quality of workplace relationships.

RESULTS

Greater workplace control and higher quality workplace relationships were associated with greater work engagement. Greater hoarding symptoms and attention difficulties at work were associated with more psychiatric work impairment days. Work engagement statistically mediated the association between the quality of workplace relationships and work impairment, though mediation was also significant when reversing the mediating and outcome variables.

CONCLUSIONS

Among a community sample of employed individuals, greater hoarding symptoms were associated with greater psychiatric work impairment. Work-related variables, such as co-worker relationships and attention difficulties, contributed additional variance above that accounted for by hoarding symptoms. There were significant associations between co-worker relationships, work engagement, and workplace impairment, though the direction of the mediation model is unclear. Future research should examine factors associated with unemployment in hoarding disorder.

PRACTITIONER POINTS

Clinicians should be aware that greater hoarding severity directly contributes to greater workplace impairment. Clinicians should consider prioritizing the reduction in clutter in living areas that impact one's daily activities and subsequent ability to attend work. Clinicians should assess and treat workplace impairment by helping individuals achieve greater control at work, developing higher quality interpersonal relationships, and improving their attentional abilities.

Burnout prevalence in intensive care nurses in Argentina

PURPOSE

Burnout syndrome among intensive care professionals has been widely documented internationally. Few studies address the incidence and prevalence in Latin America. And there are no validated studies about the situation in Argentina. Our goal was to determine burnout prevalence among intensive care nurses in Argentina and related risk factors.

MATERIALS AND METHODS

Online self-administered survey evaluating demographic variables and the Maslach Burnout Inventory in 486 critical care nurses between June and September 2016.

RESULTS

A percentage of 84.4 of participants show moderate or high levels of burnout syndrome (95% CI 80.8 to 87.4). No significant association was found between burnout and gender, age, years of practice, academic degree, role or multiplicity of jobs. There was no statistical difference in burnout prevalence among different types of populations of care (neonatal, paediatric or adult care). Nurse to patient ratios of 1:3 or higher was found to be a statistically significant risk factor for emotional exhaustion and depersonalization sub-scales (P=.002 and .0039, respectively).

CONCLUSION

More than 80% of nurses caring for critically ill patients in Argentina show moderate or high levels of burnout syndrome and this is related to a high nurse:patient ratio (1:3 or higher).

A Daily Diary Approach to the Examination of Chronic Stress, Daily Hassles and Safety Perceptions in Hospital Nursing

PURPOSE

Stress is a significant concern for individuals and organisations. Few studies have explored stress, burnout and patient safety in hospital nursing on a daily basis at the individual level. This study aimed to examine the effects of chronic stress and daily hassles on safety perceptions, the effect of chronic stress on daily hassles experienced and chronic stress as a potential moderator.

METHOD

Utilising a daily diary design, 83 UK hospital nurses completed three end-of-shift diaries, yielding 324 person days. Hassles, safety perceptions and workplace cognitive failure were measured daily, and a baseline questionnaire included a measure of chronic stress. Hierarchical multivariate linear modelling was used to analyse the data.

RESULTS

Higher chronic stress was associated with more daily hassles, poorer perceptions of safety and being less able to practise safely, but not more workplace cognitive failure. Reporting more daily hassles was associated with poorer perceptions of safety, being less able to practise safely and more workplace cognitive failure. Chronic stress did not moderate daily associations. The hassles reported illustrate the wide-ranging hassles nurses experienced.

CONCLUSION

The findings demonstrate, in addition to chronic stress, the importance of daily hassles for nurses' perceptions of safety and the hassles experienced by hospital nurses on a daily basis. Nurses perceive chronic stress and daily hassles to contribute to their perceptions of safety. Measuring the number of daily hassles experienced could proactively highlight when patient safety threats may arise, and as a result, interventions could usefully focus on the management of daily hassles.