Healthcare providers' perceived support from their organization is associated with lower burnout and anxiety amid the COVID-19 pandemic

The impact of a climate of perceived organizational support on nurses' well-being and healthcare-unit performance: A longitudinal questionnaire study

AIM

To investigate the relationship between nurses' climate of perceived organizational support, and their well-being and healthcare-unit performance.

DESIGN

A two-wave cohort questionnaire study among nurses within six hospitals in Sweden.

METHODS

Hypotheses were tested using cross-lagged path models on the individual (organizational support, job satisfaction, burnout, intention to stay) and aggregate levels (care-unit organizational support, team effectiveness, patient safety climate and patient safety). Analyses were based on 1.817 nurses in 228 care-units (T1), 1.362 nurses in 213 care-units (T2) and longitudinal samples of 711 nurses and 140 care-units.

RESULTS

Organizational support (T1) positively influenced job satisfaction (T2) and tended to decrease burnout (T2) but did not affect turnover intent. Reversed relationships were also found. No statistically significant prospective effects were found on the aggregate level.

CONCLUSION

The results indicated a prospective reciprocally reinforcing relationship between organizational support and job satisfaction. Burnout and intention to stay were predictors rather than outcomes of the organizational support climate.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

A climate where nurses perceive that their organization values their contributions and cares about their well-being is beneficial for their job satisfaction and health, which, according to previous research, may influence nurse retention.

IMPACT

The study addressed perceived organizational support as a potential predictor of nurses' well-being and healthcare-unit performance. A mutually reinforcing relation was indicated between organizational support and nurses' job satisfaction and health. Job dissatisfaction, burnout symptoms and turnover intentions were prospectively negatively related to the organizational support. Identifying and implementing a variety of practical measures to support perceptions of organizational support may be an effective way for healthcare management to start and sustain the development of a healthier work environment for healthcare professionals.

REPORTING METHOD

STROBE statement for cohort studies.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Impact of burnout and professional fulfillment on intent to leave among pediatric physicians: The findings of a quality improvement initiative

BACKGROUND AND OBJECTIVES

Physician burnout is rampant, and physician retention is increasingly hard. It is unclear how burnout impacts intent to leave an organization. We sought to determine how physician burnout and professional fulfillment impact pediatric physicians' intent to leave (ITL) an organization.

DESIGN AND METHODS

We performed 120, 1:1 semi-structured interviews of our pediatric faculty and used the themes therefrom to develop a Likert-scale based, 22-question battery of their current work experience. We created a faculty climate survey by combining those questions with a standardized instrument that assesses burnout and professional fulfillment. We surveyed pediatric and pediatric-affiliated (e.g. pediatric surgery, pediatric psychiatry, etc.) physicians between November 2 and December 9, 2022. We used standard statistical methods to analyze the data. An alpha-level of 0.05 was used to determine significance.

RESULTS

A total of 142 respondents completed the survey, 129 (91%) were Department of Pediatrics faculty. Burnout was present in 41% (58/142) of respondents, whereas 30% (42/142) were professionally fulfilled. There was an inverse relationship between professional fulfillment and ITL, p < 0.001 for the trend. Among those who were not professionally fulfilled, the odds ratio of ITL in the next three years was 3.826 [95% CI 1.575-9.291], p = 0.003. There was a direct relationship between burnout and ITL, p < 0.001 for the trend.

CONCLUSIONS

Among pediatric physicians, professional fulfillment is strongly, inversely related with ITL in the next three years. Similarly, burnout is directly related with ITL. These data suggest a lack of professional fulfillment and high burnout are strong predictors of pediatric physician turnover.

Evaluating Systemic Burnout in Medical Oncology Through a National Oncology Mentorship Program

PURPOSE

Mentorship has a positive influence on trainee skills and well-being. A 2022 Pilot Mentorship Program in New South Wales involving 40 participants revealed high burnout rates in Medical Oncology trainees. As part of an Australia-wide inaugural National Oncology Mentorship Program in 2023 (NOMP23), a national survey was undertaken to assess the prevalence of burnout, anxiety, depression, professional fulfilment, and drivers of distress in the Australian medical oncology workforce.

METHODS

NOMP23 is a 1-year prospective cohort study that recruited medical oncology trainees and consultants using e-mail correspondence between February and March 2023. Each participant completed a baseline survey which included the Maslach Burnout Index (MBI), Stanford Professional Fulfilment Index, and Patient Health Questionnaire-4 for anxiety and depression.

RESULTS

One hundred and twelve participants (56 mentors, 56 mentees) were enrolled in NOMP23, of which 86 (77%) completed the baseline survey. MBI results at baseline demonstrated that 77% of consultants and 82% of trainees experienced burnout in the past 12 months. Professional fulfilment was noted to be <5% in our cohort. Screening rates of anxiety and depression in trainees were 32% and 16%, respectively, compared with 7% and 2% for consultants. When assessing reasons for workplace stress, two thirds stated that heavy patient load contributed to stress, while almost three quarters attributed a heavy administrative load. Lack of supervision was a key stressor for trainees (39%), as was lack of support from the training college (58%).

CONCLUSION

Trainees and consultant medical oncologists demonstrate high rates of burnout and low professional fulfilment. The NOMP23 program has identified a number of key stress factors driving burnout and demonstrated concerning levels of anxiety and depression. Ongoing mentorship and other well-being initiatives are needed to address these issues.

Predictive modeling of burnout based on organizational culture perceptions among health systems employees: a comparative study using correlation, decision tree, and Bayesian analyses

Burnout is a significant concern, particularly within the healthcare field, affecting both nurses and physicians. It is a common issue in health systems, which encompass a range of healthcare facilities, such as hospitals, physician practices, ambulatory sites, and administrative offices like finance. Despite this, there has not been an extensive exploration of burnout in employees working directly with patients versus those in non-patient-facing roles within these health systems. It is important to note that organizational culture plays a crucial role in influencing various aspects of employees' work-life balance and their experiences of burnout. This study adopts a cross-sectional design, involving the distribution of a 57-question Likert scale survey to employees in health systems. These employees serve in various roles, both patient-facing and non-patient-facing, within jointly owned healthcare organizations, which encompass hospitals, ambulatory sites, and administrative offices. The survey was disseminated through trade organizations and employees at the managerial level and above within these health systems. Data was collected between October 2022 and January 2023, resulting in a total of 67 responses. The study employs correlation analysis to explore the connection between organizational culture and burnout. Furthermore, a decision tree model is constructed to predict burnout scores based on survey responses, specifically the question regarding the perceived positivity of the organizational culture. The decision tree models indicate that perceiving organizational culture as positive, safety-oriented, and supportive predicts various outcomes for individuals, including job retention, positive experiences with patients, increased callousness, and stimulation while working with colleagues. Bayesian analysis, considering the small sample size, reinforces these findings and provides a different perspective, incorporating prior knowledge and credible intervals. An association test suggests a strong link between a positive organizational culture and burnout symptoms, while another test supports a connection with engagement signs. Similar to nurses and physicians, administrative health systems' personnel are susceptible to burnout. Organizational culture can affect burnout. Therefore, health systems' leaders should cultivate an organizational culture that protects against burnout.

Hidden and Understaffed: Exploring Canadian Medical Laboratory Technologists' Pandemic Stressors and Lessons Learned

(1) Background: The COVID-19 pandemic has highlighted the critical role of medical laboratory technologists (MLTs) in the healthcare system. Little is known about the challenges MLTs faced in keeping up with the unprecedented demands posed by the pandemic, which contributed to the notable staff shortage in the profession. This study aims to identify and understand the stressors of MLTs in Canada and the lessons learned through their lived experiences during the pandemic. (2) Methods: In this descriptive qualitative study, we conducted five semi-structured focus groups with MLTs working during the pandemic. The focus group sessions were audio-recorded and then transcribed verbatim. Thematic analysis was used to inductively code data and identify themes. (3) Results: A total of 27 MLTs across Canada participated in the study. Findings highlighted four key themes: (i) unexpected challenges navigating through the uncertainties of an ever-evolving pandemic; (ii) implications of staff shortage for the well-being of MLTs and quality of patient care; (iii) revealing the realities of the hidden, yet indispensable role of MLTs in predominantly non-patient-facing roles; and (iv) leveraging insights from the COVID-19 pandemic to enhance healthcare practices and preparedness. (4) Conclusion: The study provides in-depth insight into the experiences of MLTs across Canada during the pandemic. Based on our findings, we provide recommendations to enhance the sustainability of the laboratory workforce and ensure preparedness and resiliency among MLTs for future public health emergencies, as well as considerations as to combating the critical staff shortage.

Relationship of Organizational Support, Psychological Capital, and Engagement Among Clinical Nursing Teachers

BACKGROUND

Clinical nursing teachers play a critical role in nursing education, and their engagement is important to ensure the quality of clinical teaching.

PURPOSE

To describe the level of engagement and determine the relationships among organizational support, psychological capital, and engagement among clinical nursing teachers.

METHODS

A cross-sectional study was conducted among 246 clinical nursing teachers, from 4 teaching hospitals in China, using a self-report questionnaire. The questionnaire measured organizational support, psychological capital, and work engagement.

RESULTS

Clinical nursing teachers reported a medium level of engagement in teaching. Both organizational support and psychological capital had positive effects on teachers' engagement. Psychological capital partially mediated the relationship between organizational support and engagement.

CONCLUSIONS

Measures to improve organizational support and psychological capital are essential to enhance the engagement among clinical nursing teachers.

Burnout and associative emotional status and coping style of healthcare workers in COVID-19 epidemic control: A cross-sectional study

Objective

The aim of this study was to evaluate the prevalence of burnout, clinical anxiety, depression, and insomnia and to estimate the associations of adverse emotional status, coping style, and level of self-efficacy with burnout of healthcare workers in the Shenzhen Longgang District Frontline District Headquarters of COVID-19 epidemic control, China.

Methods

In this cross-sectional study, 173 staff completed the anonymous questionnaires of the Maslach Burnout Inventory, Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder 7-item Scale (GAD-7), Insomnia Severity Index (ISI), General Self-efficacy Scale, and Simplified Coping Style Questionnaire electronically (https://www.wjx.cn/) in June 2022. Hierarchical logistic regression was used to explore the associated factors of burnout in this study.

Results

The prevalence of burnout in our participants (defined as high emotional exhaustion or high depersonalization) was 47.40%, and reduced personal accomplishment was 92.49%. The prevalence of clinically significant depression (the cutoff score of ≥15), anxiety (the cutoff score of ≥10), and insomnia (the cutoff score of ≥15) was 11.56, 19.08, and 19.08%, respectively. There was a degree of overlap between burnout and other measures of adverse mental status, most notably for anxiety (odds ratio, 27.049; 95% CI, 6.125–117.732; p &lt; 0.001). Hierarchical logistic regression demonstrated that burnout was strongly associated with anxiety (OR = 23.889; 95% CI, 5.216–109.414; p &lt; 0.001) and negative coping style (OR = 1.869; 95% CI, 1.278–2.921; p &lt; 0.01) independently.

Conclusion

Medical staff involved in COVID-19 epidemic control in the post-epidemic era were at high risk of burnout, and most of them were in low personal accomplishment. Reducing anxiety and improving coping style by medical management institutions from the system level may be effective in alleviating burnout in healthcare workers.

The Effect of Work Engagement and Perceived Organizational Support on Turnover Intention among Nurses: A Meta-Analysis Based on the Price–Mueller Model

Aim. To elaborate on the relationship between work engagement, perceived organizational support, and the turnover intention of nurses by analysing some potential moderators. Background. Nurses’ turnover intention is negatively impacted by their level of work engagement and perceptions of organizational support. However, it is challenging to reach a consistent conclusion. Methods. Data were acquired from six electronic databases. Each study was evaluated using the quality assessment tool for cross-sectional studies of the Agency for Healthcare Research and Quality (AHRQ). STATA 15.0 was used to analyse the data, and a random effects model was used. The groups that included two or more studies were added to the moderator analysis. Results. A total of 40 study articles involving 23,451 participants were included. The turnover intention of nurses was inversely associated with work engagement (coefficient: −0.42) and perceived organizational support (coefficient: −0.32). A substantial moderating role was played by cultural background, economic status, working years, and investigation time ( $P<0.05$ ). Conclusion. Work engagement and organizational support significantly reduced turnover intention among nurses. Considering the acute shortage of nurses worldwide, nurses with lower wages, fewer working years, and lower levels of work engagement should be given more attention and support from their organizations. Implications for Nursing Management. The meta-analysis suggested that managers should give their employees a more organizational support and promote their work engagement to motivate nurses’ retention intention and maintain a stable workforce with little employee turnover.

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

BACKGROUND

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

OBJECTIVE

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Unpacking the design, implementation and uptake of community-integrated health care services: a critical realist synthesis

Introduction

Community-integrated care initiatives are increasingly being used for social and health service delivery and show promising outcomes. Nevertheless, it is unclear what structures and underlining causal agents (generative mechanisms) are responsible for explaining how and why they work or not.

Methods and analysis

Critical realist synthesis, a theory-driven approach to reviewing and synthesising literature based on the critical realist philosophy of science, underpinned the study. Two lenses guided our evidence synthesis, the community health system and the patient-focused perspective of integrated care. The realist synthesis was conducted through the following steps: (1) concept mining and framework formulation, (2) searching for and scrutinising the evidence, (3) extracting and synthesising the evidence (4) developing the narratives from causal explanatory theories, and (5) disseminate, implement and evaluate.

Results

Three programme theories, each aligning with three groups of stakeholders, were unearthed. At the systems level, three bundles of mechanisms were identified, that is, (1) commitment and motivation, (2) willingness to address integrated health concerns and (3) shared vision and goals. At the provider level, five bundles of mechanisms critical to the successful implementation of integrated care initiatives were abstracted, that is, (1) shared vision and buy-in, (2) shared learning and empowerment, (3) perceived usefulness, (4) trust and perceived support and (5) perceived role recognition and appreciation. At the user level, five bundles of mechanisms were identified, that is, (1) motivation, (2) perceived interpersonal trust, (3) user-empowerment, (4) perceived accessibility to required services and (5) self-efficacy and self-determination.

Conclusion

We systematically captured mechanism-based explanatory models to inform practice communities on how and why community-integrated models work and under what health systems conditions.

PROSPERO registration number

CRD42020210442.

COVID 19 pandemic: Impact of changes experienced on social workers' professional quality of life in Singapore

COVID-19 has impacted all spheres of life massively. Among the emerging studies on the psychosocial impact of the pandemic, few studies look specifically at how social workers are impacted. To understand this gap, this study surveyed 337 social workers. The findings showed that changes experienced in the workplace were enormous and caused secondary traumatic stress while engendering compassion satisfaction among social workers, but the presence of social support moderated to keep the secondary traumatic stress at bay. Resilience mediated association between social and workplace support and compassion fatigue. Social support seemed to have the largest effect on reducing stress through resilience. Workplace support also helped mitigate burnout. In conclusion, continued social and workplace support will be key to supporting social workers during a pandemic.

Impact of the COVID-19 pandemic on the development of burnout syndrome in healthcare providers: prevalence and predictive factors

BACKGROUND

In Tunisia, the pandemic is still ongoing, resulting in the burnout of healthcare providers.

AIMS

This study aimed to assess the impact of the management of COVID-19 patients on the physical and mental health of healthcare providers, and to identify the independent and predictive variables for the three components of severe burnout: emotional exhaustion, depersonalization, and lack of personal accomplishment at work.

METHODS

It was a cross-sectional survey. Data were collected between February 8, and April 11, 2021. Healthcare providers, who were positive for COVID, completed the questionnaire. The primary endpoint was to assess the degree of burnout in healthcare providers by adopting the original version of the severe Maslach Burnout Inventory: emotional exhaustion (≥30), depersonalization (≥12), and lack of personal accomplishment at work (≤ 33). A descriptive analysis followed by a bi- and multivariate analysis was performed to identify independent and predictive factors for each component of burnout.

RESULTS

700 healthcare providers were audited. Emotional exhaustion was ≥ 30 in 86%, depersonalization was ≥ 12 in 61%, and lack of personal accomplishment at work was ≤ 33 in 69%. Of the 700 healthcare providers, 93% were working at the same time in the COVID units, 85% had not received compensatory rest. Healthcare provider who had been infected by COVID-19 was the only independent predictive variable of severe emotional exhaustion and severe depersonalization. Healthcare provider who had been infected by COVID-19 and did not have a compensatory rest were two independent predictive variables of severe lack of personal accomplishment at work.

CONCLUSION

Healthcare provider who had been infected by COVID-19 was the only predictive variable of severe emotional exhaustion and severe depersonalization. Healthcare provider who had been infected by COVID-19 and did not have a compensatory rest were two independent and predictive variables of severe lack of personal accomplishment at work.