Lotte N. Dyrbye, MD, MHPE, Mayo Clinic; Tait D. Shanafelt, MD, Mayo Clinic; Christine A. Sinsky, MD, American Medical Association; Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN, American Nurses Association; Jay Bhatt, DO, MPH, MPA, American Hospital Association; Alexander Ommaya, DSc, Association of American Medical Colleges; Colin P. West, MD, PhD, Mayo Clinic; David Meyers, MD, Agency for Healthcare Research and Quality

/pdf/burnout-among-health-care-professionals-a-call-to-explore-4xe27z2enb.pdf

Burnout Among Health Care Professionals: A Call to Explore and Address This Underrecognized Threat to Safe, High-Quality Care

The assumption of an automatic link between disaster exposure and pathological outcomes is increasingly being questioned. Recognition of the possibility of positive reactions and growth outcomes in this context necessitates the development of alternative models and, in particular, the accommodation of the resilience construct in research and intervention agenda. Reviews possible vulnerability and resilience factors and adopts a risk management framework to outline its potential for modelling the complex relationships between these variables and both growth and distress outcomes. Resilience and vulnerability is discussed at dispositional, cognitive and organisational levels. The paradigm developed here focuses attention on facilitating recovery and growth in professionals for whom disaster work and its consequences is an occupational reality.

Disaster response: risk, vulnerability and resilience

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

/pdf/a-cross-sectional-study-exploring-the-relationship-between-rh8bvl4kjz.pdf

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

Workplace violence (WPV) is a global public health problem and has caused a serious threat to the physical and mental health of healthcare workers. Moreover, WPV also has an adverse effect on the workplace behavior of healthcare workers. This study has three purposes: (1) to identify the prevalence of workplace violence against physicians; (2) to examine the association between exposure to WPV, job satisfaction, job burnout and turnover intention of Chinese physicians and (3) to verify the mediating role of social support. A cross-sectional study adopted a purposive sampling method to collect data from March 2017 through May 2017. A total of nine tertiary hospitals in four provinces, which provide healthcare from specialists in a large hospital after referral from primary and secondary care, were selected as research sites based on their geographical locations in the eastern, central and western regions of China. Descriptive analyses, a univariate analysis, a Pearson correlation, and a mediation regression analysis were used to estimate the prevalence of WPV and impact of WPV on job satisfaction, job burnout, and turnover intention. WPV was positively correlated with turnover intention (r = 0.238, P < 0.01) and job burnout (r = 0.150, P < 0.01), and was negatively associated with job satisfaction (r = − 0.228, P < 0.01) and social support (r = − 0.077, P < 0.01). Social support was a partial mediator between WPV and job satisfaction, as well as burnout and turnover intention. The results show a high prevalence of workplace violence in Chinese tertiary hospitals, which should not be ignored. The effects of social support on workplace behaviors suggest that it has practical implications for interventions to promote the stability of physicians’ teams. (Project Identification Code: HMUIRB2014005), Registered March 1, 2014.

/pdf/the-impact-of-workplace-violence-on-job-satisfaction-job-5fbafw7azd.pdf

The impact of workplace violence on job satisfaction, job burnout, and turnover intention: the mediating role of social support

Burnout is characterized by physical and emotional exhaustion from long-term exposure to emotionally demanding work. Burnout affects interpersonal skills, job performance, career satisfaction, and psychological health. However, little is known about the burden of burnout among healthcare providers in sub-Saharan Africa. Relevant articles were identified through a systematic review of PubMed, Web of Science (Thomson Reuters), and PsycINFO (EBSCO). Studies were selected for inclusion if they examined a quantitative measure of burnout among healthcare providers in sub-Saharan Africa. A total of 65 articles met our inclusion criteria for this systematic review. Previous studies have examined burnout in sub-Saharan Africa among physicians (N = 12 articles), nurses (N = 26), combined populations of healthcare providers (N = 18), midwives (N = 2), and medical or nursing students (N = 7). The majority of studies assessed burnout using the Maslach Burnout Inventory. The highest levels of burnout were reported among nurses, although all healthcare providers showed high burnout. Burnout among healthcare providers is associated with their work environments, interpersonal and professional conflicts, emotional distress, and low social support. Available studies on this topic are limited by several methodological challenges. More rigorously designed epidemiologic studies of burnout among healthcare providers are warranted. Health infrastructure improvements will eventually be essential, though difficult to achieve, in under-resourced settings. Programs aimed at raising awareness and coping with burnout symptoms through stress management and resilience enhancement trainings are also needed.

/pdf/systematic-review-of-burnout-among-healthcare-providers-in-2rebqrx1vs.pdf

Systematic review of burnout among healthcare providers in sub-Saharan Africa

Long-term care nursing staff are subject to considerable occupational stress and report high levels of burnout, yet little is known about how stress and social support are associated with burnout in this population. The present study utilized the job demands-resources model of burnout to examine relations between job demands (occupational and personal stress), job resources (sources and functions of social support), and burnout in a sample of nursing staff at a long-term care facility (N = 250). Hierarchical linear regression analyses revealed that job demands (greater occupational stress) were associated with more emotional exhaustion, more depersonalization, and less personal accomplishment. Job resources (support from supervisors and friends or family members, reassurance of worth, opportunity for nurturing) were associated with less emotional exhaustion and higher levels of personal accomplishment. Interventions to reduce burnout that include a focus on stress and social support outside of work may be particularly beneficial for long-term care staff.

/pdf/stress-social-support-and-burnout-among-long-term-care-yg340eh73y.pdf

Stress, Social Support, and Burnout Among Long-Term Care Nursing Staff.

Although much attention, in terms of clinical and research efforts, has been given to the psychological effects of various traumatic events, systematic study of trauma following accidents has been virtually ignored until recently. This omission is striking given that some of the earliest descriptions of what is now referred to as posttraumatic stress disorder (PTSD) were related to traumatic accidental injury. For instance, in 1871, Rigler described the effects of injuries caused by railroad accidents (e.g., passenger car derailments, train crashes), labeling the resultant outcome “compensation neurosis” (Trimble, 1985). This term captured the intermingled effects of having incurred a traumatic injury and the seeking of compensation (e.g., legal, medical, and financial) for such injuries. The possibility of malingering was recognized early on, particularly in the case of individuals seeking compensation for psychological distress (Trimble, 1985).

The Psychological Impact of Accidental Injury

The psychological assessment of older adults poses challenges for the clinician comparable to those faced by such eminent sleuths as Hercule Poirot, Jessica Fletcher, and even Sherlock Holmes. Indeed, anyone drawn to murder mysteries would find the assessment of older adults an equally challenging, intriguing, and provocative undertaking. The thorough assessment of an older adult has many of the characteristics of a murder investigation, requiring consideration of the intimate interplay of physical, psychological, and environmental variables. Any investigator or clinician worthy of his or her salt would, for example, question everyone familiar with the behavior of the individual of interest (never trusting one source), directly inspect the environment in which behaviors of interest occurred, employ the most accurate, reliable, and valid measurement instruments, gather clues resulting from the interactions of the target individual with the environment, obtain descriptions or directly observe the interaction of the target individual with significant others, determine who gained and who suffered as a consequence of the individual’s behavior, assemble clues (assessment results) from multiple sources to establish convergent validity for hypotheses, and systematically test hypotheses until a satisfactory and empirically defensible conclusion could be reached. Though the assessment of older adults and the investigation of a murder share principles and procedures, they part company with the consideration of their functions, notwithstanding the analogous relationship between a murderer and a disease or disorder.

Lynn Emer Northrop

Papers

Stress, Social Support, and Burnout Among Long-Term Care Nursing Staff.

The Psychological Impact of Accidental Injury

Assessment of Older Adults

Undergraduate education and master's-level training.

21 – Behavioral Management of Problem Behaviors Associated with Dementia