Evaluating The Level of Burnout Among Healthcare Professionals
Evaluating The Level of Burnout Among Healthcare Professionals
Evaluating The Level of Burnout Among Healthcare Professionals
DOI: 10.2478/aussoc-2018-0002
Introduction
In these last decades, the studies on the mental health of medical staff have
become an important subject in international literature; however, there are few
information regarding the level of burnout in medical staff. Their specific job
requirements often consist in dealing with urgent situations in a high level of
human risk. Researchers showed that burnout syndrome does not have immediate
manifestations but appears as a gradual reaction of emotional breakdown
due to the prolonged exposure to stress factors, which leads to an increase in
dehumanization level and professional dissatisfaction (Leiter 1991).
Burnout is often defined by fatigue, demoralization, dissatisfaction, incapability,
ageing, and decrease in motivation and in the joy of living. This is experienced
24 Kinga MAKKAI
personally because of the working conditions and the expectation for a higher
performance (Demerouti et al. 2011).
The term was introduced in the 1970s by psychologist Herbert Freudenberger,
who in 1980 published Burn Out: The High Cost of High Achievement. What It Is
and How to Survive It, in which he described this disorder (Freudenberger 1970).
The burnout syndrome is often described as having three dimensions: emotional
exhaustion, depersonalization, and professional achievement. In emotional
exhaustion, we perceive the emotion when the person feels emptied of emotional
resources and becomes extremely vulnerable to stress agents. Depersonalization
means that the person is distancing himself from other people, reduces personal
achievements, and lives in a critical spirit (oriented towards others and himself
equally), associated with a decrease in efficiency but also with negative thinking
and evaluation (Demerouti et al. 2011).
Employees with a higher risk of burnout are likely to present more health
problems such as anxiety, depression, sleeping disorders, memory loss, and neck
pain (Peterson et al. 2008). In a study among 3,000 employees in Finland, Ahola
(2007) reported a widespread depression, anxiety, and alcohol dependence among
employees who suffered from burnout. Also, Hakanen and Schaufeli (2012) found
among 2,000 dentists a positive correlation between burnout and emotions of
depression and dissatisfaction with life. Also, regarding physical health, Kim et
al. (2011) showed that social workers with higher levels of burnout reported more
health-related problems through the research (3 years), i.e. insomnia, headaches,
infections of the respiratory and the gastrointestinal system. Burnout syndrome is
also an independent risk factor in infections such as the flu (Mohren et al. 2003),
in type 2 diabetes (Melamed et al. 2006), and in cardiovascular diseases (Ahola
2007). In a 10-year research by Ahola et al. (2010), it was deducted that burnout,
especially exhaustion, would be a risk of overall survival.
One of the most frequently quoted models of burnout, i.e. the Job Demands
–Recourses Model (Demerouti et al. 2001), suggests that the working conditions
are the main antecedents of the syndrome of burnout. The high job demands,
which can be physical, emotional, cognitive, or organizational, are doubled
by insufficient and inadequate resources, and this results in developing the
syndrome. High workload is a result of job demands, which is the most powerful
exhaustion predictor (Lee & Ashforth 1996). The increase of interest in burnout
syndrome is because more and more people suffer from it in different professions.
Evaluating the Level of Burnout among Healthcare Professionals 25
Epidemiological data suggests the seriousness of this problem and the negative
effects it has in the workplace and at home. This alone explains why there are this
many studies of burnout in the last 40 years (Epp 2012). These days, employees
are thinking and worrying more and more about their work life (Rebber 1985),
where the work-related stress is a psychological stress, wherefore it results in
compulsion and physical, mental, and social tension. The satisfaction in work
is one of the most important factors of increased performance and provokes
positive opinions about the individual’s work, which stands in correlation with
the salary, social value of the job, and the work (Rebber 1985).
The syndrome of burnout affects physical, academic, and social performance
at the same time. It is a procedure when positive or negative reactions are given
under stress. Burnout provokes aggressiveness, decrease in performance, quality,
and competence in the job, wherefore it has effects not only on the individual
but also on the people with whom s/he is in interaction with. Several studies
describe that women are affected by more stress than men and cope with it in
different ways (Witkin 2001). Others (e.g. Bakker et al. 2014) have classified
unusual work conditions as important factors in work-related stress, which lead
to anxiety and depression. Some (e.g. Ahola et al. 2010) argue that the high level
of control and the low complexity of the job generate a decreased level of stress,
and the employee feels valued.
Specialized literature talks about sociodemographic, vocational, and
psychological variables which coexist with the syndrome of burnout. Important
research questions include these variables’ relevance and their relationship with
the syndrome. This means we have to research the risk factors and protective
factors which are related to different professions. The importance of these variables
are recognized by all the researchers, but at the same time these produce the most
conflicting results (Blegen 1993, Prins et al. 2007, Zagaro & Soeken 2007).
In consequence, exhausted employees can manifest one or more of the
withdrawal behaviors (Hanish 1995), which can be lateness, absence, or turnover
(Maslach et al. 2001). Employees which remain at work ill (presentism), have
a lower performance (Cooper 1996) because they have to invest more time and
energy in their work. Demerouti et al. (2009) found mutual relations between
burnout, job demands, and presentism among nurses who work at hospitals.
The syndrome of burnout is one of the most popular subjects in occupational health.
Studies show that employees who present higher levels of risk in developing the
syndrome (for example, who are chronically tired and have a negative and critical
opinion about work) manifest affected work performance and can develop serious
health problems (Bakker et al. 2014). A prominent problem consists in the matter
26 Kinga MAKKAI
that employees who present higher levels of burnout tend to remain in trouble.
Furthermore, research shows that this syndrome can become stable for 5, 10, or
even 15 years (Bakker et al. 2000, Hakanen et al 2011, Schaufeli et al 2011).
Which is the reason that burnout persists this long? Until now, the syndrome
was not charged of being a continuous process (ten Brummelhuis et al. 2011).
Previous studies suggest that the syndrome has structural causes in the
professional environment, especially high job demands and low resources
(Alarcon 2011, Demerouti et al. 2011, Lee & Ashforth 1996). Another study also
indicates that individual factors, such as neurosis or perfectionism, play an
important role in the development of burnout because these features predispose
the employees to face the demands improperly (Swider & Zimmerman 2010).
Despite this knowledge, we know very little about the individual roles in the
process of developing the syndrome of burnout.
The causes of burnout are divided into two categories: situational and
individual factors (Bakker et al. 2014). Situational factors include job demands
and resources. Job demands lead to fatigue and psychological distancing from
the job (Bakker et al. 2000). Ambiguity, conflict, stress, workload, and tension are
among the most important job demands which lead to burnout (Alarcon 2011,
Lee & Ashforth 1996). The resources are physical, psychological, social, and
organizational aspects of work, which help in reaching a purpose, reduce job
demands, and stimulate personal development through valuable work (Bakker
& Demerouti 2007). The relationship between resources and burnout remains
constantly negative (Demerouti et al. 2001).
A possible explanation for the negative relation between burnout and
performance would be that tired employees cannot concentrate and therefore
make more mistakes, whereas burnt-out employees do not want to help others
(Swider & Zimmerman 2010) and do not receive any help themselves, which
leads to a decrease in productivity (Bakker et al. 2014).
In the 21st century, burnout has been investigated from the individuals’
perspective (Bergman & Lundh 2015, Bergman et al. 2003). In the context of
burnout, this approach is capable of revealing the intra-individual heterogeneity
of the syndrome and its development in time. More specifically, this means
identifying different types of models of individual burnout and individual
development trajectories. This approach also makes the distinction between
burnout and other work-related well-being variables on an interpersonal level.
However, person-oriented analytical methods are based on the heterogeneity of
the population (Laursen & Hoff 2006).
Evaluating the Level of Burnout among Healthcare Professionals 27
For 25 years, the Romanian healthcare system was in constant transition and reform,
without continuity and clear objectives. This is probably due to the insufficient
funding and the frequent circuit of the ministries (Todorova et al. 2009, Vlădescu
et al. 2008). The World Health Organization in 2009 declared that the Romanian
healthcare system is among the most poorly financed ones in Europe, and it has a
low priority regarding the distribution of resources among public sectors. In 2006,
the GDP share of healthcare was 3.9%, less than half of the European average, i.e.
8.92%, and less than other countries’, for example, Hungary’s (8.3%). Although
the salary in healthcare is less than the national average, in 2010, there was a 25%
decrease in this sector. Furthermore, Romania is one of the European countries
with the lowest density of medical staff, meaning 2 doctors and 4 nurses per 1,000
people, which indicates the overwhelming workload they are exposed to (Băban
et al. 2005, Schafer et al. 2010, Bria et al. 2013).
Studies agree that emotional demands are the predictors of burnout, but only
few investigate the role of cognitive demands (Bakker et al. 2011, de Jonge et al.
2010). Although the negative interaction between work and home was evaluated
by some authors as a mediator between risk factors and burnout (Geurts et al.
1999), most of the literature indicate that it is a predictor of the syndrome (Bakker
et al. 2004). Based on the demands–resources model, there were studies carried
out among healthcare professionals, for example, doctors in the primordial
prophylaxis (Schaufeli et al. 2011) or young doctors (Schaufeli et al 2009) but
only a few in ambulance personnel (van der Ploeg & Kleber 2003). Studies
show that ambulance personnel has a higher risk of developing physical and
mental problems, although the results vary in different countries (Steurd et al.
2011). Ambulance personnel in Romania has medium to high levels of burnout
according to one of the few studies treating this subject (Popa et al. 2010).
Evaluating the Level of Burnout among Healthcare Professionals 29
The aim of the present study is to update the knowledge in the field of burnout
among healthcare professionals and also to raise attention to this non-functional
aspect of the healthcare system in Romania. Furthermore, the purposes include
determination of an average level of burnout among healthcare professionals
(doctors and nurses) and the differences in burnout between those who work
in governmental hospitals and private ones, but also the differences in burnout
depending on gender, age, and experience.
The study proposes the following hypotheses:
– Medical professionals who work at state hospitals have higher levels of
burnout than the ones who work at private hospitals.
– Nurses have higher levels of burnout than doctors.
– The level of burnout increases with the time spent in the domain.
– Burnout levels do not correlate significantly with sex.
Methodology
The subjects of the research are doctors and nurses who work at state hospitals as
well as private ones, all of them from Târgu-Mureş (Romania). In total, there are
60 subjects from which 15 doctors work at state hospitals, 15 at private hospitals,
15 nurses work at state hospitals, and 15 at private hospitals – in total, 12 men
and 48 women, aged between 22 and 54 years old.
The sampling method was non-probabilistic and was based on voluntary
participation. I went to several hospitals, advertised the research, and went back
after a week to collect the questionnaires.
The questionnaire was based on the Maslach Burnout Inventory – Human
Services Survey (MBI-HSS), which consists of three dimensions: emotional
exhaustion, depersonalization, and personal accomplishment (Maslach et al.
1997). The emotional exhaustion subscale assesses feelings of being emotionally
outworn by work. The depersonalization subscale measures an impersonal
response toward patients. The personal accomplishment subscale assesses feelings
of competence and achievement. In contrast to the previous two subscales, lower
means on this sub-scale correspond with higher degrees of burnout, meaning that
the values of this subscale had to be reversed in order to get the real data.
Other questions in the questionnaire investigated respondents’ socio-
demographic background, i.e. age, gender, occupation, and experience in the
medical field. The collected data were then introduced into the SPSS statistics
program and were analyzed as follows.
30 Kinga MAKKAI
Research findings
Regarding gender, there were not found significant differences between the
burnout levels of men (2.71 – 2.03 – 3.3) and women (2.25 – 2.33 – 3.59); p =
0.083. The numbers in the parentheses represent the burnout levels degraded to
subscales. The first number represents emotional exhaustion, the second number
depersonalization, and the third one personal accomplishment.
The subjects’ experience in the field varies between 1 and 25 years, and this
does not have any significant correlation with burnout. Those with maximum 5
years of experience have a satisfaction level of 2.81, whereas those with minimum
6 years have 2.78; p = 0.480.
There was not found any correlation regarding the job either. Doctors have
satisfaction levels of 3.4 – 2.06 – 3.54, whereas nurses 1.09 – 2.34 – 3.52; p =
0.015. The three numbers represent the subscales as well.
However, there was found a significant (p < 0.001) association between the
burnout levels of those who work at state hospitals (3 – 3.35 – 4.94) and those
who work at private hospitals (1.61 – 1.41 – 2.12).
Although the present research did not find any differences regarding gender,
experience in the field, or the position on the job (doctor or nurse), we did find a
significant difference between workers in state and private hospitals, regardless
of their jobs. State hospital workers have a much higher burnout level than
the ones working in private hospitals. This is due to the very high workload.
There is a great number of patients per doctor/nurse per day, every day. This is
accentuated by the fact that this county’s hospital is much in demand by patients
from the whole country.
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