Burnout in Nursing Profession

Burnout in Nursing ProfessionThe aim of this writings review is to identify the signifi nookiet factors tie in to burnout in the nursing profession. Nurses be most susceptible and vulnerable to the development of burnout, mainly because of the nature and emotional demands of their job. Burnout in the nursing profession is a significant concern in nursing, because it has detrimental effects both on separates and organisations. For the individual nurse, the neuroendocrine response yields physiologic reactions that may ultimately contri entirelye to illness. In the health care organisation, run away burnout may contribute to absenteeism and turnover, both of which detract from the quality of care. Burnout is reported to originate from work itself as well as from characteristics of the individual nurse. There are as well as buffers to mitigate the development of burnout.BackgroundFreudenberger (1974) first coined the term burnout to describe the build-up of feelings that professi onals let when their emotional resources are depleted (Janssen, Schaufeli Houkes 1999). Maslach and Jackson (1981) further refined this term as a syndrome of emotional exhaustion, depersonalisation and reduced personal accomplishment. Their guide is a piece of seminal work and their concept on burnout has been widely accepted since. steamy exhaustion manifests in nurses as a general loss of feeling and concern, trust, interest, and spirit. It likewise involves feelings of fatigue, being used up, irritability, frustration and wearing out (Maslach et al 1981). depersonalization disorder refers to showing a detachment of the nurse from the patient by actively ignoring the qualities that make them unique and engaging people (Maslach et al 1981). The third dimension of the burnout syndrome is the end of nurses in evaluating their work negatively. Nurses feel unhappy about themselves and dissatisfied with their accomplishments on the job (Maslach et al 1981).Burnout is measured by the Maslach Burnout Inventory (Maslach et al 1981). The internal harmony of this tool has been widely tested using Cronbachs coefficient alpha (Maslach, Jackson Leiter 1996) and hence could be considered to be a standard measure for burnout (Hannigan, Edwards, Burnard, Coyle Fothergill 2000). This survey tool is a 22 item questionnaire consisting of the three subscales mentioned above of the burnout syndrome. The items are stoold in a 7-point Likert scale ranging from 0 (never) to 6 (daily). A senior tall degree of burnout is reflected in high scores on the emotional exhaustion (EE) and depersonalisation (DP) subscales and a mortified score on the personal accomplishment (PA) which is rated reciprocally. An reasonable degree of burnout is reflected in average scores on the three subscales and a low degree of burnout is reflected in low scores on the EE and DP subscales and a high score on the PA subscales (Maslach et al 1981).RationaleBurnout is frequently been reported as a causing factor for attrition of nurses from the nursing profession (Armstrong-Stassen, Al-Maaitah, Cameron Horsburgh 1994). In profit burnout in nursing has been associated with poor patient satisfaction and poor patient outcome (Vahey, Aiken, Sloane, Clarke Vargas 2004, Nayeri, Negarandeh, Vaismoradi, Ahmadi Faghihzadeh 2009). These adverse outcomes of burnout could cast off significant indelible impact on the capital of Singapore governments aim to establish Singapore as a reputable medical hub in the ASEAN region. Studies and statistics have shown that nurses in Singapore are at risk of ontogenesis burnout (Boey, Chan, Ko, Goh Lim 1997, Lim Yuen 1998, EnterpriseOne 2006), however, surprisingly, no explore have been done in Singapore to assess the level of burnout and the colligate factors of burnout in their nurses. Therefore, this lit review is initiated to generate a wide understanding of what is known about burnout in the nursing profession. This could have implica tions for understanding the overall well-being of the nurses in Singapore.Aims and ObjectivesAim and objective To identify the significant factors related to burnout in the nursing profession.MethodA literature search was conducted using the keywords nurses and burnout on CINAHL and MEDLINE. The search is supplemented with a manual search in journals published in Singapore for further information regarding related seek conducted in the local context and a supplementary issue forth-up of other cited materials in Google Scholar, where appropriate.FindingsCollating the evidence from the literature led to the identification of three main themes for the related factors of burnout for nurses. The themes are assay of the health care professionals, individual variables and leadership as the buffering factor.The proposition that high stress clinical care settings as organisational stressors have been extensively examined. Therefore not surprisingly, studies on burnout done in medical, sur gical and high dependency units were most handsome (Nayeri et al 2009, Adali Pirami 2002). Gillespie and Melby (2003) purported that the reason is because the nursing staffs working at these demanding areas are likely to spend considerable snip during their working day in intense interactions with people. enchantment Maslach-Pines (2000) suggested that it is because the nature of the work of these departments is often described as physically demanding and nurses are too continually faced with heavy demands for pity, sympathy and compassion. However, while many studies indorse a strong correlation between high levels of stress in high stress work environments and increased incidence and degree of burnout among nurses (Schmitz, Neumann Oppermann 2000), others declare evidence showing in that location is no correlation (Buunk, Ybema, Zee, Schaufeli Gibbons 2001). In the study conducted by Buunk et al (2001), it is being demonstrated that nurses working in high stress, specia lize environments are less burned out than their counterparts working in those perceived as low stress environments. However, it should be noted that the participants for their research are nurses who have at least 10 years of working experience. They would have been able to handle their stress more efficiently and would have been less prone to burnout. Therefore, it can be argued that this research lost its reliability because the sample represents a group of generally healthy workers (Demerouti, Geurts, Bakker Euwema 2004997). Moreover, the researchers also conducted a face-to-face interrogate with the participants. By the interview questions, the participants could infer that the researchers are interested to determine their stress related behaviour. Therefore, the sensitive nature of these questions would have inflicted a response bias as participants do not want to be stigmatised as not being able to cope (Maslach, Jackson Leiter 1996).In more recent years, among the organis ational stressors, workload as a contribute factor to burnout is more greennessly reported and associated with the emotional reflexion of the burnout syndrome (Greenglass, Burke Moore 2003, Lin, St John McVeigh 2009). Taris, Le Blanc, Schaufeli and Schreurs (2005) suggested that a high score on this single aspect of the burnout syndrome will be sufficient enough to predict burnout. Authors proposed that the 21st century health care reform has further intensified nurses workload. The work intensification studies in and nearly health care are providing convincing evidence on the extent to which efficiencies achieved by health care organisations are largely due to the increased workloads of nurses as a result of both staff reductions and change magnitude activity and patient complexity (Green 2004, Aiken, Clarke, Sloane Sochalski 2001). It is argued that increased workload will lead to increased stress and in turn leads to higher chances of burnout (Maslach Leiter 2008). There fore, it can be speculated that there should be widespread concomitant increase in reported severity of burnout due to the increased draw on nurses. Nonetheless, the question stops as to why in the same situational conditions, some nurses burn out, whereas others show no syndrome.The most likely explanation is that causes of burnout are found in both the environment and the individual. Significant kindreds between burnout and certain demographic characteristics have been reported but the results are still far from conclusive. The a couple of(prenominal) socio-demographic variables most commonly being investigated are age, gender and marital status. In their study, Maslach, Schaufeli and Leiter (2001) reported that age has most consistently been related to burnout. Burnout has been observed more often among young workers than among those aged over 30 or 40 years and it seems to occur rather early in ones work career.Schaufeli and Greenglass (2001) accounted that regarding gender differences in burnout, results are mixed and may reflect difference in roles or occupations. Maslach et al (2001) found that emotional exhaustion has usually been reported to be more common among women, whereas depersonalisation has been more common among men. Bakker, Demerouti and Schaufeli (2002) conducted a study in which a wide range of different occupations and organisations were recruited and answered through the internet, women reported higher levels of burnout than men did, specially when they were relatively young or had relatively little work experience. However, the respondents were mostly men and rather young (Bakker et al 2002). Schaufeli and Enzmann (1998) with regard to marital status, those who are unmarried, peculiarly men, appear to be more prone to burnout compared with those who are married. Singles seem to experience even higher burnout levels than those who are divorced.Personality characteristics as the psychological aspects of individual variables were exp lored as an important variable in the burnout process in a number of investigations (Simoni Paterson 1997, Allen Mellor 2002, Bhler Land 2003). However, the specific features of personality that affect the perception of burnout remain un give. Garrosa, Moreno-Jimnez, Liang and Gonzlez (2008) proposed a model of prediction of burnout in nursing and they reported that their findings give support that personality factors are significant predictors of the three aspects of burnout. But the authors were not clear on which personality characteristics were investigated. Allen et al (2002) and Zellars, Perrew and Hochwarter (2000) reported that neuroticism is associated with the emotional exhaustion aspect of burnout and external locus of control also demonstrated positive relationship with burnout. However, Bhler et al (2003) and Toscano and Ponterdolph (1998) reported that findings are mixed for hardiness.Interestingly, more recent studies indentified leadership as a factor related to b urnout (Kanste, Kyngs Nikkil 2007, Corrigan, Diwan, Campion Rashid 2002). leadership issues did not appear as a noteworthy factor related to burnout in earlier studies, even though it had been discussed some twenty years agone by Bass (1985). Nonetheless, leadership issues cannot be considered as new, but rather they appear to have increased in relative significance. Weber (2007) articulated that the increasing calls over the last decade for considering leadership as a related factor of burnout is particularly because of the chronic recruitment and retention issues confronting the nursing profession. There is also a rich source of comment on the impact of health care reform on nurses and nursing in the health care arena research literature (Aiken et al 2001). In a study conducted by Laschinger and Leiter (2006), their findings also support the key role of strong nursing leadership in creating conditions for work engagement and ultimately, safe, high-quality patient care. Demerou ti, Bakker, Nachreiner and Schaufeli (2000), in their proposed model of burnout and life satisfaction amongst nurses, identified that an individuals engagement with their work will predict a degree of low burnout. However, Stordeur, Dhoore and Vandenberghe (2001) warned that if leaders are too tyrannical and control-oriented, their leadership could exacerbate the burnout process.Among the different types of leadership, transformational leadership has been most commonly proposed and viewed as a buffer which moderates the impact of burnout (Stordeur et al 2001). Transformational leaders are visionary, balanced, self-aware and confident of breaking existing professional boundaries (Stordeur et al 2001). Nonetheless, findings from the study by Stordeur et al (2001) have to be viewed with cautious. This is because they only move to measure the relationship between leadership and the emotional aspects of the burnout syndrome. The other two dimensions, depersonalisation and lack of person al accomplishment were not measured. Further studies would have to be taken to establish implicit links between leadership and burnout. Ulrich, Buerhaus, Donelan, Norman Dittus (2005) found that effective control over practice resulted in increased status, follow and recognition. Hochwlder (2008) further emphasised that through a chain reaction, transformational leadership style engenders group cohesion and empowerment in nurses and hence it has been found that transformational leadership is inversely correlated with burnout in nurses.DiscussionsPast research on burnout in Singapore is generally anecdotal in nature (Tung 2000). Others attempt to investigate the nurses stress level and their association with the psychological well-being and several work-related outcomes such as job satisfaction, organisational commitment, intention to quit and job-induced tension (Boey et al 1997, Lim et al 1998). In a study on stress among nurses in the emergency department in Singapore, Lateef, N g and Anatharaman (2001) reported that the nurses who are older, have more working experiences and hold higher positional post had lower stress scores as compared to those who are young, have less working experience and have lower positional post. However, the authors did not trace insights to explain these observable facts. While such research gives indication that there is a high level of stress in the nurses in Singapore, it cannot be implied that there would be a high degree of burnout in these nurses. While it is clear that stress results in burnout among some individuals, also apparent, yet not explained by the confirmable evidence is the fact that others faced with high levels of stress do not experience burnout. Therefore an implicit relationship of high level of stress and high degree of burnout cannot be deduced because there is evidence of high stress being associated with low burnout (Bunnk et al 2001). Therefore, studies on burnout have to be conducted to investigate the burnout phenomenon among the nurses in Singapore. For the time being, it could only be speculated that nurses in Singapore are at risk of developing burnout.From the findings, it is shown that nursing burnout appears to be the result of not only contextual factors but also individual factors. Results from the studies on the socio-demographic variables and personality characteristics are weak and ambiguous. Only age has been identified as a relatively good correlate to burnout, with younger nurses being more susceptible. It would be reasonable to believe that younger nurses are more at risk to burnout because they have to move from a familiar educational environment into the workforce where there are high expectations of them to rapidly function as a competent nurse (Schaufeli et al 1998). As a result, they experience challenges transitioning from student to practicing professional nurse (Godinez, Schweiger, Gruver Ryan 1999).Transformational leadership could result in low burn out. It is important to note that low degree of burnout represents a positive psychological arouse and an effective state of well-being (de Rijk, Le Blanc, Schaufeli de Jonge 1998). In the emerging literature, there is a shift from the traditional focus on weaknesses and malfunctioning toward understanding homo strength and optimum functioning at work (Gustafsson Strandberg 2009). Conceiving of low burnout as wellness makes a contribution to the literature because it focuses on the positive aspects of work. Positive research has the potential to improve the image of nursing and attract a new generation to the profession. It also have implications for identifying and modifying possible areas of frustration that would result in burnout and hence help relieve the high costs of turnover by improving nurse retention (Teng, Shyu Chang 2007). The major contribution of such an approach is that it enhances the understanding of how the centering of the health care organisational can af fect nurses well-being. This knowledge is essential for the future development and well-being of all nurses and the profession of nursing.Research implicationsCurrent research focuses on examining the burnout phenomenon in sagacious settings and their findings have presented evidence that the level of burnout might not be influenced by different clinical settings. Therefore, future studies should move beyond the acute care settings to better understand the burnout phenomenon.Except for one, all authors of the research used for this literature review utilised cross-sectional methodology, therefore, casual relationships cannot be made from their results. Their findings also cannot be generalised in another milieu. Longitudinal research is required in order to enhance the understanding of the burnout process. Maslach et al (1981) had pointed out that longitudinal research although presents a large challenge, it is of critical importance for the comprehension of burnout. Future longitu dinal examinations should establish a profile of the nurses at the beginning of their employment then follow up over a longer period of time in correlation with burnout status and the related factors influencing the development of the burnout process (Ekstedt Fagerberg 2005).For all of the studies used for this literature review, the data are collected using self-reports from the participants. Many authors warned that self-reported data might be contaminated by common method variance, because both the in capable and dependent variables are based upon one source of information which is the participants (Demerouti et al 2000). Therefore, future research should also utilised objective means for collecting the result findings. remainderThe concept of burnout has sustained the interest of nurses and researchers for several decades. Despite the large amount of studies done in attempt to investigate and predict the related factors of burnout, no conclusive data could be drawn. This is bec ause the health care system is in constant change. The factors that relate to burnout will present different relative significance with the changes. Notwithstanding this, the related factors to burnout could generally be classified as both organisational and personal related. Therefore, to base practice, burnout intervention programmes should be multidimensional consisting of work-related as well as personal order approaches.