Violence in hospitals and burnout among nursing staff

BackgroundNursing staff, especially in violence-prone emergency departments (ED), are at high risk of burnout. Frequently experienced violence is expected to have a strong impact on the nursing staff's burnout. This study aimed to examine the differences in the level of burnout between nursing staff who work in the ED and nursing staff who work in other inpatient departments, and its relationship with violence in various hospitals in Israel.MethodA cross-sectional study that utilized a three-part questionnaire: demographic data, degree of burnout, and frequency occurrence of violence events against nurses.Results150 nurses in EDs (N = 75) and inpatient departments (N = 75) were sampled. Significant differences were found between the two groups: Nurses in EDs experienced a higher degree of burnout than nurses in other hospital departments, and the degree of burnout was found to have a positive relationship with exposure to both verbal and physical workplace violence.ConclusionsNursing staff in EDs could develop a high degree of burnout, and exposure to workplace violence could exacerbate it. The physical and emotional safety of the staff is an important aspect in preventing burnout, and creating a secure work environment.     

Nurse burnout: work related and demographic factors as culprits

This study was an examination of the combined ability of perceived work environment, demographic, and work-related variables to predict burnout among 314 nurses at a large metropolitan hospital. The three dimensions of burnout measured were emotional exhaustion, depersonalization, and personal accomplishment. High work pressure and low work involvement and supervisor support predicted emotional exhaustion. Task orientation, work pressure, work involvement, and age predicted both depersonalization and personal accomplishment. Burnout among nurses on each of the three work shifts also was examined. Results are discussed from the perspective of how to decrease or to prevent burnout among nurses.     

工作场所暴力与护士长工作倦怠的相关分析

目的：探讨护士长工作倦怠与遭受工作场所暴力之间的关系。方法：对福建省各级医院213名护士长进行有关遭受工作场所暴力情况和工作倦怠情况的问卷调查。结果：遭受工作场所暴力的护士长工作倦怠中的情绪衰竭和去人格化两个维度比未遭受者明显严重（P〈0.05）;遭受心理暴力次数与情绪衰竭、去人格化程度呈显著正相关；多元逐步回归研究显示情绪衰竭和去人格化的影响因素是年龄和工作场所暴力，个人成就感丧失的影响因素是职称。结论：工作场所暴力事件可以导致护士长工作倦怠的产生，通过减少工作场所暴力事件，有可能减轻护士长的王作倦怠。     

Who would want to be a nurse? Violence in the workplace – a factor in recruitment and retention

In a climate of a declining nursing workforce where violence and hostility is a part of the day-to-day lives of most nurses, it is timely to name violence as a major factor in the recruitment and retention of registered nurses in the health system. Workplace violence takes many forms such as aggression, harassment, bullying, intimidation and assault. Violent acts are perpetrated against nurses from various quarters including patients, relatives, other nurses and other professional groups. Research suggests that nurse managers are implicated in workplace violence and bullying. Furthermore, there may be a direct link between episodes of violence and aggression towards nurses and sick leave, burnout and poor recruitment and retention rates. This paper explores what is known about workplace violence as it affects nurses, and calls for managerial support and policy to act to improve work environments for all nurses.     

The association of Chinese hospital work environment with nurse burnout,job satisfaction,and intention to leave

The purpose of this study was to describe nurse burnout, job satisfaction, and intention to leave and to explore the relationship of work environment to nursing outcomes in a sample of 9,698 nurses from 181 hospitals in China. Nurses reported moderate levels of emotional exhaustion and depersonalization and high levels of reduced personal accomplishment. Nearly one-fifth of the nurses reported high levels of burnout on all three dimensions. Forty-five percent of the nurses were dissatisfied with their current job; these nurses were most dissatisfied with their salary. Five percent of nurses reported an intention to leave. Nurses reporting mixed and good work environments were less likely to report high burnout, job dissatisfaction, and intention to leave compared with those in poor work environments. The results suggest that high burnout and low job satisfaction are prominent problems for Chinese nurses, and improving work environment might be an effective strategy for better nursing outcomes in Chinese hospitals.     

Burnout in Psychiatric Nursing: Examining the Interplay of Autonomy,Leadership Style,and Depressive Symptoms

It is important to consider ways in which nurses can be protected from experiencing the effects of burnout. This study examined the relationships between leadership style of psychiatric nurse supervisors, work role autonomy, and psychological distress in relation to psychiatric nurse burnout. Eighty-nine psychiatric nurses from Montana and New York hospitals completed an online survey that assessed their work-related experiences. Overall, results of this study indicate that the participants were experiencing high levels of emotional exhaustion and depersonalization when compared to a normative sample of mental health workers. Results also showed that leadership style and work role autonomy are likely to be environmental factors that protect against burnout in nurses. Finally, it was shown that the relationship between depressive symptoms and the burnout component of personal accomplishment may be influenced by nurses’ perceptions of the leadership style in their work environment. These findings are important because nurse supervisor leadership styles and amount of autonomy are characteristics of the work environment that may be amenable to change through training and intervention.     

Impact of hospital security programmes and workplace aggression on nurse perceptions of safety

Aim To assess how nurses’ perception of their safety and risk of violence was affected by their work environment and whether this perception correlated with their actual risk. Background The work environment has an impact on nurses’ perception of their risk of violence and this perception affects worker productivity, quality, employee retention, worker satisfaction and their actual safety. Methods A cross-sectional survey was conducted in person of 314 emergency department nurses and 143 psychiatric nurses, and assault data was collected from injury logs. Results This study found that nurses in the emergency and psychiatric units differed in their perception of violence and safety. The workplace elements that led to a perception of lower risk of violence were not correlated with a lower rate of injury from violent acts. The nurses’ beliefs about the adequacy of security equipment, security guards and the frequency of verbal abuse were strongly correlated with perceived safety. Conclusion Several factors that influence nurses’ perception of their risk of violence are not well correlated with their actual risk. Implications for nursing management Managers must address workplace elements that affect nurse perceptions because this has an impact on quality and employee retention. They must also address factors that have an impact on the actual risk of violence because this study showed, for the first time, that these may differ from perceptions.     

上海市三级甲等医院急诊科护士工作场所暴力情况与工作倦怠现状及相关性调查

目的探讨上海市三级甲等医院急诊科护士遭受工作场所暴力情况与工作倦怠的现状及二者之间的相关性。方法采用医院工作场所暴力调查问卷与工作倦怠问卷对上海市两家三级甲等医院急诊科的150名护士进行工作场所暴力和工作倦怠两个方面的调查,并分析两者的相关性。结果急诊科护士遭受工作场所暴力发生率为65．3％;本组护士的情绪衰竭、个人成就感丧失维度得分分别为（19．56±6．63）,（34．13±7．02）分,均高于常模的（22．19±9．53）,（36．53±7．34）分,差异均有统计学意义（t分别为3．281,3．776;P〈0．01）;本组护士与常模去人格化倾向维度得分比较,差异无统计学意义（P〉0．05）;遭受暴力组护士情绪衰竭、去人格化倾向维度得分分别为（20．13±8．65）,（7．53±3．03）分,均高于未遭受暴力护士组的（17．57±7．12）,（6．43±2．15）分,差异均有统计学意义（t分别为2．023,2．324;P〈0．05）;是否遭受暴力和年龄是情绪衰竭和去人格化倾向的影响因素,职称和年龄是个人成就感丧失的影响因素。结论急诊护士遭受工作场所暴力伤害可引起护士工作倦怠产生,采取减少暴力伤害的措施对减轻急诊护士工作倦怠是十分必要的。     

Relationship between perceived time pressure during visits and burnout among home visiting nurses in Japan

Aim: The rapidly rising number of older people has inevitably caused an increasing demand for home visiting nurses. Nursing managers must develop a healthy workplace to recruit and retain a workforce of nurses. This study focused on home visiting nurses’ perceptions of time pressure as a changeable work demand. The aim was to investigate perceptions of time pressure and reveal the relationship between perceived time pressure and burnout among home visiting nurses. Methods: From 32 agencies in three districts, 28 home visiting nurses agreed to participate in this study. Two hundred and eight home visiting nurses received an anonymous self‐administered questionnaire by mail, and 177 (85.1%) filled out and returned the questionnaire to the researchers. The Job Demands‐Resources model for burnout, which explains the relationship between a work environment and employee well‐being, was used as a conceptual guide. Three survey instruments were employed: questions on sociodemographic variables and worksite environments, including time pressure; the Japanese burnout inventory; and a Japanese version of the job content questionnaire. Multiple regression analyses were performed to examine the relationships between time pressure and burnout inventory scores. Results: About 30% of home visiting nurses perceived time pressure frequently. When home visiting nurses perceived time pressure more frequently, they experienced higher emotional exhaustion and depersonalization. Conclusion: Time pressure was often perceived as another job demand and had a significant relationship with burnout. This indicates the importance of lessening time pressure to develop healthy work places for community health nurses.     

急诊护士遭受工作场所暴力后对工作倦怠的影响

目的探讨急诊护士工作倦怠与遭受工作场所暴力之间的关系,为采取干预措施提供依据。方法采用护士职业倦怠调查表及遭受工作场所暴力情况问卷,对北京市4家三级甲等医院的166名护士进行调查。结果急诊护士遭受暴力组在情绪衰竭、去人格化、个人成就感丧失的维度得分高于未遭受暴力组,2组个人成就感丧失比较差异有统计学意义（P〈0．05）,而情绪衰竭、去人格化比较差异无统计学意义（P〉0．05）。躯体冲突严重影响了护士的心理健康（P〈0．01）。结论工作场所暴力事件可以导致急诊护士工作倦怠的产生,对护士造成严重的心理伤害,应采取有效预防措施控制工作场所暴力的发生,减少护士对工作及患者的倦怠不满,确保护士的心理健康。     

Predictors of nurses' professional burnout: a study in a university hospital

This study was designed to examine the level of burnout and to identify stressor among nurses in a teaching hospital. Based on a sample of 625 nurses, results show that burnout levels are moderate (M. = 24.3, SD = 9.3) and comparable to those observed in physicians (M. = 26.6, SD = 9.8) and in the administrative staff of the same hospital (M. = 25.1, SD = 11.9). Multiple regression analyses selected 11 predictors significantly associated with burnout. Some contributed positively to burnout (job strain, lack of social support, conflicts with other nurses, conflicts with physicians, presence of stressors related to private life, feeling that the job is threatened, full-time vs. part-time status), whereas others contributed negatively (perceived job control, hierarchical level, death and dying of patients, feeling protected against occupational hazards). It is worthy of noting that leadership dimensions were not significantly related to burnout, once stressors were included in the regression model. We also tested Karasek's (1979) model, according to which job demands interact with perceived job control in influencing burnout. For example, the worst situation is one in which job demands are high and perceived control is low. This is defined as a high-strain job. The results from this study confirm that perceived control reduces the effect of job strain on burnout. This suggests that if job strain is high, managers can reduce its effect by providing nurses with opportunities to control their work environment and relations with patients. Results also demonstrate that burnout is negatively correlated with job satisfaction and perceived unit effectiveness. Managers should invest in prevention programs, since burnout is as deleterious to individuals as to the organization. A limitation of this study is its focus on emotional exhaustion which is known to be the first step of the burnout process. Future research should examine whether the predictors identified here would also be relevant for explaining further stages of the burnout process, such as depersonalization and reduced personal accomplishment.     

Factors that contributed to burnout among intensive care nurses during the COVID-19 pandemic in Saudi Arabia: A constructivist grounded theory

BackgroundIntensive care unit (ICU) nurses experience high levels of burnout during the COVID-19 pandemic due to multiple stressors. It has long been known that burnout is negatively associated with patient and staff outcomes. Understanding the triggers for intensive care nurses’ burnout during the pandemic can help to develop appropriate mitigation measures.ObjectiveThe objective of this study was to examine intensive care nurses’ experiences during the COVID-19 pandemic in Saudi Arabia to develop insights into the factors that influenced burnout.MethodsThe study was informed by a constructivist grounded theory design. The study was conducted in an adult ICU in a tertiary hospital in the Makkah province in the Kingdom of Saudi Arabia. All participants were registered nurses with at least 6 months’ experience in intensive care and experienced caring for COVID-19 patients.FindingsThis paper reports on preliminary findings from interviews with 22 intensive care nurses. A core category ‘pandemic pervasiveness’ was identified from the interview data, which makes reference to the ever-present nature of the pandemic beyond the ICU context. Family, work, and the wider world context are the three groups of contextual factors that influenced nurses' experience and perception of burnout.ConclusionMany issues identified from the findings in this study can be attributed to shortages in the intensive care nursing workforce. Thus, we join others in calling for healthcare organisations and policymakers to be creative in finding new ways to meet nurses' needs, motivate, and empower them to maintain and sustain the nursing workforce in highly demanding areas, such as ICUs. Nursing managers can play a crucial role in mitigating nurses’ burnout by identifying and tackling sources of stress that exist among their staff, specifically team conflict, workplace harassment, and discrimination.     

Prevalence of burnout risk and factors associated with burnout risk among ICU nurses during the COVID-19 outbreak in French speaking Belgium

ObjectiveBurnout is a global work-related phenomenon. Intensive care unit (ICU) nurses are at risk of burnout and the COVID-19 pandemic may increase this risk. The objectives of this study were to assess the prevalence of burnout risk and identify risk factors among ICU nurses during the COVID-19 pandemic.Research methodologyWeb-based survey performed during the first wave of the COVID-19 pandemic in French speaking Belgium.Main outcome measuresRisk of burnout was assessed with the Maslach Burnout Inventory scale.ResultsA total of 1135 ICU nurses responded to the questionnaire. The overall prevalence of burnout risk was 68%. A total of 29% of ICU nurses were at risk of depersonalisation (DP), 31% of reduced personal accomplishment (PA), and 38% of emotional exhaustion (EE). A 1:3 nurse-to-patient ratio increased the risk of EE (OR = 1.77, 95% CI: 1.07–2.95) and DP (OR = 1.38, 95% CI: 1.09–2.40). Those who reported having a higher perceived workload during the COVID-19 pandemic were at higher risk for all dimensions of burnout. Shortage of personal protective equipment increased the risk of EE (OR = 1.78, 95% CI: 1.35–3.34) and nurses who reported having symptoms of COVID-19 without being tested were at higher risk of EE (OR = 1.40, 95% CI: 1.68–1.87).ConclusionsTwo-thirds of ICU nurses were at risk of burnout and this risk was associated with their working conditions during the first wave of the COVID-19 pandemic. We recommend monitoring the risk of burnout and implementing interventions to prevent and manage it, taking into account the factors identified in this study.     

Work stress and perceived organisational support on young Korean nurses’ care for COVID-19 patients

BackgroundSince the outbreak of COVID-19 worldwide, frontline nurses have faced tremendous stress. Younger nurses in their early-to-mid careers can be more exposed to burnout and work stress, and perceived organisational support can influence the quality of nursing care for vulnerable patients.AimTo identify the impact of younger nurses’ work stress and perceived organisational support on their willingness to care for COVID-19 patients.MethodsThe cross-sectional secondary data analysis included 211 hospital nurses (<35 years) in South Korea with a mean age of 24.60 years (SD=1.90). Multiple logistic regression analysis was used to identify the factors influencing willingness to care.FindingsSupplying personal protective equipment, training in the use of personal protective equipment, lower work stress, and positive perceptions of organisational support significantly increased early-career nurses’ willingness to care. For mid-career nurses, being male and higher work stress significantly increased their willingness to care.DiscussionSupport, including COVID-19-related education or training, should be provided to reduce work stress arising from being exposed to infection or while providing care to critically ill patients, especially among early-career nurses. Support from nurse managers, senior staff, and colleagues could help younger nurses cope better with the challenges of COVID-19, thus increasing their willingness to care.ConclusionPerceived organisational support may facilitate early-career nurses’ organisational commitment. Healthy work environments can relieve early-to-mid-career nurses’ work stress, thus facilitating patient-centred care.     

The value of intentional self-care practices: The effects of mindfulness on improving job satisfaction,teamwork, and workplace environments

BackgroundBurnout rates among nurses have detrimental impact on job satisfaction, teamwork, and patient care. This costs millions of dollars in the healthcare system and challenges nurse leaders to address in order to keep up with the healthcare demands. Furthermore, burnout is especially relevant in our current healthcare climate, as frontline nurses have increased workload and multiple psychosocial stressors during the coronavirus disease (COVID-19) pandemic (Sultana, Sharma, Hossain, Bhattacharya, & Purohit, 2019). Literature also suggests that mindful self-care practices need to be reinforced in order to impact burnout long term (Chamorro-Premuzic & Lusk, 2017). Project7 Mindfulness Pledge© is an accessible and voluntary mindfulness tool that nurses can utilize in their individual practice to reduce burnout and does not require significant time commitment.ObjectiveTo evaluate the effectiveness of intentional self-care practices on nurse burnout and workplace environment by measuring job satisfaction and teamwork among nurses.MethodsComparisons between inpatient units on data from the National Database of Nursing Quality Indicators (NDNQI) with the Practice Environment Scale (PES), specifically on job enjoyment and teamwork, were done utilizing ANOVA.ResultsResults show that nurses in an inpatient unit that implemented Project7 has significantly higher job satisfaction as compared to units that did not implement Project7.ConclusionsThis suggests that this tool provides an effective and accessible mindfulness framework managers and directors can utilize to improve job satisfaction, teamwork, and thereby reduce burnout to create healthier work environments.     

护士工作环境对职业倦怠的影响

目的探讨护士工作环境对护士职业倦怠的影响,为改善护士职业倦怠程度提供依据。方法抽取某市4所综合医院的536名护士,采用Maslach工作倦怠量表和护士工作环境量表进行问卷调查。结果护士情感耗竭处于中度倦怠,去人格化处于低度倦怠,个人无效感处于高度倦怠。对护士职业倦怠产生影响的工作环境因素有内部工作动机、对实践的控制、团队合作和文化敏感性。结论护士工作环境与职业倦怠程度密切相关,对护士职业倦怠的干预措施应从改善工作环境入手。     

精神神经专科医院护士工作倦怠中人格解体及相关压力源的调查

目的了解精神神经专科医院护士工作倦怠中人格解体的现状及与人格解体相关的压力源。方法采用中式工作倦怠量表和自行设计的精神神经专科医院护士压力源调查表,分别对精神神经专科医院227名护士进行问卷调查。结果本组护士人格解体的检出率为33．9％,中度倦怠中人格解体占77．0％,重度倦怠中人格解体占100％;在5个压力源的子量表中,与护士人格解体相关系数最高的条目分别为病人带来的压力、同事间关系、新技术的要求、长辈的照顾和精力不足,且均存在显著相关。结论精神神经科护士人格解体检出率较高,护理管理者应从组织和个体层面积极进行干预,以提高护士预测和应对压力的认知能力,保障护士职业群体和服务对象的安全。     

Job demands-resources, burnout and intention to leave the nursing profession: A questionnaire survey

Objectives

The aims of the paper are to examine the role of burnout in the relationship between stress factors related to nurses’ work and social environment and intention to leave the profession and to investigate the nature of the relationship between burnout and intention to leave the nursing profession.

Background

A postulate of the job demands-resources model is that two distinct yet related processes contribute to the development of burnout. The energetic process originates from demands and is mainly centered on emotional exhaustion; the motivational process originates from resources and is mainly centered on depersonalization. Moreover, we postulated that the two components of burnout are linked indirectly to intention to leave the profession via psychosomatic complaints, associated with the energetic process, and via professional commitment, associated with the motivational process.

Method

The research model was tested on cross-sectional data collected in 2005 from 1636 registered nurses working in hospitals who responded to a self-administrated questionnaire.

Results

Demands are the most important determinants of emotional exhaustion and indirectly induce depersonalization via emotional exhaustion, whereas resources mainly predict depersonalization. Moreover, emotional exhaustion and depersonalization are linked to psychosomatic complaints and professional commitment, which are in turn associated with intention to leave the profession.

Conclusion

The results suggest that a dual strategy is needed in order to retain nurses within the profession: a decrease in job demands, coupled with an increase in available job resources. In particular, nurses’ tasks and role should be restructured to reduce work overload and increase the meaning of their work.