Burnout in community mental health nurses: findings from the all-Wales stress study

Stress and its outcomes are significant problems for mental health workers. Questionnaires were sent to 614 community mental health nurses (CMHNs) in Wales. Three hundred and one responded (49%). Of these, 283 completed the Maslach Burnout Inventory (MBI) (Maslach et al. 1996). Half of those who responded indicated that they were emotionally overextended and exhausted by their work. One quarter of respondents were found to possess negative attitudes towards their clients, and approximately one in seven experienced little or no sense of satisfaction with their work. Working in an urban environment and lacking a supportive line manager were indicators for higher emotional exhaustion. CMHNs were significantly more likely to have negative attitudes towards their clients if they: were male; worked with an elderly care caseload; lacked job security; and had an unsupportive line manager. However, CMHNs who had worked longer within the field of community mental health were more likely to have positive attitudes towards their clients. Those CMHNs who had not completed a specialist postqualifying education course and those who did not hold a supervisory or management position were found to have a lowered sense of personal satisfaction in their work. Those CMHNs who reported that they drank alcohol were more satisfied with their sense of personal accomplishments achieved in their work.     

Maintaining equilibrium: a theory of job satisfaction for community mental health nurses

This study aimed to explore what was satisfying in the role of community mental health nurse (CMHN). Previous studies have emphasized sources of dissatisfaction but the emphasis on satisfaction allowed the researchers to explore positive aspects of the role which have been largely neglected in previous studies and to explore how these nurses managed to sustain satisfaction. This study used a grounded theory, and the primary source of data was in‐depth interviews collected over a 1‐year period with 12 CMHNs. Data were analysed using the constant comparative method and theoretical sampling. The therapeutic relationship (being therapeutic, knowing oneself, knowing how) was identified as the most significant source of satisfaction for the CMHNs, but this was mediated by three properties associated with role performance – working for the organization, belonging to a team and maintaining a personal life. The properties associated with role performance affected the participants' experience of the therapeutic relationship which determined whether the CMHNs found their job satisfying. This process of balance and counter‐balance is best explained by the core category maintaining equilibrium which accounts for the dynamic interaction that occurs between the therapeutic relationship properties and the role performance properties. As a core category maintaining equilibrium describes the process in which the participants were impelled towards satisfaction.     

A comparison of the work and values of community mental health nurses in two mental health NHS Trusts

With the reconfiguration of health services in both the primary and secondary sectors, the role of community mental health nurses (CMHNs) has become a highly contested one within mental health care. There would be great variability in the skills that CMHNs possess, the contexts in which they work and the nature of the work they do. This study sought to explore aspects of the work of those nurses who provide services at the interface between policy and practice. Two groups of CMHNs were compared, one working in an urban setting (Trust A) and the other in a rural (Trust B), focusing particularly on caseloads and client mix, the values held by CMHNs, the models of care they utilize and what they consider would improve care in the future. A specially designed 39-item questionnaire was employed, with a mix of open and closed questions, and statements to which participants were asked to respond on a three-point Likert scale. The findings raised interesting issues around collaborative working, whether CMHNs are happy to take on clients previously on their caseload, bureaucratization, autonomy, role definition within a culture of working with primary care, lack of specific models utilized by CMHNs, and the demand for greater training and educational support. The implications of the study are discussed with the aim of assisting mental health nurses determine their future roles.     

The work and values of mental health nurses observed

While there is agreement among stakeholders that change is required in mental healthcare, yet the precise nature of this change and how it should be brought about are relatively under-explored. Research has looked at developments taking place in primary mental health services, but relatively little has examined the work of community mental health nurses (CMHNs), especially those working at the interface between primary and secondary care. This study used a 39-item questionnaire to explore how CMHNs perceive their role and the degree to which they are able to carry it out. The findings suggests that while CMHNs are enthusiastic about their work and are keen to see mental health services develop in primary care, many are concerned about how they are perceived by other health personnel, deficiencies in their therapeutic skills and the level of support they currently receive. The study concludes by suggesting areas that managers, commissioners and educators should target to enable CMHNs to continue to play their part in a service that relies heavily upon them.     

A comparative study of the perceptions of British mental health nurses and psychiatrists of their work environment

This comparative study of the perceptions of mental health nurses and psychiatrists about aspects of their work environment was undertaken in the West Midlands in England. The aim of the study was to ascertain the extent to which the environment in which mental health professionals' work impacts on their own mental and physical well-being. Seventy-four psychiatrists and 301 mental health nurses responded to a postal questionnaire. Analysis of data indicated that significant differences exist between nurses and psychiatrists in their working conditions, their physical working environment, their sources of support with a work-related problem, and the effects of their work on their own mental and physical health. The main recommendation derived from this study was to improve communication between mental health professionals and their managers by giving more structured feedback and guidance about one's work performance. This may help to alleviate the mental strain many mental health professionals experience in their work.     

Concerns, satisfaction, and retention of Canadian community health nurses

This study of Canadian community health nurses (N = 1,044) compared the work-related concerns, job satisfaction, and factors influencing the retention of public health, home care, and community care access center (CCAC) nurses. Community health nurses identified similar work-related issues as being of greatest concern to them, but there were significant differences among the 3 groups of nurses in the magnitude of these concerns. There were also significant differences among the 3 groups for satisfaction with their jobs and their immediate supervisors, with CCAC nurses being the least satisfied except for the greater dissatisfaction of home care nurses with their pay and benefits. For the retention factors, the differences were primarily in the areas of job features and supportive work relationships. There are both similarities and differences among public health, home care, and CCAC nurses. Initiatives to address community health nurses' concerns, improve their job satisfaction, and increase their retention will require interventions tailored to the specific community health care setting.     

Job satisfaction in psychiatric nursing

In recent years, mental health services across Europe have undergone major organizational change with a move from institutional to community care. In such a context, the impact of change on the job satisfaction of psychiatric nurses has received little attention in the literature. This paper reports on the job satisfaction of psychiatric nurses and data were collected in 2003. The population of qualified psychiatric nurses (n = 800) working in a defined geographical health board area was surveyed. Methodological triangulation with a between-methods approach was used in the study. Data were collected on job satisfaction using a questionnaire adopted from the Occupational Stress Indicator. A response rate of 346 (43%) was obtained. Focus groups were used to collect qualitative data. Factors influencing levels of job satisfaction predominantly related to the nurses work location. Other factors influencing job satisfaction included choice of work location, work routine, off duty/staff allocation arrangements, teamwork and working environment. The results of the study highlight to employers of psychiatric nurses the importance of work location, including the value of facilitating staff with choices in their working environment, which may influence the recruitment and retention of nurses in mental health services.     

Resilience of nurses who work in community mental health workplaces in Palestine

People in Palestine live and work in a significantly challenging environment. As a result of these challenges they have developed resilient responses which are embedded in their cultural context. ‘Sumud’, in particular, is a socio‐political concept which refers to ways of surviving in the context of occupation, chronic adversity, lack of resources and limited infrastructure. Nurses' work in Palestine is an under‐researched subject and very little is known about how nurses adjust to such challenging environments. To address this gap in the literature this study aimed to explore the resilience of community mental health nurses (CMHNs) who work in Palestine. An interpretive qualitative design was chosen. Fifteen face‐to‐face interviews were completed with participants. Thirty‐two hours of observations of the day‐to‐day working environment and workplace routines were conducted in two communities' mental health centres. Written documents relating to practical job‐related policies were also collected from various workplaces. Thematic analysis was used across all data sources resulting in four main themes, which describe the sources of resilience among CMHNs. These sources are ‘Sumud and Islamic cultures’, ‘Supportive relationships’, ‘Making use of the available resources’, and ‘Personal capacity’. The study concludes with a better understanding of resilience in nursing, which draws on wider cultural contexts and social ecological responses. The outcomes from this study will be used to develop the resilience of CMHNs in Palestine.     

Stress amongst district nurses: a preliminary investigation

This paper presents the results of a pilot study investigating stress among district nurses in the north-west of England. Nurses completed questionnaires covering job satisfaction, mental health, stress, Type A behaviour, health behavior, coping skills and demographic details. A specific measure of stress was developed following in-depth interviews with primary care professionals, including district nurses. A total of 79 district nurses took part in the study. The major sources of stress isolated by the district nurses related to: time pressure, administrative responsibility, having too much to do, factors not under their control, interruptions, keeping up with National Health Service (NHS) changes, and lack of resources. Factor analysis of stress questionnaire responses identified five major factors: demands of the job and lack of communication, working environment, problems with patients, work/home interface and social life, and career development. The highest levels of satisfaction were reported for the amount of variety in their job and the lowest level of job satisfaction was reported for chance of promotion. The results revealed that the mental wellbeing of the nurses was higher than that of the other population groups. Furthermore, multivariate analysis revealed three major stressors that were predictive of high levels of job dissatisfaction: demands of the job and lack of communication, working environment, and career development. The implications of the findings for further research are considered.     

An analysis of the relationship between job satisfaction and job stress in correctional nurses

Stamps and Piedmonte's Index of Work Satisfaction and Harris's Nurse Stress Index were completed by 287 registered nurses employed in state prison health care facilities in order to assess job satisfaction and job stress among correctional nurses. Correctional nurses' expectations about job satisfaction were influenced by pay and autonomy. This finding was consistent with studies of hospital nurses. Important sources of job satisfaction were professional status and interaction with employees. Analysis of differences between expectations and sources of job satisfaction may provide understanding of career benefits and sources of dissatisfaction. Time pressures and organizational support and involvement were sources of stress. Multivariate analyses showed an inverse relationship between stress and job satisfaction. Information about job satisfaction and work stress and their correlates may be used to develop strategies to improve the recruitment and retention of correctional nurses.     

Community mental health nurses in Wales: self-reported stressors and coping strategies

There is evidence to suggest that community mental health nurses experience stress and burnout related to their work. Previous research has been limited by a number of methodological problems. One of the problems is that studies have tended to have small or unrepresentative samples, and many researchers have only examined mental health nurses as a subset within their research, which limits the generalizability of the findings. The All-Wales Community Mental Health Nurse (CMHN) Stress Study was set up in order to address this issue. The total population of CMHNs in Wales was surveyed (N = 614) and 301 (49%) responded. The questionnaire booklet contained a number of validated instruments to measure stress, burnout, and coping, together with a demographic questionnaire. The demographic questionnaire included three open ended-questions. These questions were asked in order in determine the CMHNs' own views of the sources of stress in the workplace, and to investigate which methods they use to cope. This paper reports the findings from the content analysis of the three questions. The results from the other measures are reported in the companion paper (Edwards et al. 2000). The most frequently cited stressors included perceived workload, excessive paperwork and administration, and a broad spectrum of client-related issues. Coping strategies that CMHNs reported using included peer support, a range of personal strategies such as relaxation, and belief in self and supervision. It appears from the findings that a range of factors such as organizational pressures and factors related to working with patients are important in determining stress levels, and that informal rather than formal support networks are the preferred methods of coping.     

Education for community mental health nurses: a summary of the key debates

A wide range of post-qualifying education courses exist for community mental health nurses (CMHNs) working in the UK. 'Specialist practitioner' courses emphasize shared learning between CMHNs and members of other community nursing branches. These programmes typically include course content drawing on the social and behavioural sciences, as well as on material more tailored to the clinical needs of practitioners. Such courses and their predecessors have been subject to criticism, however. Courses have been described as anachronistic, and failing to take account of recent advances in treatment modalities. In addition concerns about the generic focus of some programmes have also been raised. Educational alternatives, such as programmes preparing nurses and other mental health workers to provide 'psycho-social interventions' have, correspondingly, become increasingly popular. In this paper we explore some of the debates surrounding the education of CMHNs, and explore the context in which CMHNs work and in which educational programmes are devised. We consider the multidisciplinary environment in which CMHNs practise, the differing client groups with which CMHNs work, the developing policy framework in which mental health care is provided, demands for more user-responsive education, and the relationship between higher educational institutions and health care providers. We conclude the paper with a series of questions for CMHN educators and education commissioners.     

A stepwise multivariate analysis of factors that contribute to stress for mental health nurses working in the community

AIMS: The aim of the study was to examine the variety, frequency and severity of stressors experienced by community mental health nurses (CMHNs) in Wales. BACKGROUND: Numerous studies undertaken throughout the United Kingdom (UK) have indicated that those health professionals working as part of community teams are experiencing increasing levels of stress and burnout. Sample sizes have tended to be small and participants have been drawn mainly from sites in England. METHODS: A questionnaire booklet, which included a number of validated measures, was distributed to 614 CMHNs. These included Maslach Human Services Survey, Community Psychiatric Nursing (CPN) Stress Questionnaire, PsychNurse Coping Questionnaire, Rosenberg Self-Esteem Scale and General Health Questionnaire GHQ-12. The study was the largest of its kind conducted in the UK. RESULTS: Data were collected from 301 CMHNs, representing a response rate of 49%. Community mental health nurses identified the most stressful issues as trying to maintain a good quality service in the midst of long waiting lists and poor resources and having too many interruptions while trying to work in the office. The best demographic predictors of high stress scores were having an unsupportive line manager, working with a specific client group and not having job security. These factors accounted for 20% of the variance in the total stress score. When the results from the psychometric instruments were included, 46% of the variance in the total stress score was accounted for. The predictive variables were emotional exhaustion, working with a specific client group, job security and alcohol consumption. CONCLUSIONS: These findings indicate that there is a need to create more supportive environments both in terms of job security and management support, especially for those working in the fields of severe mental illness and rehabilitation.     

The relationship between primary health care practitioners' job satisfaction and characteristics of their practice settings

Today, individuals spend much of their time at the workplace, and theorists argue that an individual's employment experience is an integral part of his or her social identity. Current research emphasizes the importance of job satisfaction to a person's entire life adjustment. Yet little data exists about the job satisfaction of nurses working in the advanced practice role of primary care. The purposes of this article's study were to describe those individual and situational factors that contribute to job satisfaction and dissatisfaction among nurse practitioners, and to explore the relationship between levels of job satisfaction and characteristics of primary health care practitioners' work/practice settings. The study results suggest that, overall, NPs demonstrate a high level of job satisfaction; only 9 percent reported overall dissatisfaction with their jobs. Autonomy, sense of accomplishment and time spent in patient care ranked as the top three factors contributing to job satisfaction. The highest ranked dissatisfier was salary. Differences in satisfaction existed according to several practice-setting characteristics. Fewer factors than initially expected were associated with overall job satisfaction. The correlates that were noted, however, identified number of years of experience and self-perceived skill levels as important variables contributing to overall job satisfaction. Implications of these findings for the early guidance of practitioners assuming the advanced-practice role and for the NP educational curriculum are discussed.     

Retaining the mental health nursing workforce: early indicators of retention and attrition

In the UK, strategies to improve retention of the mental health workforce feature prominently in health policy. This paper reports on a longitudinal national study into the careers of mental health nurses in the UK. The findings reveal little attrition during the first 6 months after qualification. Investigation of career experiences showed that the main sources of job satisfaction were caregiving opportunities and supportive working relationships. The main sources of dissatisfaction were pay in relation to responsibility, paperwork, continuing education opportunities, and career guidance. Participants were asked whether they predicted being in nursing in the future. Gender and ethnicity were related to likelihood to remain in nursing in 5 years time. Age, having children, educational background, ethnic background, and time in first job were associated with likelihood of remaining in nursing at 10 years. Associations between elements of job satisfaction (quality of clinical supervision, ratio of qualified to unqualified staff, support from immediate line manager, and paperwork) and anticipated retention are complex and there are likely to be interaction effects because of the complexity of the issues. Sustaining positive experiences, remedying sources of dissatisfaction, and supporting diplomats from all backgrounds should be central to the development of retention strategies.     

临床护士幸福进取感在工作满意度与职业认同中的中介效应

目的 探讨临床护士积极心理健康在职业认同与工作满意度中的中介效应.方法 采用幸福进取者调查问卷、工作满意度调查表及护士职业认同调查问卷对300名临床护士护士进行调查.结果 临床护士工作满意度程度为57.30％,工作满意度不同程度的临床护士的幸福进取感及职业认同感存在显著性差异（P＜0.01）,幸福进取感不满意得分为（2.31±0.26）,低满意得分为（3.68±0.42）,高满意得分为（4.59±0.38）,各维度得分比较差异有统计学意义（F=7.68,P＜0.01）;护士职业认同问卷不满意得分为（55.24 ±6.37）,低满意得分为（63.35 ±5.46）,高满意得分为（82.49 ±7.62）,各维度得分差异有统计学意义（F=9.34,P＜0.01）,幸福进取感各维度与工作满意度及职业认同感存在正相关性（r =0.226 ～0.337,P＜0.01）.结论 临床护士工作满意度不高,工作满意度及职业认同受积极心理健康的影响.     

Clinical supervision, burnout, and job satisfaction among mental health and psychiatric nurses in Finland

This paper presents the findings from a survey of Finnish mental health and psychiatric nurses. The aim of the study was to describe and evaluate the current state of clinical supervision, and ascertain the levels of burnout and job satisfaction experienced by these health care professionals. Clinical supervision was found beneficial for mental health and psychiatric health care professionals in terms of their job satisfaction and levels of stress. The findings seem to demonstrate that efficient clinical supervision is related to lower burnout, and inefficient supervision to increasing job dissatisfaction.     

Work related stress,burnout, job satisfaction and general health of nurses: A follow‐up study

Nurses experience high levels of work related stress and burnout as well as low job satisfaction and poor general health owing to the nature of their work. This paper seeks to provide a better understanding of the nature of relationships between work related stress, burnout, job satisfaction and general health of nurses over one year. This study involved a longitudinal design. Two hundred and seventy seven nurses from four hospitals completed a follow up survey consisting of five questionnaires. Data were collected between 2013 and 2014. The data were analysed using generalized estimation equation analysis. Lack of support was associated with burnout, patient care was associated with job satisfaction and staff issues were associated with general health of nurses. Burnout is more strongly related to job satisfaction than general health. The findings of this study could inform evidence based policy and practice through interventions aimed at improving job satisfaction and reducing the impact of burnout on general health of nurses.     

四川省护士感知的工作环境与工作满意度的相关性研究

[目的]调查四川省护士感知的工作环境和工作满意度现况,为提高护士工作满意度提供干预依据.[方法]采用护理工作环境量表及工作满意度调查表,调查四川省20所二级、三级综合医院1 112名护士.[结果]护士感知的工作环境中“医护合作关系”得分最高,其次为“护士参与医院事务”,“充足的人力和物力”得分最低.护士工作满意度维度中“工作独立性”满意度得分最高,其次为“工作安排”满意度,收入得分最低.工作环境各维度与工作满意度呈正相关（P＜0.05或P＜0.01）;护士在目前医院的工作年限和充足的人力与物力对护士工作满意度具有预测作用（P＜0.05）.[结论]关注护士感知的工作环境对工作满意度的预测作用,并就其影响因素制定干预措施,以期提升护士工作满意度,留任护理人才,提升护理品质.