ZJAWISKO WYPALENIA ZAWODOWEGO WŚRÓD PERSONELU PIELĘGNIARSKIEGO PRACUJĄCEGO NA ODDZIAŁACH ZABIEGOWYCH

Małgorzata Paplaczyk1, Zuzanna Radosz2, Alicja Domagała3, Joanna Chrobak-Bień4, Marta Przybycień5, Paulina Dusińska6, Joanna Bonior7

1PHD STUDENT, FACULTY OF HEALTH SCIENCES, JAGIELLONIAN UNIVERSITY MEDICAL COLLEGE, UNIVERSITY HOSPITAL IN CRACOW, POLAND

2PHD STUDENT, FACULTY OF HEALTH SCIENCES, JAGIELLONIAN UNIVERSITY MEDICAL COLLEGE IN CRACOW, POLAND

3HEALTH POLICY AND MANAGEMENT DEPARTMENT, INSTITUTE OF PUBLIC HEALTH, JAGIELLONIAN UNIVERSITY MEDICAL COLLEGE, CRACOW, POLAND

4MEDICAL UNIVERSITY OF ŁÓDŹ, LODZ, POLAND

5UNIVERSITY HOSPITAL IN CRACOW, POLAND, CRACOW, POLAND

6PHD STUDENT, FACULTY OF HEALTH SCIENCES, JAGIELLONIAN UNIVERSITY MEDICAL COLLEGE IN CRACOW, POLAND

7DEPARTMENT OF MEDICAL PHYSIOLOGY, FACULTY OF HEALTH SCIENCES, JAGIELLONIAN UNIVERSITY MEDICAL COLLEGE, CRACOW, POLAND

 

Abstract

Introduction: The nursing staff are particularly exposed to occurrence of chronic stress, and as a result the burnout syndrome may develop.

Aim: The aim of the study was to determine the threat level of burnout among the nursing staff working in surgical wards and to indicate the consequences of this issue as a challenge for healthcare managers.

Material and Methods: The research was conducted among nursing staff (n=71) working in surgical wards. The author’s questionnaire and the Professional Burnout Questionnaire of MBI Ch. Maslach in the Polish adaptation of T. Pasikowski were used. The Mini COPE questionnaire Inventory developed by Ch. Carver assessed the frequency of using 14 coping strategies by the respondents.

Results: Nursing staff are at risk of burnout, which is affected by their place of residence and additional employment. The existence of a high burnout rate in individual subscales affects the use of negative coping strategies with stress.

Conclusions: To prevent the occurrence of chronic stress and burnout syndrom, pro-quality measures are necessary to professionalize nursing, increase wages and extend the professional competence of nurses and attempt to modernize and implement solutions that are successfully used in other European Union countries.

Streszczenie

Wstęp: Personel pielęgniarski jest szczególnie zagrożony występowaniem przewlekłego stresu, w wyniku którego może rozwinąć się zespół burnout.

Cel pracy: Określenie poziomu zagrożenia wypaleniem zawodowym personelu pielęgniarskiego pracującego na oddziałach zabiegowych.

Materiał i metody: Badanie przeprowadzono wśród personelu pielęgniarskiego (n=71) pracującego na oddziałach chirurgicznych. Wykorzystano autorski kwestionariusz ankiety oraz Kwestionariusz Wypalenia Zawodowego MBI Ch. Maslach w polskiej adaptacji T. Pasikowskiego.

Wyniki: Personel pielęgniarski jest zagrożony występowaniem wypalenia zawodowego, na którego wpływ ma miejsce zamieszkania oraz posiadanie dodatkowego zatrudnienia.

Wnioski: Aby zapobiec występowaniu wypalenia zawodowego konieczne są działania projakościowe w celu profesjonalizacji pielęgniarstwa, wzrost wynagrodzeń i rozszerzenie kompetencji zawodowych, pielęgniarek oraz próba unowocześnienia i wdrożenia rozwiązań stosowanych z powodzeniem w innych krajach Unii Europejskiej.

Public Health Forum 2018;IV(XII)4(47):251-262

INTRODUCTION

The concept of occupational burnout has been repeatedly described in the scientific literature as a response to the emerging exhaustion, fatigue, loss of strength and energy, especially among employees performing social professions [1]. There are many definitions in the literature that refer directly to the phenomenon of burnout. Individual definitions look for its sources in various phenomena, from irregularities in the organization of the workplace by individual inclinations to resources and support. The variety of definitions clearly indicates that the burnout syndrome is a dynamic concept. The modernization in all aspects of life, which can be observed, certainly had an impact on the need to determine this phenomenon and attempt to prevent its development [2,3]. The concept of occupational burnout was a topic addressed mainly by Christina Maslach [4] and the definition she developed is the most commonly used definition among researchers dealing with this phenomenon [5]. She describes professional burnout as: “[…] a psychological syndrome of emotional exhaustion, depersonalization and a reduced sense of personal achievements that may occur in people who work with other people in a certain way.” Another definition of professional burnout was proposed by H. Sęk [4], who situates it in cognitive-competence terms. The model focuses on experience, environmental factors, coping skills and individual characteristics of the individual. In a person subjected to failure at work, characterized by a lack of motivation and the occurrence of chronic stress, a burnout syndrome may develop. It depends on several factors: individual characteristics, resources, support, and level of empathy, seniority and the frequency of stressful stimuli resulting from the specifics of work. The burnout syndrome in nurses, although it occurs according to a specific model, its occurrence should be treated individually, and its course can be very dynamic [5].

Research indicates that the problem of chronic stress and burnout can occur at every stage of nurses’ professional career. In Poland, the nurse profession comes with many burdens. The main factors that cause stress are poor work organization and work overload, as well as feeling the need to be reliable. Medical staff experience tension and work under the pressure that may cause chronic stress, which is the most common cause of burnout [6].
In case of the Polish nurses, some of the main reasons behind occupational burnout are the excessive workload and the search for additional sources of employment, motivated by low wages. Factors such as night work, non-compliance with work hygiene, and too many patients per nurse, result in reduced efficiency and health problems [7]. On December 28, 2012, the Ministry of Health published the Ordinance of the Minister of Health on the method of setting minimum standards for the employment of nurses and midwives in non-commercial medical entities [8], which concerned the number of nurses that should be employed in individual departments. Unfortunately, due to the very low interest of young people in this profession, and the increase in emigration of staff to EU countries, only a few wards are able to meet the requirements set by the Ministry of Health. Hospitals are struggling with the lack of nursing staff, and the problem is growing every year. Data from 2017, presented by the Organization for Economic Cooperation and Development (OECD) [9] shows that Poland in among the countries that are at the bottom of the list of the European Union countries comparing the number of nursing staff per 1000 inhabitants. According to data from the Supreme Council of Nurses and Midwives (NRPiP) [10], in 2016 this ratio was 5.66. This is a very unfavourable and worrying result when compared to a country with a similar development rate such as the Czech Republic, for which this ratio is 8, or to a highly developed country such as Switzerland where there are 17.56 nurses per 1000 inhabitants. In the same report, NRPiP warns that by 2030 this ratio will go down to 3.81. Considering the demography of the Polish society, the OECD recommends that the activities undertaken by the Polish Ministry of Health should aim at achieving the ratio value of 9.4 nurses per 1000 inhabitants. Alarming data from reports is a reflection of the situation in Polish hospitals. Personnel problems, resulting from the lack of an adequate number of staff, are the reason for assigning additional tasks to nurses who are already burdened with many obligations resulting from the Act regulating the profession [11]. They care for the patients, carry out medical orders, conduct educating tasks, and also undertake many independent actions using the knowledge and skills obtained during additional training. Nurses are also entrusted with handling more and more of extensive documentation. All these activities take a lot of time, and require commitment and continuous development of knowledge, practice and training [6,7,8,9,10].

Current situation of Polish nursing is extremely difficult. Due to the unsatisfactory working and employment conditions, young people are not interested in working in this profession. The unfavourable age structure of Polish nurses causes concern and challenge for continuity of medical services and the stability of healthcare system.

THE AIM

The aim of the study was to determine the level of occupational burnout risk of nursing staff working in surgical wards and to indicate consequences of this issue as a challenge for healthcare managers.

MATERIAL AND METHODS

The study was carried out among nursing staff working in surgical treatment units in University Hospital in Cracow, Poland from May to September 2017. The study used the method of a diagnostic survey, consisting of 13 questions covering socio-demographic data (age, sex, place of residence, marital status, vocational and postgraduate education, work experience), as well as information on employment (satisfaction with remuneration, additional work in another medical facility, opinion on the development opportunities provided by the employer) and Maslach Burnout Inventory (MBI) by Ch. Maslach in the Polish adaptation of T. Pasikowski [12]. The tool consists of 22 questions related to the issues related to burnout syndrome in three categories: emotional exhaustion (EE), depersonalization (DEP) and reduced personal accomplishment (PA). For each subscale, the results are calculated separately, whereas by aggregating the results, the overall level of occupational burnout can be determined. To assess the different ways in which people respond to stress, the Mini Questionnaire – COPE Inventory developed by Ch. Carver, and adapted in Polish by Z. Juczyński and N. Ogińska – Bulik was used [13]. The tool examines the types of coping strategies of both healthy and sick people. It consists of 28 questions, answering which the examined person determines the frequency of feeling a given way on a scale from 0 (never) to 3 (always). Each strategy is described by two questions in the questionnaire, for which the average is calculated, and which are assigned to particular categories: Active Coping, Planning, Positive reframing, Acceptance, Humor, Religion, Use of emotional support, Use of instrumental support, Self-distraction, Denial, Venting, Substance use, Behavioural disengagement, Self-blame.

As part of the statistical analysis of the quantitative variables (i.e. the ones expressed as a number) the following measures were calculated were the mean, standard deviation, median, quartiles, minimum and maximum.
The analysis of qualitative variables (i.e. the ones not expressed as a number) was performed calculating the number and percentage of occurrences of each value.
The comparison of the values of quantitative variables in two groups was performed using the Student’s t test (where the variable had a normal distribution in the analyzed groups) or the Mann-Whitney test (where there was no normal distribution).
The comparison of the values of quantitative variables in three or more groups was performed by analysis of variance, ANOVA (where the variable had a normal distribution in the analyzed groups) or the Kruskal-Wallis test (where there was no normal distribution).
The correlation between the two quantitative variables was analyzed using the Spearman’s coefficient (when at least one of the variables did not have a normal distribution). The strength of dependence was interpreted according to the following scheme: | r | ≥ 0.9 – very strong correlation, 0.7 ≤ | r | <0.9 – strong correlation, 0.5 ≤ | r | <0.7 – medium-strong correlation, 0.3 ≤ | r | <0.5 – weak correlation, | r | <0.3 – very poor correlation. The normality of the variable distribution was examined using the Shapiro-Wilk test. The significance level in the analysis was agreed at 0.05. The analysis was carried out in the R program, version 3.4.2.
The study was conducted in accordance with the principles of the Helsinki Declaration, and with the approval of the Director of the University Hospital in Kraków. Each respondent expressed verbal consent to complete the questionnaires.

RESULTS

CHARACTERISTICS of the studied group

70 nurses and 1 male nurse took part in the study. The criterion for inclusion in the study was the condition of working in a department with an interventional profile in a shift mode and the informed consent of the examined person to conduct the study. The average age of the respondents was 41 years (SD = 10.75) and ranged from 23 to 60 years. The study group was dominated by people living in the village (39.44%) and the city above 100,000. (32.39%). People who live in cities from 25,000 up to 100,000 (7.04%) formed the smallest group. The average length of service in the profession was 17.82 years (SD = 11.28) and ranged from 1 to 37 years. Half of the examined group were people in marriages (53.2%). A large group were people who were not in formal relationships (32.39%). The level of education of the studied group is shown in Table 1.

Satisfaction with remuneration in the studied group

Among the respondents, only 2.82% were satisfied with their salary in the main place of work (Table 2).

Providing development opportunities

In the research group, 76.06% believe that the current employer does not provide them with the opportunity to develop in the place of employment (Table 3).

The opportunity to receive promotion

70.42% of respondents said that they never received promotion in the main workplace (Table 4).

Having an additional workplace

Most of the respondents had an additional place of work in another medical facility (67.61%) (Table 5).

Occupational burnout

The general indicator of occupational burnout in the study group

Ch. Maslach’s Questionnaire allows to assess the risk of occupational burnout in three aspects (subscales): emotional exhaustion, depersonalization and reduced personal accomplishment . The results on each of these subscales are expressed on a scale from 0 – 100, where a higher score means a higher level of professional burnout. In addition, the overall burnout rate is also calculated, being the average of three subscales.

The average overall occupational burnout rate was 37.02 points (SD = 19.54) out of 100 possible and ranged from 3.7 to 78.8 points. The median was 33.98 points, so in half of the respondents the professional burnout was on the lower level, and in half on the higher than 33.98 points. The first and third quartiles were 22.31 and 55.19, respectively, so the typical level of occupational burnout in the analyzed group is between 22.31 and 55.19 points (Table 6).

Occupational burnout in the study group on individual subscales

The occupational burnout was mainly due to emotional exhaustion (average 47.89 points out of 100 possible), slightly less satisfaction from work (average 42.61 points), and in the least depersonalization (20.56 points) (Table 7).

Determinants of occupational burnout risk in the studied group

Age

The result of the Ch. Maslach’s questionnaire had no normal distribution, therefore the Spearman correlation coefficient was used for the analysis. Correlation coefficients are statistically insignificant (p> 0.05), therefore the level of occupational burnout does not depend significantly on age (Table 8).

Influence of marital status on the threat of burnout in the studied group

The result of the Ch. Maslach’s questionnaire regarding civil status did not have a normal distribution in the analyzed groups, therefore the analysis was carried out using the Kruskal-Wallis test. All p values are higher than 0.05, meaning that the level of occupational burnout did not depend significantly on marital status (Table 9).

The impact of the place of residence of the respondents on the risk of burnout

The result of the Ch. Maslach’s questionnaire did not have a normal distribution in the analyzed groups, therefore the analysis was carried out using the Kruskal-Wallis test, and the graph presents medians, quartiles and ranges of values. The value of p is lower than 0.05 for emotional exhaustion and the general indicator of occupational burnout, meaning that they depended significantly on place of work. To answer the question of how exactly this relationship looks, a post-hoc analysis was made. It showed that: emotional exhaustion was significantly higher in case of people from large cities (DM) than in case of people from small towns (MM), and the general rate of burnout was significantly higher in people from large cities and from rural areas (W) than in people from small towns (Table 10, Figure 1).

The impact of having an additional work places on the occupational burnout risk

The result of the Ch. Maslach questionnaire did not have a normal distribution in the analyzed groups, therefore the analysis was carried out using the U Mann-Whitney test. The p-value is lower than 0.05 for depersonalization, personal accomplishment and general burnout rate, therefore they depended on undertaking additional work. People who had an additional job place were more burn out in these areas (Table 11).

The impact of the seniority of the respondents on the risk of burnout

The result of the Ch. Maslach’s questionnaire had no normal distribution (p from the Shapiro-Wilk test below 0.05), therefore the Spearman correlation coefficient was used for the analysis. Correlation coefficients are statistically insignificant (p> 0.05), meaning that the level of occupational burnout does not depend significantly on the seniority (Table 12).

Impact of applied coping strategies on occupational burnout among nursing staff working in surgical wards

The Mini COPE questionnaire assesses the frequency of using 14 coping strategies by the respondents. The scores of the MiniCOPE strategy were not normally distributed, therefore in the Spearman’s correlation coefficient was used in the analysis.

The study examined the correlation between the overall occupational burnout rate and the strategies nurses use for coping with stress. The analysis of the results shows that the overall rate of occupational burnout is related to the frequency of using 5 out of 14 strategies (p <0.05). Correlations with positive reframing and acceptance strategies are negative, the higher the general index of occupational burnout, the less frequently these strategies are applied. Correlations with strategies of substance use, behavioural disengagement and self-blame are positive, the higher the overall burnout rate, the more often these strategies are applied. The strongest overall rate of occupational burnout affects the frequency of the disengagement strategy (Table 13, Figure 2).

The study examined relationship between strategies for coping with stress and occupational burnout in terms of emotional exhaustion. Emotional exhaustion has a significant effect on the frequency of using 3 out of 14 strategies (p <0.05). Correlations with strategies for the substance use, behavioural disengagement and self-blame are positive; the greater the emotional exhaustion, the more often these strategies are applied. Emotional exhaustion affects mainly the frequency of using the disengagement strategy (Table 14, Fig. 3).

Another examined relationship was that between strategies for coping with stress and depersonalization as a component of occupational burnout. Depersonalization significantly influences the frequency of application of 4 out of 14 strategies (p <0.05). Correlations with strategies of turning to religion, venting, behavioural disengagement and self-blame are positive, the greater the depersonalization, the more often these strategies are applied. Depersonalization most strongly affects the frequency of application of the venting strategy (Table 15, Fig. 4).

Another examined relationship was the one between strategies for coping with stress and occupational burnout in terms of personal accomplishment. Reduced personal accomplishment has a significant impact on the frequency of application of 6 out of 14 strategies (p <0.05). Correlations with active coping strategies, planning, positive reframing and acceptance are negative, the greater reduced personal accomplishment, the less frequently these strategies are applied. Correlations with strategies of substance use and behavioural disengagement are positive, the greater reduced personal accomplishment, the more often these strategies are applied. Reduced personal accomplishment affects the strongest the frequency of using the disengagement strategy (Table 16, Fig. 5).

DISCUSSION

The medical staff is particularly susceptible to the development of the burnout syndrome due to factors that have been observed by Ch. Maslach [4]. Research clearly indicates the increased occurrence of burnout among professions associated with frequent contact with another person and the need to face the other person’s problems. In addition, employees of healthcare units must meet a number of requirements, are subject to specific rules and procedures. Moreover, according to the legal regulations regarding individual medical professions [14], there is a requirement of continuing education, which causes additional burdens and pressure. These factors are additional determinants next to the theories of burnout syndrome already defined in the literature. The results of the conducted research largely correspond to the results presented by other researchers who also studied the phenomenon of occupational burnout among medical personnel.

The average overall occupational burnout rate in the examined group of nurses is 37.02 points (on a scale from 0 to 100), and the result of every third person tested was over 50 points. The result of the indicator consisted of average results in individual subscales. A particularly high average result was obtained in the emotional exhaustion subscale (47.89 points on a scale from 0 to 100) and reduced personal accomplishment (42.61 points on a scale from 0 to 100 points). These results are very similar to the results obtained by Cepuch and Dębska [15] in the examination of primary health care nurses at received results in the area of emotional exhaustion at the level of 22.8 points (on a scale from 0 to 54). And also Wilczek – Rużyczka [16] in the study of surgical nurses received similar results in the area of dissatisfaction at the level of 30.84 points (on a scale from 0 to 48). Similar results concerning emotional exhaustion were obtained by nurses from the United Kingdom (21.8 points on a scale from 0 to 54) in the study by Poghosyan et al. [17] analyzing the occupational burnout of nurses in six countries, however these results were significantly lower than ones of nurses from Japan (29.4 points) and higher than nurses from Germany (18.4 points). The results of own research are also higher for emotional exhaustion in comparison to nurses examined by Poretro et al. [18], who studied the level of occupational burnout of Spanish nurses (17.8 points).

The examined group of nurses was analyzed in terms of the impact of socio – demographic factors on the level of occupational burnout. The results of authors’ own research showed that the age of the examined personnel does not affect the level of professional burnout. These results are comparable to the results obtained among German nurses examined by Kowalski et al. [19] who also stated in their research that the age of the staff does not correlate with the occurrence of burnout syndrome. In turn, Kędra and Sanak [7] examined Polish nurses working in departments of different profiles, among which there was a dependence of the occurrence of burnout syndrome based on age – the burnout syndrome occurred more often in case of older nurses.

The age of staff is directly related to seniority. As the analysis of the results showed, the average length of service was 17.81 years. Authors’ own research does not indicate that the occupational experience as well as age correlated with the occurrence of occupational burnout among the examined personnel. Also, research by Kowalski et al. [19] among nurses in Germany and by Marcysiak et al. [20], who examined nurses working in outpatient clinics and in hospital wards, point to the lack of dependence between seniority and occupational burnout. Marcysiak et al. [20], however, indicate a higher rate of emotional exhaustion in case of people with longer work experience. Cipora et al. [21] achieved completely different results in their research, which stated that the longer the seniority of the staff, the more frequently the nursing staff burnout occurs. Despite the lack of results obtained at the level of statistical significance in own study, distinctly available literature indicates that seniority is one of the key determinants of burnout incidence or its index is clearly higher in case of people with longer work experience.

The next analyzed factor among the studied group was marital status. The analysis of the research indicated the lack of dependence between the marital status and the occurrence of the burnout syndrome. It is worth noting that the highest result of both the general rate of occupational burnout and emotional exhaustion among the respondents were held by divorced nurses. Similar results in their research were obtained by Cipora et al. [21] with a difference in emotional exhaustion, the ratio of which was the highest among married women. Certainly, personal failures as well as lack of support translate into such results.

As indicated by the analysis of the study results, the nurses’ residence has a significant influence on the occurrence of the burnout syndrome. The studied group is heterogeneous with regards to the place of residence, but the question of territorial conditions is evident. The area around the city of Krakow is dominated by villages and small towns, hence the study group usually lives in the city above 100,000 residents or in neighboring villages. The results of the study showed that people living in the city above 100,000 residents had a high rate of emotional exhaustion, which correlated with the place of residence. On the other hand, the general indicator of occupational burnout correlated also with living in large cities, but this dependence also occurs among people living in villages. A study by Cipora et al. [21] also showed that people living in rural areas and in large cities are characterized by the same occurrence of burnout, however, these results were not statistically significant. Probably there are several factors responsible for the lack of differences in the place of residence. People living in the villages struggle with greater fatigue associated with the need to travel to the workplace. However, people living in big cities are overwhelmed by the inconveniences of living in large metropolises, including pace of life or lack of a sufficient number of green areas.

In the study, only two people indicated that they were satisfied with the received remuneration. Research on the job satisfaction indicates the issue of remuneration as one of the key to improving the situation of nurses in the workplace. In the study by Sowińska et al. [22] and Kędra and Sanak [7] the vast majority of respondents indicated that an increase in remuneration would improve their job satisfaction.

The salary of the respondents is closely related to taking up additional employment in other medical facilities. Authors’ own research indicated a very worrying fact that almost 70% of the respondents had an additional workplace. These persons also indicated that increasing the salary in the main place of work could become the reason for resigning from additional work. The salary of the respondents is closely related to taking up additional employment in other medical facilities. The own study indicated a very worrying fact that almost 70% of the respondents had an additional workplace. These persons also indicated that increasing the salary in the basic place of work could be the reason for resignation from additional work.

“Rzeczpospolita” in early 2017 published alarming data: most of Polish nurses work much more than full time post [23]. The question here is not only about the safety of the overworked personnel, but above all about the safety of the patients that these people provide care for. It is probably not surprising that the result of authors’ own study, that having additional work is a determinant of the occurrence of burnout.

The result is statistically significant for several areas of occupational burnout: depersonalization, reduced personal accomplishment and overall burnout rate. A review of available literature indicates that it is a very strong relationship that has been proven in many studies. Workload is a strong determinant of the occurrence of occupational burnout, among others in Turkish nurses in Tekindal et al. [24] and in Hungarian nurses in Kovacs et al. [25] study. Excessive workload is a factor that characterizes the work of nurses in many European countries, and the problem of occupational burnout of nurses is a global one. This is confirmed by a study carried out [17] in six countries from different regions of the world, which indicates that occupational burnout also occurs in industrialized and highly developed countries, including Japan, USA or United Kingdom. Germany leads among these countries as there the level of occupational burnout is the lowest. The results of this study correspond with the results obtained in the international research project R4CAST [26], which, among others, discussed the issues of workload of nursing staff, especially in terms of quality and patient satisfaction with care, as well as patient safety. The survey showed that the least burdened with work are nurses in Germany, which probably affects the lower level of occupational burnout of staff in this country.

It is worth taking a look at health systems in European countries, e.g. United Kingdom, where nurses are more independent and successfully take over the competences previously reserved to doctors. In German system of auxiliary professions is also developed, thanks to which nurses can focus on the implementation of tasks in line with their competencies [27]. In Poland, the health system has not yet been adapted to the presence of nurses with such high qualifications, disproportionate to the ability of implementing them in practice. This means that nurses are often burdened with work below their competences.

The obtained results of the occupational burnout index were correlated with the applied strategies of coping with stress. Statistical analysis showed a relationship between experiencing occupational burnout and the strategies of substance use, behavioural disengagement and self-blame. These results correlate the most with emotional exhaustion – the more exhausted the people, the more often they used these negative coping strategies. Ch. Carver, the author of the Mini COPE questionnaire, points that the use of these strategies in the long term may cause depression, which indicates that examined staff is at a high risk of experiencing this disorder. Similar results were obtained in the group of nurses examined by Marcysiak et al. [20] In this study the results were obtained using the Maslach Burnout Inventory (MBI) and the Coping Inventory for Stressful Situations (CISS), which includes similar methods of coping with stress as the Mini COPE questionnaire. Also in this study the people at risk of occupational burnout applied most commonly the problem- and emotion-focused strategies. In addition, the authors pointed out that those who use these strategies lose interest in work and have difficulties in performing their duties [18]. These results are a reflection of the lack of appropriate measures in the Polish health system that would grant nurses professional support in the area of coping skills.

In summary, in case of the nursing staff there are several key factors which cause the hazard of the occupational burnout of the stuff. These include socio-demographic factors, excessive workload and factors related to low remuneration. Occupational burnout is also closely related to the adoption of inappropriate coping strategies that may even aggravate its occurrence. The obtained results confirm the assumptions of the theories regarding occupational burnout and indicate deficits in the organization of work of nursing staff, as well as in occupational burnout as a problem affecting nurses at every stage of their professional career. The results of the study also show that nurses working in surgical wards are at a similar risk of occupational burnout as the staff working on wards of different profiles, which underlines the importance of these factors as the ones causing occupational burnout. In the face of the progressive aging of highly developed societies, the problem of nursing staff deficits is becoming more and more important. Difficulties in providing adequately qualified personnel and the existence of occupational burnout among working nurses negatively affect the quality of care and efficiency of patient therapy. Therefore, studying the phenomenon of occupational burnout is all the more important, and providing support to nurses at every stage of their professional career is one of the key actions that can help reduce it.

CONCLUSION

The threat of occupational burnout in nursing staff is a global phenomenon. The level of occupational burnout varies between countries, and the results of Polish nurses may be compared with the results of countries such as United Kingdom or Hungary. The impact of excessive workload on the occurrence of occupational burnout clearly indicates that one of the ways of limiting it are activities aimed at increasing the number of nursing staff, among others by increasing wages, introducing incentive systems, reorganizing the current health system and providing trainings. Prevention of burnout syndrome should focus on granting the safety of nurses at work by reducing the influence of physical and mental factors, and providing support from specialists at the moment of experiencing the first symptoms of the burnout syndrome.

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Financed from the resources of the Jagiellonian University Medical College in Cracow.

Conflict of interest

Authors declare no conflict of interest

Corresponding author:

Joanna Bonior

Department of Medical Physiology,

Faculty of Health Sciences,

Jagiellonian University Medical College, Cracow, Poland;

e-mail: joanna.bonior@uj.edu.pl

tel: 12 634 33 97 w. 24

Received: 17.11.2018

Accepted: 20.12.2018

Table 1. Education in the group of respondents.

Education

n§

%

Secondary

22

30,99%

BA†

24

33,80%

MA

25

35,21%

†– bachelor;

‡ – master;

§ – number of respondents;

Table 2. Satisfaction with salary in the studied group.

Satisfaction with the salary

n†

[%]

No

69

97,18

Yes

2

2,82

† – number of respondents;

Table 3. Possibility of development in the workplace in the responders’ opinion.

Possibility of development

n†

[%]

No

54

76,06

Yes

17

23,94

†– number of respondents;

Table 4. Possibility of receiving a promotion in the workplace in the responders’ opinion.

Promotion received

n†

[%]

No

50

70,42

Yes

21

29,58

†- number of respondents;

Table 5. Having an additional workplace.

Additional workplace

n

[%]

No

23

32,39

Yes

48

67,61

†– number of respondents;

Table 6. General indicator of occupational burnout in the studied group.

n†

Average

SD‡

Median

Q1§

Q3¶

71

37,02

19,54

33,98

22,31

55,19

† – number of respondents;

‡ – standard deviation;

§ – 1st quartile;

¶ – 3rd quartile;

Table 7. Occupational burnout in the examined group on individual subscales.

Occupational burnout

n†

Average

SD

Median

Q1§

Q3¶

Emotional exhaustion

71

47,89

28,02

44,44

27,78

72,22

Depersonalization

71

20,56

22,42

20

0

40

Reduced personal accomplishment

71

42,61

29,92

37,5

12,5

62,5

† – number of respondents;

‡ – standard deviation;

§ – 1st quartile;

¶ – 3rd quartile;

Table 8. Influence of age on the risk of burnout.

Occupational burnout

Correlation with age

Correlation coefficient

P*

Direction of dependence

Strength of dependence

Emotional exhaustion

0,16

0,182

Depersonalization

-0,053

0,658

Reduced of personal accomplishment

-0,076

0,531

Overall indicator of occupational burnout

0,021

0,865

*Spearman’s correlation coefficient (p<0,05);

Table 9. Influence of marital status of respondents on the threat of burnout.

Occupational burnout

Marital status

n

Average

SD‡

Median

Q1§

Q3¶

p*

Emotional exhaustion

Single

23

41,55

25,34

33,33

22,22

55,56

0,298

Divorced

7

55,56

23,13

44,44

44,44

72,22

Married

38

51,46

30,72

44,44

33,33

77,78

Depersonalization

Single

23

26,09

25,18

20

10

40

0,423

Divorced

7

25,71

27,6

20

0

50

Married

38

17,89

19,61

20

0

35

Reduced personal accomplishment

Single

23

46,2

29,3

50

18,75

62,5

0,779

Divorced

7

39,29

37,8

37,5

6,25

68,75

Married

38

42,43

30,14

37,5

15,62

62,5

Overall indicator of occupational burnout

Single

23

37,94

17,67

35,28

25,32

51,85

0,978

Divorced

7

40,19

27,92

44,81

16,9

58,24

Married

38

37,26

19,47

33,61

22,8

56,76

† – number of respondents;

‡ – standard deviation;

§ – 1st quartile;

¶ – 3rd quartile;

* Kruskal Wallis test (p<0,05);

Table 10. The impact of the place of responders’ residence on the risk of burnout.

Occupational burnout

Place of residence

N†

Average

SD‡

Median

Q1§

Q3

P*

Emotional exhaustion

Village(W)

28

49,6

29,24

44,44

22,22

69,44

0,011

City up to 100 000. (MM)

20

34,44

24,69

33,33

22,22

44,44

DM >

City> 100 000. (DM)

23

57,49

25,66

44,44

44,44

83,33

MM

Depersonalization

Village (W)

28

24,29

19,89

20

0

40

0,144

City up to 100 000 (MM)

20

14

20,62

0

0

20

City> 100 000. (DM)

23

21,74

26,22

20

0

20

Reduced personal accomplishment

Village (W)

28

46,88

32,92

50

12,5

78,12

0,155

City up to 100 000. (MM)

20

31,25

23,47

25

12,5

40,62

City> 100 000. (DM)

23

47,28

29,67

37,5

31,25

68,75

Overall indicator of occupational burnout

Village(W)

28

40,25

19,1

37,82

27,64

56,18

0,022

City up to 100 000. (MM)

20

26,56

15,35

25,23

15,09

33,19

DM, W >

City> 100 000. (DM)

23

42,17

20,56

41,85

23,8

59,35

MM

† – number of respondents;

‡ – standard deviation;

§ – 1st quartile;

¶ – 3rd quartile;

* Kruskal Wallis test (p<0,05);

Table 11. The impact of having additional work on the threat of occupational burnout.

Occupational burnout

Additional workplace

n†

Average

SD

Median

Q1§

Q3

p *

Emotional exhaustion

No

23

41,55

23,74

44,44

27,78

50

0,256

Yes

48

50,93

29,6

44,44

30,56

77,78

Depersonalization

No

23

11,3

15,76

0

0

20

0,016

Yes

48

25

23,88

20

0

40

Reduced personal accomplishment

No

23

29,35

24,89

25

12,5

37,5

0,009

Yes

48

48,96

30,27

50

25

75

Overall indicator of occupational burnout

No

23

27,4

14,64

26,11

20,69

30,05

0,005

Yes

48

41,63

20,03

40,6

26,5

58,03

† – number of respondents;

‡ – standard deviation;

§ – 1st quartile;

¶ – 3rd quartile;

*U Mann Whitney test (p<0,05);

Table 12. The impact of seniority on the threat of burnout.

Occupational burnout

Correlation with age

Correlation coefficient

P*

Direction of dependence

Strength of dependence

Emotional exhaustion

0,185

0,123

Depersonalization

-0,024

0,846

Reduced personal accomplishment

-0,004

0,976

Overall indicator of occupational burnout

0,084

0,487

*Spearman’s correlation coefficient (p<0,05);

Table 13. The influence of general indicator of occupational burnout on strategies of coping with stress.

Strategies of coping with stress (mini-COPE subscale)

Correlation coefficent

Correlation with general indicator of occupational burnout

P*

Direction of dependence

Strenght of dependence

1

Active action

-0,099

0,413

2

Planning

-0,211

0,078

3

Positive revaluation

-0,247

0,038

negative

very weak

4

Acceptance

-0,249

0,037

negative

very weak

5

Sense of humor

0,021

0,861

6

Turn to religion

0,222

0,063

7

Looking for emotional support

-0,121

0,315

8

Looking for instrumental support

-0,152

0,205

9

Doing something else

0,024

0,84

10

Denial

0,169

0,158

11

Abreaction

0,197

0,1

12

Use of psychoactive substance

0,293

0,013

positive

very weak

13

No action

0,443

<0,001

positive

weak

14

Blaming yourself

0,357

0,002

positive

weak

*Spearman’s correlation coefficient (p<0,05);

Table 14. The influence of emotional exhaustion on strategies of coping with stress.

Strategies of coping with stress (mini-COPE subscale)

Correlation coefficenct

Correlation with emotional exhaustion

P*

Direction of dependence

Strenght of dependence

1

Active action

-0,097

0,422

2

Planning

-0,178

0,137

3

Positive revaluation

-0,205

0,087

4

Acceptance

-0,233

0,051

5

Sense of humor

0,141

0,241

6

Turn to religion

0,199

0,097

7

Looking for emotional support

-0,056

0,644

8

Looking for instrumental support

-0,072

0,549

9

Doing something else

0,176

0,141

10

Denial

0,209

0,081

11

Abreaction

0,162

0,176

12

Use of psychoactive substance

0,263

0,026

positive

very weak

13

No action

0,382

0,001

positive

weak

14

Blaming yourself

0,302

0,01

positive

weak

*Spearman’s correlation coefficient (p<0,05);

Table 15. The influence of depersonalization on strategies of coping with stress.

Strategies of coping with stress (mini-COPE subscale)

Correlation coefficenct

Correlation with depersonalization

P*

Direction of dependence

Strenght of dependence

1

Active action

0,112

0,352

2

Planning

0,13

0,28

3

Positive revaluation

0,02

0,868

4

Acceptance

0,019

0,873

5

Sense of humor

0,082

0,498

6

Turn to religion

0,248

0,037

positive

very weak

7

Looking for emotional support

-0,009

0,941

8

Looking for instrumental support

-0,025

0,835

9

Doing something else

-0,015

0,902

10

Denial

0,075

0,536

11

Abreaction

0,354

0,002

positive

weak

12

Use of psychoactive substance

0,124

0,302

13

No action

0,241

0,043

positive

very weak

14

Blaming yourself

0,263

0,027

positive

very weak

*Spearman’s correlation coefficient (p<0,05);

Table 16. The influence of reduced personal accomplishment on strategies of coping with stress.

Strategies of coping with stress (mini-COPE subscale)

Correlation coefficenct

Correlation with personal accomplishment

P*

Direction of dependence

Strenght of dependence

1

Active action

-0,242

0,042

negative

very weak

2

Planning

-0,283

0,017

negative

very weak

3

Positive revaluation

-0,278

0,019

negative

very weak

4

Acceptance

-0,257

0,031

negative

very weak

5

Sense of humor

-0,115

0,338

6

Turn to religion

0,119

0,324

7

Looking for emotional support

-0,115

0,339

8

Looking for instrumental support

-0,152

0,207

9

Doing something else

-0,17

0,155

10

Denial

0,041

0,732

11

Abreaction

-0,01

0,932

12

Use of psychoactive substance

0,245

0,04

positive

very weak

13

No action

0,309

0,009

positive

weak

14

Blaming yourself

0,212

0,075

*Spearman’s correlation coefficient (p<0,05);

Fig 1. The impact of the place of responders’ residence on the risk of burnout.

Fig. 2. The influence of general indicator of occupational burnout on strategies of coping with stress.

Fig. 3. The influence of emotional exhaustion on strategies of coping with stress.

Fig. 4. The influence of depersonalization on strategies of coping with stress.

Fig. 5. The influence of reduced personal accomplishment on strategies of coping with stress.