The effect of profession on burnout in hospital staff

The effect of profession on burnout in hospital staff Abstract Background A high level of burnout has been described in health professionals. However, literature regarding other hospital employees is scarce. Aims To assess the prevalence of burnout in different professional groups of hospital staff and how the professional category is associated with levels of burnout. Methods Employees of a University Hospital in Portugal completed a self-administered online questionnaire in 2014–2015. We used the Portuguese version of the Maslach Burnout Inventory—Human Services Survey and scored three dimensions of burnout (emotional exhaustion, depersonalization, personal accomplishment) as low, average or high. We estimated odds ratios (OR) and 95% confidence intervals (95% CI) by logistic regression, adjusting for age, sex, use of anxiolytic/antidepressant drugs and job satisfaction. Results There was a 10% response rate; 368 questionnaires were available for analysis. High levels of burnout due to emotional exhaustion were observed in all professional categories. Nurses, administrative staff and technicians more frequently scored higher levels of emotional exhaustion (59%, 50% and 50%, respectively) and lack of personal accomplishment (41%, 52% and 38%, respectively) than physicians and healthcare assistants. Not all professionals scored highly for depersonalization. Emotional exhaustion scores were significantly lower in healthcare assistants than nurses (adjusted OR 0.26, 95% CI 0.10–0.64). Conclusions Burnout affects all professional categories of hospital staff. Future studies should use larger, more representative samples of hospital staff, perform longitudinal analyses and analyse data on specifics of each professional category and other potential confounders. Burnout, hospital setting, professional category Introduction Burnout is a major challenge to workers’ psychological and physical health and organizational functioning and effectiveness [1]. Moreover, healthcare workers need to be empathetic towards patients’ anxiety and pain [2]. During the last decade, we have witnessed a dehumanization of organizations due to an economic focus that, along with poorer work conditions, increased the discrepancy between job demands and work resources, which can lead to burnout [3]. Despite growing interest in the impact of burnout in health professionals [4], literature regarding other hospital employees is scarce. This study aimed to fill this gap by assessing the prevalence of burnout in hospital employees and the association between professional category and burnout levels. Methods Between December 2014 and April 2015, we asked employees of a university general hospital in Porto, Portugal, to complete a questionnaire on the hospital intranet. We used structured questionnaires to collect socio-demographic data, work-related characteristics and participants’ use of anxiolytic/antidepressant drugs in the last 6 months. We assessed burnout using the Portuguese translation of the Maslach Burnout Inventory – Human Services Survey (MBI-HSS) [5]. This comprises 22 items about attitudes and emotions experienced by professionals in their workplace, on three subscales: emotional exhaustion (nine items), depersonalization (five items) and personal accomplishment (eight items). We categorized scores for each subscale into low, average and high risk [6]. We performed statistical analysis using Stata 11.0 (College Station, TX, 2009). We analysed sample characteristics as counts and proportions. We fitted logistic regression models for each dimension and computed crude and adjusted odds ratios (OR) and the respective 95% confidence intervals (95% CI) for the association between professional category and high (versus low and average) levels of burnout. Results Of the 5644 members of hospital staff, 557 (10%) completed the questionnaire. Our sample comprised a higher proportion of nurses (51% versus 35%) and administrative staff (25% versus 9%) than the hospital workforce, while healthcare assistants (11% versus 19%) and physicians (14% versus 28%) were under-represented. After excluding those with missing burnout values (n = 186) and professional categories (n = 3), our final sample comprised 368 participants. One hundred and eighty-seven (51%) participants were nurses, of whom 159 (85%) were female. Healthcare assistants were the professional group with the highest proportion (67%) of participants aged over 40 years. Nurses and healthcare assistants more frequently reported working shifts (75% and 60%, respectively), while 68% of physicians reported working more than 40 h/week. Physicians and healthcare assistants reported less frequently considering changing jobs and workplace in the month prior to data collection. Thirty-five per cent of respondents reported using anxiolytic or antidepressant drugs in the previous 6 months (Table 1). Table 1. Participants’ sociodemographic and work-related characteristics according to professional category   Professional categorya    Health care assistants, n (%)  Nurses, n (%)  Technicians, n (%)  Administrative staff, n (%)  Physicians, n (%)  Overall  40  (11)  187  (51)  34  (9)  54  (15)  53  (14)  Sex   Female  34  (85)  159  (85)  28  (82)  43  (80)  31  (59)   Male  6  (15)  28  (15)  6  (18)  11  (20)  22  (41)  Age (years)   ≤40  12  (33)  113  (61)  24  (73)  32  (60)  26  (49)   >40  24  (67)  71  (39)  9  (27)  21  (40)  27  (51)  Marital statusb   With a partner  24  (62)  127  (68)  19  (56)  41  (76)  28  (54)   Without a partner  15  (38)  60  (32)  15  (44)  13  (24)  24  (46)  Type of contractc   Government employees  18  (49)  111  (60)  13  (38)  18  (34)  32  (65)   Others  19  (51)  73  (40)  21  (62)  35  (66)  17  (35)  Scheduled   Fixed  16  (40)  46  (25)  19  (56)  45  (83)  24  (47)   Shifts  24  (60)  139  (75)  15  (44)  9  (17)  27  (53)  Hours of work per week   ≤40  31  (94)  145  (83)  29  (85)  47  (92)  16  (32)   >40  2  (6)  29  (17)  5  (15)  4  (8)  34  (68)  Job satisfaction   Completely/very dissatisfied  3  (8)  48  (26)  5  (15)  13  (25)  8  (15)   Dissatisfied  16  (40)  70  (38)  15  (45)  14  (26)  19  (36)   Satisfied  19  (47)  61  (33)  12  (36)  24  (45)  24  (45)   Completely/very satisfied  2  (5)  7  (4)  1  (3)  2  (4)  2  (4)  Considered changing jobs (last month), yes  11  (31)  111  (63)  21  (66)  28  (61)  19  (37)  Considered changing workplace (last month), yes  8  (27)  84  (52)  16  (57)  31  (69)  20  (40)  Anxiolytic/antidepressant drugs (last 6 months), yes  17  (44)  58  (31)  13  (38)  24  (4)  18  (34)  Burnout dimensionse   Emotional exhaustion    High  13  (32)  110  (59)  17  (50)  27  (50)  20  (38)    Average  14  (35)  39  (21)  8  (24)  18  (33)  15  (28)    Low  13  (33)  38  (20)  9  (26)  9  (17)  18  (34)   Depersonalization    High  4  (10)  32  (17)  6  (18)  4  (7)  10  (19)    Average  7  (18)  51  (27)  10  (29)  14  (26)  9  (17)    Low  29  (72)  104  (56)  18  (53)  36  (67)  34  (64)   Personal accomplishment    High  12  (30)  76  (41)  13  (38)  28  (52)  15  (28)    Average  8  (20)  58  (31)  15  (44)  12  (22)  20  (38)    Low  20  (50)  53  (28)  6  (18)  14  (26)  18  (34)    Professional categorya    Health care assistants, n (%)  Nurses, n (%)  Technicians, n (%)  Administrative staff, n (%)  Physicians, n (%)  Overall  40  (11)  187  (51)  34  (9)  54  (15)  53  (14)  Sex   Female  34  (85)  159  (85)  28  (82)  43  (80)  31  (59)   Male  6  (15)  28  (15)  6  (18)  11  (20)  22  (41)  Age (years)   ≤40  12  (33)  113  (61)  24  (73)  32  (60)  26  (49)   >40  24  (67)  71  (39)  9  (27)  21  (40)  27  (51)  Marital statusb   With a partner  24  (62)  127  (68)  19  (56)  41  (76)  28  (54)   Without a partner  15  (38)  60  (32)  15  (44)  13  (24)  24  (46)  Type of contractc   Government employees  18  (49)  111  (60)  13  (38)  18  (34)  32  (65)   Others  19  (51)  73  (40)  21  (62)  35  (66)  17  (35)  Scheduled   Fixed  16  (40)  46  (25)  19  (56)  45  (83)  24  (47)   Shifts  24  (60)  139  (75)  15  (44)  9  (17)  27  (53)  Hours of work per week   ≤40  31  (94)  145  (83)  29  (85)  47  (92)  16  (32)   >40  2  (6)  29  (17)  5  (15)  4  (8)  34  (68)  Job satisfaction   Completely/very dissatisfied  3  (8)  48  (26)  5  (15)  13  (25)  8  (15)   Dissatisfied  16  (40)  70  (38)  15  (45)  14  (26)  19  (36)   Satisfied  19  (47)  61  (33)  12  (36)  24  (45)  24  (45)   Completely/very satisfied  2  (5)  7  (4)  1  (3)  2  (4)  2  (4)  Considered changing jobs (last month), yes  11  (31)  111  (63)  21  (66)  28  (61)  19  (37)  Considered changing workplace (last month), yes  8  (27)  84  (52)  16  (57)  31  (69)  20  (40)  Anxiolytic/antidepressant drugs (last 6 months), yes  17  (44)  58  (31)  13  (38)  24  (4)  18  (34)  Burnout dimensionse   Emotional exhaustion    High  13  (32)  110  (59)  17  (50)  27  (50)  20  (38)    Average  14  (35)  39  (21)  8  (24)  18  (33)  15  (28)    Low  13  (33)  38  (20)  9  (26)  9  (17)  18  (34)   Depersonalization    High  4  (10)  32  (17)  6  (18)  4  (7)  10  (19)    Average  7  (18)  51  (27)  10  (29)  14  (26)  9  (17)    Low  29  (72)  104  (56)  18  (53)  36  (67)  34  (64)   Personal accomplishment    High  12  (30)  76  (41)  13  (38)  28  (52)  15  (28)    Average  8  (20)  58  (31)  15  (44)  12  (22)  20  (38)    Low  20  (50)  53  (28)  6  (18)  14  (26)  18  (34)  In some variables, the total may not be what is expected due to missing data. aHealthcare assistants include those who assist patients with personal and therapeutic care needs such as personal hygiene, feeding, dressing, physical mobility; technicians include psychologists, diagnostic and therapeutic technicians and other allied health professionals; and administrative staff include managers who plan, direct, coordinate and evaluate provision and operations of clinical services. bWith a partner includes married or living together; not partnered includes separated, divorced, widowed or single participants. cOther than governmental job work contract includes employment contracts with open-ended and fixed-term contracts. dShifts include nights or not. eAnswers were collected using a seven-point Likert scale ranging from “never” to “every day” and were added to create a score for each burnout dimension. We categorized each dimension score into low (emotional exhaustion ≤ 16, depersonalization ≤ 6 and personal accomplishment ≥ 39), average (emotional exhaustion between 17 and 26, depersonalization between 7 and 12 and personal accomplishment between 32 and 38) and high (emotional exhaustion ≥ 27, depersonalization ≥ 13 and personal accomplishment ≤ 31) [6]. View Large Table 1. Participants’ sociodemographic and work-related characteristics according to professional category   Professional categorya    Health care assistants, n (%)  Nurses, n (%)  Technicians, n (%)  Administrative staff, n (%)  Physicians, n (%)  Overall  40  (11)  187  (51)  34  (9)  54  (15)  53  (14)  Sex   Female  34  (85)  159  (85)  28  (82)  43  (80)  31  (59)   Male  6  (15)  28  (15)  6  (18)  11  (20)  22  (41)  Age (years)   ≤40  12  (33)  113  (61)  24  (73)  32  (60)  26  (49)   >40  24  (67)  71  (39)  9  (27)  21  (40)  27  (51)  Marital statusb   With a partner  24  (62)  127  (68)  19  (56)  41  (76)  28  (54)   Without a partner  15  (38)  60  (32)  15  (44)  13  (24)  24  (46)  Type of contractc   Government employees  18  (49)  111  (60)  13  (38)  18  (34)  32  (65)   Others  19  (51)  73  (40)  21  (62)  35  (66)  17  (35)  Scheduled   Fixed  16  (40)  46  (25)  19  (56)  45  (83)  24  (47)   Shifts  24  (60)  139  (75)  15  (44)  9  (17)  27  (53)  Hours of work per week   ≤40  31  (94)  145  (83)  29  (85)  47  (92)  16  (32)   >40  2  (6)  29  (17)  5  (15)  4  (8)  34  (68)  Job satisfaction   Completely/very dissatisfied  3  (8)  48  (26)  5  (15)  13  (25)  8  (15)   Dissatisfied  16  (40)  70  (38)  15  (45)  14  (26)  19  (36)   Satisfied  19  (47)  61  (33)  12  (36)  24  (45)  24  (45)   Completely/very satisfied  2  (5)  7  (4)  1  (3)  2  (4)  2  (4)  Considered changing jobs (last month), yes  11  (31)  111  (63)  21  (66)  28  (61)  19  (37)  Considered changing workplace (last month), yes  8  (27)  84  (52)  16  (57)  31  (69)  20  (40)  Anxiolytic/antidepressant drugs (last 6 months), yes  17  (44)  58  (31)  13  (38)  24  (4)  18  (34)  Burnout dimensionse   Emotional exhaustion    High  13  (32)  110  (59)  17  (50)  27  (50)  20  (38)    Average  14  (35)  39  (21)  8  (24)  18  (33)  15  (28)    Low  13  (33)  38  (20)  9  (26)  9  (17)  18  (34)   Depersonalization    High  4  (10)  32  (17)  6  (18)  4  (7)  10  (19)    Average  7  (18)  51  (27)  10  (29)  14  (26)  9  (17)    Low  29  (72)  104  (56)  18  (53)  36  (67)  34  (64)   Personal accomplishment    High  12  (30)  76  (41)  13  (38)  28  (52)  15  (28)    Average  8  (20)  58  (31)  15  (44)  12  (22)  20  (38)    Low  20  (50)  53  (28)  6  (18)  14  (26)  18  (34)    Professional categorya    Health care assistants, n (%)  Nurses, n (%)  Technicians, n (%)  Administrative staff, n (%)  Physicians, n (%)  Overall  40  (11)  187  (51)  34  (9)  54  (15)  53  (14)  Sex   Female  34  (85)  159  (85)  28  (82)  43  (80)  31  (59)   Male  6  (15)  28  (15)  6  (18)  11  (20)  22  (41)  Age (years)   ≤40  12  (33)  113  (61)  24  (73)  32  (60)  26  (49)   >40  24  (67)  71  (39)  9  (27)  21  (40)  27  (51)  Marital statusb   With a partner  24  (62)  127  (68)  19  (56)  41  (76)  28  (54)   Without a partner  15  (38)  60  (32)  15  (44)  13  (24)  24  (46)  Type of contractc   Government employees  18  (49)  111  (60)  13  (38)  18  (34)  32  (65)   Others  19  (51)  73  (40)  21  (62)  35  (66)  17  (35)  Scheduled   Fixed  16  (40)  46  (25)  19  (56)  45  (83)  24  (47)   Shifts  24  (60)  139  (75)  15  (44)  9  (17)  27  (53)  Hours of work per week   ≤40  31  (94)  145  (83)  29  (85)  47  (92)  16  (32)   >40  2  (6)  29  (17)  5  (15)  4  (8)  34  (68)  Job satisfaction   Completely/very dissatisfied  3  (8)  48  (26)  5  (15)  13  (25)  8  (15)   Dissatisfied  16  (40)  70  (38)  15  (45)  14  (26)  19  (36)   Satisfied  19  (47)  61  (33)  12  (36)  24  (45)  24  (45)   Completely/very satisfied  2  (5)  7  (4)  1  (3)  2  (4)  2  (4)  Considered changing jobs (last month), yes  11  (31)  111  (63)  21  (66)  28  (61)  19  (37)  Considered changing workplace (last month), yes  8  (27)  84  (52)  16  (57)  31  (69)  20  (40)  Anxiolytic/antidepressant drugs (last 6 months), yes  17  (44)  58  (31)  13  (38)  24  (4)  18  (34)  Burnout dimensionse   Emotional exhaustion    High  13  (32)  110  (59)  17  (50)  27  (50)  20  (38)    Average  14  (35)  39  (21)  8  (24)  18  (33)  15  (28)    Low  13  (33)  38  (20)  9  (26)  9  (17)  18  (34)   Depersonalization    High  4  (10)  32  (17)  6  (18)  4  (7)  10  (19)    Average  7  (18)  51  (27)  10  (29)  14  (26)  9  (17)    Low  29  (72)  104  (56)  18  (53)  36  (67)  34  (64)   Personal accomplishment    High  12  (30)  76  (41)  13  (38)  28  (52)  15  (28)    Average  8  (20)  58  (31)  15  (44)  12  (22)  20  (38)    Low  20  (50)  53  (28)  6  (18)  14  (26)  18  (34)  In some variables, the total may not be what is expected due to missing data. aHealthcare assistants include those who assist patients with personal and therapeutic care needs such as personal hygiene, feeding, dressing, physical mobility; technicians include psychologists, diagnostic and therapeutic technicians and other allied health professionals; and administrative staff include managers who plan, direct, coordinate and evaluate provision and operations of clinical services. bWith a partner includes married or living together; not partnered includes separated, divorced, widowed or single participants. cOther than governmental job work contract includes employment contracts with open-ended and fixed-term contracts. dShifts include nights or not. eAnswers were collected using a seven-point Likert scale ranging from “never” to “every day” and were added to create a score for each burnout dimension. We categorized each dimension score into low (emotional exhaustion ≤ 16, depersonalization ≤ 6 and personal accomplishment ≥ 39), average (emotional exhaustion between 17 and 26, depersonalization between 7 and 12 and personal accomplishment between 32 and 38) and high (emotional exhaustion ≥ 27, depersonalization ≥ 13 and personal accomplishment ≤ 31) [6]. View Large Nurses, technicians and administrative staff more frequently scored high levels of burnout due to emotional exhaustion (59%, 50% and 50%, respectively) and due to lack of personal accomplishment (41%, 38% and 52%, respectively). Sixty per cent of all participants scored low levels of burnout due to depersonalization (Table 1). After adjustment for sex, age, job satisfaction and use of anxiolytic/antidepressant drugs, there was a significant association between professional category and high burnout levels. Healthcare assistants were less likely than nurses, to score high levels of burnout due to emotional exhaustion (adjusted OR 0.26, 95% CI 0.10–0.64). There were no statistically significant differences in other domains, according to professional category (Table 2). Table 2. Crude and adjusted OR for the association between professional category and high burnout levels (emotional exhaustion, depersonalization and lack of personal accomplishment)   High burnout levelsa    Emotional exhaustion  Depersonalization  Personal accomplishment    Crude OR (95% CI)  Adjusted OR (95% CI)b  Crude OR (95% CI)  Adjusted OR (95% CI)b  Crude OR (95% CI)  Adjusted OR (95% CI)b  Nurses  1    1    1    1    1    1    Healthcare assistants  0.34  (0.16–0.69)  0.26  (0.10–0.64)  0.54  (0.18–1.62)  0.99  (0.29–3.36)  0.63  (0.30–1.30)  0.93  (0.38–2.05)  Technicians  0.70  (0.34–1.46)  0.55  (0.23–1.31)  1.04  (0.40–2.71)  0.84  (0.28–2.53)  0.90  (0.43–1.91)  0.83  (0.38–1.84)  Administrative staff  0.70  (0.38–1.29)  0.68  (0.33–1.41)  0.39  (0.13–1.15)  0.32  (0.10–1.04)  1.57  (0.86–2.89)  1.52  (0.80–2.89)  Physicians  0.42  (0.23–0.79)  0.52  (0.25–1.11)  1.13  (0.51–2.47)  1.42  (0.57–3.54)  0.58  (0.30–1.12)  0.67  (0.33–1.36)    High burnout levelsa    Emotional exhaustion  Depersonalization  Personal accomplishment    Crude OR (95% CI)  Adjusted OR (95% CI)b  Crude OR (95% CI)  Adjusted OR (95% CI)b  Crude OR (95% CI)  Adjusted OR (95% CI)b  Nurses  1    1    1    1    1    1    Healthcare assistants  0.34  (0.16–0.69)  0.26  (0.10–0.64)  0.54  (0.18–1.62)  0.99  (0.29–3.36)  0.63  (0.30–1.30)  0.93  (0.38–2.05)  Technicians  0.70  (0.34–1.46)  0.55  (0.23–1.31)  1.04  (0.40–2.71)  0.84  (0.28–2.53)  0.90  (0.43–1.91)  0.83  (0.38–1.84)  Administrative staff  0.70  (0.38–1.29)  0.68  (0.33–1.41)  0.39  (0.13–1.15)  0.32  (0.10–1.04)  1.57  (0.86–2.89)  1.52  (0.80–2.89)  Physicians  0.42  (0.23–0.79)  0.52  (0.25–1.11)  1.13  (0.51–2.47)  1.42  (0.57–3.54)  0.58  (0.30–1.12)  0.67  (0.33–1.36)  aVersus low and average levels. bAdjusted for sex, age, use of anxiolytic/antidepressant drugs and job satisfaction. Due to possible collinearity, the final model was not adjusted for considered changing job and considered changing workplace, assuming that these variables may represent a proxy for job satisfaction. View Large Table 2. Crude and adjusted OR for the association between professional category and high burnout levels (emotional exhaustion, depersonalization and lack of personal accomplishment)   High burnout levelsa    Emotional exhaustion  Depersonalization  Personal accomplishment    Crude OR (95% CI)  Adjusted OR (95% CI)b  Crude OR (95% CI)  Adjusted OR (95% CI)b  Crude OR (95% CI)  Adjusted OR (95% CI)b  Nurses  1    1    1    1    1    1    Healthcare assistants  0.34  (0.16–0.69)  0.26  (0.10–0.64)  0.54  (0.18–1.62)  0.99  (0.29–3.36)  0.63  (0.30–1.30)  0.93  (0.38–2.05)  Technicians  0.70  (0.34–1.46)  0.55  (0.23–1.31)  1.04  (0.40–2.71)  0.84  (0.28–2.53)  0.90  (0.43–1.91)  0.83  (0.38–1.84)  Administrative staff  0.70  (0.38–1.29)  0.68  (0.33–1.41)  0.39  (0.13–1.15)  0.32  (0.10–1.04)  1.57  (0.86–2.89)  1.52  (0.80–2.89)  Physicians  0.42  (0.23–0.79)  0.52  (0.25–1.11)  1.13  (0.51–2.47)  1.42  (0.57–3.54)  0.58  (0.30–1.12)  0.67  (0.33–1.36)    High burnout levelsa    Emotional exhaustion  Depersonalization  Personal accomplishment    Crude OR (95% CI)  Adjusted OR (95% CI)b  Crude OR (95% CI)  Adjusted OR (95% CI)b  Crude OR (95% CI)  Adjusted OR (95% CI)b  Nurses  1    1    1    1    1    1    Healthcare assistants  0.34  (0.16–0.69)  0.26  (0.10–0.64)  0.54  (0.18–1.62)  0.99  (0.29–3.36)  0.63  (0.30–1.30)  0.93  (0.38–2.05)  Technicians  0.70  (0.34–1.46)  0.55  (0.23–1.31)  1.04  (0.40–2.71)  0.84  (0.28–2.53)  0.90  (0.43–1.91)  0.83  (0.38–1.84)  Administrative staff  0.70  (0.38–1.29)  0.68  (0.33–1.41)  0.39  (0.13–1.15)  0.32  (0.10–1.04)  1.57  (0.86–2.89)  1.52  (0.80–2.89)  Physicians  0.42  (0.23–0.79)  0.52  (0.25–1.11)  1.13  (0.51–2.47)  1.42  (0.57–3.54)  0.58  (0.30–1.12)  0.67  (0.33–1.36)  aVersus low and average levels. bAdjusted for sex, age, use of anxiolytic/antidepressant drugs and job satisfaction. Due to possible collinearity, the final model was not adjusted for considered changing job and considered changing workplace, assuming that these variables may represent a proxy for job satisfaction. View Large Discussion We observed high levels of burnout, mainly due to emotional exhaustion, in all professional categories of hospital employees. Healthcare assistants were less likely than nurses to score highly for burnout due to emotional exhaustion. To the best of our knowledge, this is the only Portuguese study of an entire hospital workforce. However, the small numbers, low response rate and over-/under-representation of some professional categories limit generalization of our findings. In our study, nurses scored high levels of burnout in all dimensions, which is consistent with previous research reporting prevalence estimates in nurses above 50% [3,7]. Administrative staff and technicians also scored highly for burnout, mainly due to emotional exhaustion and lack of personal accomplishment. A recent study also reported high risks of work-related burnout in different hospital staff, with prevalences above 60% in nurses and physician assistants and between 30% and 40% in physicians, administrative staff and medical technicians [7]. In this study, administrative staff had similar levels of burnout to healthcare professionals, suggesting that administrative staff may also be a high-risk group for burnout. Emotional exhaustion has been reported as the most prevalent dimension of burnout [8]. Our study adds that this applies to all employees in the hospital setting. It has been proposed that emotional exhaustion may be considered the first phase of burnout, which can lead to depersonalization and reduced personal accomplishment [9]. Although our study cannot confirm this assumption, the higher prevalence of emotional exhaustion observed supports this hypothesis. Future studies should use larger and more representative samples of entire hospital workforces and perform longitudinal analyses to clarify the existence of sequential stages in burnout. Different strategies to increase participation should be considered, such as face-to-face interviews to achieve higher response rates [7,10]. Also, data on the specifics of each professional category and other factors that could mediate the association between professional category and burnout, such as diet, exercise and painkiller use, should be analysed. Key points We observed high levels of burnout due to emotional exhaustion in all professional categories of a hospital workforce. Healthcare assistants scored lower levels of burnout due to emotional exhaustion than nurses, independently of their job satisfaction, intention of changing jobs or workplace and the use of anxiolytic/antidepressant drugs. Future studies should use larger and more representative samples of hospital staff, perform longitudinal analyses and collect data on other potential confounders, taking into account the specifics of each professional category. Funding This study was institutional and realized under the coordination of the Occupational Health Department of the Centro Hospitalar de São João. It was funded by FEDER through the Operational Programme Competitiveness and Internationalization and national funding from the Foundation for Science and Technology—FCT (Portuguese Ministry of Science, Technology and Higher Education), under the Unidade de Investigação em Epidemiologia—Instituto de Saúde Pública da Universidade do Porto (EPIUnit) (POCI-01-0145-FEDER-006862; Ref. UID/DTP/04750/2013) and also by a Postdoc Grant (SFRH/BPD/103562/2014), co-funded by the FCT and the POPH/FSE Program. Acknowledgement We thank all participants for their collaboration in the study. Competing interests None declared. References 1. Carod-Artal F, Vázquez-Cabrera C. Burnout syndrome in an international setting. In: Bährer-Kohler S, ed. Burnout for Experts: Prevention in the Context of Living and Working . Boston, MA: Springer US, 2013; 15– 35. Google Scholar CrossRef Search ADS   2. Consiglio C. Interpersonal strain at work: a new burnout facet relevant for the health of hospital staff. Burnout Res  2014; 1: 69– 75. Google Scholar CrossRef Search ADS   3. Galletta M, Portoghese I, Ciuffi M, Sancassiani F, Aloja E, Campagna M. Working and environmental factors on job burnout: a cross-sectional study among nurses. Clin Pract Epidemiol Ment Health  2016; 12: 132– 141. Google Scholar CrossRef Search ADS PubMed  4. Rothenberger DA. Physician burnout and well-being: a systematic review and framework for action. Dis Colon Rectum  2017; 60: 567– 576. Google Scholar CrossRef Search ADS PubMed  5. Maslach C, Jackson S. MBI-Human Services Survey. http://www.mindgarden.com/products/mbi.htm ( 4 January 2018, date last accessed). 6. Maslach C, Jackson SE, Leiter MP. Maslach Burnout Inventory . Palo Alto, CA: Consulting Psychologists Press, 1986. 7. Chou LP, Li CY, Hu SC. Job stress and burnout in hospital employees: comparisons of different medical professions in a regional hospital in Taiwan. BMJ Open  2014; 4: e004185. Google Scholar CrossRef Search ADS PubMed  8. Gomez-Urquiza JL, Monsalve-Reyes CS, San Luis-Costas C, Fernandez-Castillo R, Aguayo-Estremera R, Canadas-de la Fuente GA. Risk factors and burnout levels in primary care nurses: a systematic review. Aten Primaria  2017;49:77–85. 9. Leiter MP, Maslach C. The impact of interpersonal environment on burnout and organizational commitment. J Organ Behav  1988; 9: 297– 308. Google Scholar CrossRef Search ADS   10. Gorgulu O, Akilli A. The determination of the levels of burnout syndrome, organizational commitment, and job satisfaction of the health workers. Niger J Clin Pract  2017; 20: 48– 56. Google Scholar CrossRef Search ADS PubMed  © The Author(s) 2018. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices) http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Occupational Medicine Oxford University Press

The effect of profession on burnout in hospital staff

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Oxford University Press
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© The Author(s) 2018. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com
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0962-7480
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1471-8405
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10.1093/occmed/kqy039
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Abstract

Abstract Background A high level of burnout has been described in health professionals. However, literature regarding other hospital employees is scarce. Aims To assess the prevalence of burnout in different professional groups of hospital staff and how the professional category is associated with levels of burnout. Methods Employees of a University Hospital in Portugal completed a self-administered online questionnaire in 2014–2015. We used the Portuguese version of the Maslach Burnout Inventory—Human Services Survey and scored three dimensions of burnout (emotional exhaustion, depersonalization, personal accomplishment) as low, average or high. We estimated odds ratios (OR) and 95% confidence intervals (95% CI) by logistic regression, adjusting for age, sex, use of anxiolytic/antidepressant drugs and job satisfaction. Results There was a 10% response rate; 368 questionnaires were available for analysis. High levels of burnout due to emotional exhaustion were observed in all professional categories. Nurses, administrative staff and technicians more frequently scored higher levels of emotional exhaustion (59%, 50% and 50%, respectively) and lack of personal accomplishment (41%, 52% and 38%, respectively) than physicians and healthcare assistants. Not all professionals scored highly for depersonalization. Emotional exhaustion scores were significantly lower in healthcare assistants than nurses (adjusted OR 0.26, 95% CI 0.10–0.64). Conclusions Burnout affects all professional categories of hospital staff. Future studies should use larger, more representative samples of hospital staff, perform longitudinal analyses and analyse data on specifics of each professional category and other potential confounders. Burnout, hospital setting, professional category Introduction Burnout is a major challenge to workers’ psychological and physical health and organizational functioning and effectiveness [1]. Moreover, healthcare workers need to be empathetic towards patients’ anxiety and pain [2]. During the last decade, we have witnessed a dehumanization of organizations due to an economic focus that, along with poorer work conditions, increased the discrepancy between job demands and work resources, which can lead to burnout [3]. Despite growing interest in the impact of burnout in health professionals [4], literature regarding other hospital employees is scarce. This study aimed to fill this gap by assessing the prevalence of burnout in hospital employees and the association between professional category and burnout levels. Methods Between December 2014 and April 2015, we asked employees of a university general hospital in Porto, Portugal, to complete a questionnaire on the hospital intranet. We used structured questionnaires to collect socio-demographic data, work-related characteristics and participants’ use of anxiolytic/antidepressant drugs in the last 6 months. We assessed burnout using the Portuguese translation of the Maslach Burnout Inventory – Human Services Survey (MBI-HSS) [5]. This comprises 22 items about attitudes and emotions experienced by professionals in their workplace, on three subscales: emotional exhaustion (nine items), depersonalization (five items) and personal accomplishment (eight items). We categorized scores for each subscale into low, average and high risk [6]. We performed statistical analysis using Stata 11.0 (College Station, TX, 2009). We analysed sample characteristics as counts and proportions. We fitted logistic regression models for each dimension and computed crude and adjusted odds ratios (OR) and the respective 95% confidence intervals (95% CI) for the association between professional category and high (versus low and average) levels of burnout. Results Of the 5644 members of hospital staff, 557 (10%) completed the questionnaire. Our sample comprised a higher proportion of nurses (51% versus 35%) and administrative staff (25% versus 9%) than the hospital workforce, while healthcare assistants (11% versus 19%) and physicians (14% versus 28%) were under-represented. After excluding those with missing burnout values (n = 186) and professional categories (n = 3), our final sample comprised 368 participants. One hundred and eighty-seven (51%) participants were nurses, of whom 159 (85%) were female. Healthcare assistants were the professional group with the highest proportion (67%) of participants aged over 40 years. Nurses and healthcare assistants more frequently reported working shifts (75% and 60%, respectively), while 68% of physicians reported working more than 40 h/week. Physicians and healthcare assistants reported less frequently considering changing jobs and workplace in the month prior to data collection. Thirty-five per cent of respondents reported using anxiolytic or antidepressant drugs in the previous 6 months (Table 1). Table 1. Participants’ sociodemographic and work-related characteristics according to professional category   Professional categorya    Health care assistants, n (%)  Nurses, n (%)  Technicians, n (%)  Administrative staff, n (%)  Physicians, n (%)  Overall  40  (11)  187  (51)  34  (9)  54  (15)  53  (14)  Sex   Female  34  (85)  159  (85)  28  (82)  43  (80)  31  (59)   Male  6  (15)  28  (15)  6  (18)  11  (20)  22  (41)  Age (years)   ≤40  12  (33)  113  (61)  24  (73)  32  (60)  26  (49)   >40  24  (67)  71  (39)  9  (27)  21  (40)  27  (51)  Marital statusb   With a partner  24  (62)  127  (68)  19  (56)  41  (76)  28  (54)   Without a partner  15  (38)  60  (32)  15  (44)  13  (24)  24  (46)  Type of contractc   Government employees  18  (49)  111  (60)  13  (38)  18  (34)  32  (65)   Others  19  (51)  73  (40)  21  (62)  35  (66)  17  (35)  Scheduled   Fixed  16  (40)  46  (25)  19  (56)  45  (83)  24  (47)   Shifts  24  (60)  139  (75)  15  (44)  9  (17)  27  (53)  Hours of work per week   ≤40  31  (94)  145  (83)  29  (85)  47  (92)  16  (32)   >40  2  (6)  29  (17)  5  (15)  4  (8)  34  (68)  Job satisfaction   Completely/very dissatisfied  3  (8)  48  (26)  5  (15)  13  (25)  8  (15)   Dissatisfied  16  (40)  70  (38)  15  (45)  14  (26)  19  (36)   Satisfied  19  (47)  61  (33)  12  (36)  24  (45)  24  (45)   Completely/very satisfied  2  (5)  7  (4)  1  (3)  2  (4)  2  (4)  Considered changing jobs (last month), yes  11  (31)  111  (63)  21  (66)  28  (61)  19  (37)  Considered changing workplace (last month), yes  8  (27)  84  (52)  16  (57)  31  (69)  20  (40)  Anxiolytic/antidepressant drugs (last 6 months), yes  17  (44)  58  (31)  13  (38)  24  (4)  18  (34)  Burnout dimensionse   Emotional exhaustion    High  13  (32)  110  (59)  17  (50)  27  (50)  20  (38)    Average  14  (35)  39  (21)  8  (24)  18  (33)  15  (28)    Low  13  (33)  38  (20)  9  (26)  9  (17)  18  (34)   Depersonalization    High  4  (10)  32  (17)  6  (18)  4  (7)  10  (19)    Average  7  (18)  51  (27)  10  (29)  14  (26)  9  (17)    Low  29  (72)  104  (56)  18  (53)  36  (67)  34  (64)   Personal accomplishment    High  12  (30)  76  (41)  13  (38)  28  (52)  15  (28)    Average  8  (20)  58  (31)  15  (44)  12  (22)  20  (38)    Low  20  (50)  53  (28)  6  (18)  14  (26)  18  (34)    Professional categorya    Health care assistants, n (%)  Nurses, n (%)  Technicians, n (%)  Administrative staff, n (%)  Physicians, n (%)  Overall  40  (11)  187  (51)  34  (9)  54  (15)  53  (14)  Sex   Female  34  (85)  159  (85)  28  (82)  43  (80)  31  (59)   Male  6  (15)  28  (15)  6  (18)  11  (20)  22  (41)  Age (years)   ≤40  12  (33)  113  (61)  24  (73)  32  (60)  26  (49)   >40  24  (67)  71  (39)  9  (27)  21  (40)  27  (51)  Marital statusb   With a partner  24  (62)  127  (68)  19  (56)  41  (76)  28  (54)   Without a partner  15  (38)  60  (32)  15  (44)  13  (24)  24  (46)  Type of contractc   Government employees  18  (49)  111  (60)  13  (38)  18  (34)  32  (65)   Others  19  (51)  73  (40)  21  (62)  35  (66)  17  (35)  Scheduled   Fixed  16  (40)  46  (25)  19  (56)  45  (83)  24  (47)   Shifts  24  (60)  139  (75)  15  (44)  9  (17)  27  (53)  Hours of work per week   ≤40  31  (94)  145  (83)  29  (85)  47  (92)  16  (32)   >40  2  (6)  29  (17)  5  (15)  4  (8)  34  (68)  Job satisfaction   Completely/very dissatisfied  3  (8)  48  (26)  5  (15)  13  (25)  8  (15)   Dissatisfied  16  (40)  70  (38)  15  (45)  14  (26)  19  (36)   Satisfied  19  (47)  61  (33)  12  (36)  24  (45)  24  (45)   Completely/very satisfied  2  (5)  7  (4)  1  (3)  2  (4)  2  (4)  Considered changing jobs (last month), yes  11  (31)  111  (63)  21  (66)  28  (61)  19  (37)  Considered changing workplace (last month), yes  8  (27)  84  (52)  16  (57)  31  (69)  20  (40)  Anxiolytic/antidepressant drugs (last 6 months), yes  17  (44)  58  (31)  13  (38)  24  (4)  18  (34)  Burnout dimensionse   Emotional exhaustion    High  13  (32)  110  (59)  17  (50)  27  (50)  20  (38)    Average  14  (35)  39  (21)  8  (24)  18  (33)  15  (28)    Low  13  (33)  38  (20)  9  (26)  9  (17)  18  (34)   Depersonalization    High  4  (10)  32  (17)  6  (18)  4  (7)  10  (19)    Average  7  (18)  51  (27)  10  (29)  14  (26)  9  (17)    Low  29  (72)  104  (56)  18  (53)  36  (67)  34  (64)   Personal accomplishment    High  12  (30)  76  (41)  13  (38)  28  (52)  15  (28)    Average  8  (20)  58  (31)  15  (44)  12  (22)  20  (38)    Low  20  (50)  53  (28)  6  (18)  14  (26)  18  (34)  In some variables, the total may not be what is expected due to missing data. aHealthcare assistants include those who assist patients with personal and therapeutic care needs such as personal hygiene, feeding, dressing, physical mobility; technicians include psychologists, diagnostic and therapeutic technicians and other allied health professionals; and administrative staff include managers who plan, direct, coordinate and evaluate provision and operations of clinical services. bWith a partner includes married or living together; not partnered includes separated, divorced, widowed or single participants. cOther than governmental job work contract includes employment contracts with open-ended and fixed-term contracts. dShifts include nights or not. eAnswers were collected using a seven-point Likert scale ranging from “never” to “every day” and were added to create a score for each burnout dimension. We categorized each dimension score into low (emotional exhaustion ≤ 16, depersonalization ≤ 6 and personal accomplishment ≥ 39), average (emotional exhaustion between 17 and 26, depersonalization between 7 and 12 and personal accomplishment between 32 and 38) and high (emotional exhaustion ≥ 27, depersonalization ≥ 13 and personal accomplishment ≤ 31) [6]. View Large Table 1. Participants’ sociodemographic and work-related characteristics according to professional category   Professional categorya    Health care assistants, n (%)  Nurses, n (%)  Technicians, n (%)  Administrative staff, n (%)  Physicians, n (%)  Overall  40  (11)  187  (51)  34  (9)  54  (15)  53  (14)  Sex   Female  34  (85)  159  (85)  28  (82)  43  (80)  31  (59)   Male  6  (15)  28  (15)  6  (18)  11  (20)  22  (41)  Age (years)   ≤40  12  (33)  113  (61)  24  (73)  32  (60)  26  (49)   >40  24  (67)  71  (39)  9  (27)  21  (40)  27  (51)  Marital statusb   With a partner  24  (62)  127  (68)  19  (56)  41  (76)  28  (54)   Without a partner  15  (38)  60  (32)  15  (44)  13  (24)  24  (46)  Type of contractc   Government employees  18  (49)  111  (60)  13  (38)  18  (34)  32  (65)   Others  19  (51)  73  (40)  21  (62)  35  (66)  17  (35)  Scheduled   Fixed  16  (40)  46  (25)  19  (56)  45  (83)  24  (47)   Shifts  24  (60)  139  (75)  15  (44)  9  (17)  27  (53)  Hours of work per week   ≤40  31  (94)  145  (83)  29  (85)  47  (92)  16  (32)   >40  2  (6)  29  (17)  5  (15)  4  (8)  34  (68)  Job satisfaction   Completely/very dissatisfied  3  (8)  48  (26)  5  (15)  13  (25)  8  (15)   Dissatisfied  16  (40)  70  (38)  15  (45)  14  (26)  19  (36)   Satisfied  19  (47)  61  (33)  12  (36)  24  (45)  24  (45)   Completely/very satisfied  2  (5)  7  (4)  1  (3)  2  (4)  2  (4)  Considered changing jobs (last month), yes  11  (31)  111  (63)  21  (66)  28  (61)  19  (37)  Considered changing workplace (last month), yes  8  (27)  84  (52)  16  (57)  31  (69)  20  (40)  Anxiolytic/antidepressant drugs (last 6 months), yes  17  (44)  58  (31)  13  (38)  24  (4)  18  (34)  Burnout dimensionse   Emotional exhaustion    High  13  (32)  110  (59)  17  (50)  27  (50)  20  (38)    Average  14  (35)  39  (21)  8  (24)  18  (33)  15  (28)    Low  13  (33)  38  (20)  9  (26)  9  (17)  18  (34)   Depersonalization    High  4  (10)  32  (17)  6  (18)  4  (7)  10  (19)    Average  7  (18)  51  (27)  10  (29)  14  (26)  9  (17)    Low  29  (72)  104  (56)  18  (53)  36  (67)  34  (64)   Personal accomplishment    High  12  (30)  76  (41)  13  (38)  28  (52)  15  (28)    Average  8  (20)  58  (31)  15  (44)  12  (22)  20  (38)    Low  20  (50)  53  (28)  6  (18)  14  (26)  18  (34)    Professional categorya    Health care assistants, n (%)  Nurses, n (%)  Technicians, n (%)  Administrative staff, n (%)  Physicians, n (%)  Overall  40  (11)  187  (51)  34  (9)  54  (15)  53  (14)  Sex   Female  34  (85)  159  (85)  28  (82)  43  (80)  31  (59)   Male  6  (15)  28  (15)  6  (18)  11  (20)  22  (41)  Age (years)   ≤40  12  (33)  113  (61)  24  (73)  32  (60)  26  (49)   >40  24  (67)  71  (39)  9  (27)  21  (40)  27  (51)  Marital statusb   With a partner  24  (62)  127  (68)  19  (56)  41  (76)  28  (54)   Without a partner  15  (38)  60  (32)  15  (44)  13  (24)  24  (46)  Type of contractc   Government employees  18  (49)  111  (60)  13  (38)  18  (34)  32  (65)   Others  19  (51)  73  (40)  21  (62)  35  (66)  17  (35)  Scheduled   Fixed  16  (40)  46  (25)  19  (56)  45  (83)  24  (47)   Shifts  24  (60)  139  (75)  15  (44)  9  (17)  27  (53)  Hours of work per week   ≤40  31  (94)  145  (83)  29  (85)  47  (92)  16  (32)   >40  2  (6)  29  (17)  5  (15)  4  (8)  34  (68)  Job satisfaction   Completely/very dissatisfied  3  (8)  48  (26)  5  (15)  13  (25)  8  (15)   Dissatisfied  16  (40)  70  (38)  15  (45)  14  (26)  19  (36)   Satisfied  19  (47)  61  (33)  12  (36)  24  (45)  24  (45)   Completely/very satisfied  2  (5)  7  (4)  1  (3)  2  (4)  2  (4)  Considered changing jobs (last month), yes  11  (31)  111  (63)  21  (66)  28  (61)  19  (37)  Considered changing workplace (last month), yes  8  (27)  84  (52)  16  (57)  31  (69)  20  (40)  Anxiolytic/antidepressant drugs (last 6 months), yes  17  (44)  58  (31)  13  (38)  24  (4)  18  (34)  Burnout dimensionse   Emotional exhaustion    High  13  (32)  110  (59)  17  (50)  27  (50)  20  (38)    Average  14  (35)  39  (21)  8  (24)  18  (33)  15  (28)    Low  13  (33)  38  (20)  9  (26)  9  (17)  18  (34)   Depersonalization    High  4  (10)  32  (17)  6  (18)  4  (7)  10  (19)    Average  7  (18)  51  (27)  10  (29)  14  (26)  9  (17)    Low  29  (72)  104  (56)  18  (53)  36  (67)  34  (64)   Personal accomplishment    High  12  (30)  76  (41)  13  (38)  28  (52)  15  (28)    Average  8  (20)  58  (31)  15  (44)  12  (22)  20  (38)    Low  20  (50)  53  (28)  6  (18)  14  (26)  18  (34)  In some variables, the total may not be what is expected due to missing data. aHealthcare assistants include those who assist patients with personal and therapeutic care needs such as personal hygiene, feeding, dressing, physical mobility; technicians include psychologists, diagnostic and therapeutic technicians and other allied health professionals; and administrative staff include managers who plan, direct, coordinate and evaluate provision and operations of clinical services. bWith a partner includes married or living together; not partnered includes separated, divorced, widowed or single participants. cOther than governmental job work contract includes employment contracts with open-ended and fixed-term contracts. dShifts include nights or not. eAnswers were collected using a seven-point Likert scale ranging from “never” to “every day” and were added to create a score for each burnout dimension. We categorized each dimension score into low (emotional exhaustion ≤ 16, depersonalization ≤ 6 and personal accomplishment ≥ 39), average (emotional exhaustion between 17 and 26, depersonalization between 7 and 12 and personal accomplishment between 32 and 38) and high (emotional exhaustion ≥ 27, depersonalization ≥ 13 and personal accomplishment ≤ 31) [6]. View Large Nurses, technicians and administrative staff more frequently scored high levels of burnout due to emotional exhaustion (59%, 50% and 50%, respectively) and due to lack of personal accomplishment (41%, 38% and 52%, respectively). Sixty per cent of all participants scored low levels of burnout due to depersonalization (Table 1). After adjustment for sex, age, job satisfaction and use of anxiolytic/antidepressant drugs, there was a significant association between professional category and high burnout levels. Healthcare assistants were less likely than nurses, to score high levels of burnout due to emotional exhaustion (adjusted OR 0.26, 95% CI 0.10–0.64). There were no statistically significant differences in other domains, according to professional category (Table 2). Table 2. Crude and adjusted OR for the association between professional category and high burnout levels (emotional exhaustion, depersonalization and lack of personal accomplishment)   High burnout levelsa    Emotional exhaustion  Depersonalization  Personal accomplishment    Crude OR (95% CI)  Adjusted OR (95% CI)b  Crude OR (95% CI)  Adjusted OR (95% CI)b  Crude OR (95% CI)  Adjusted OR (95% CI)b  Nurses  1    1    1    1    1    1    Healthcare assistants  0.34  (0.16–0.69)  0.26  (0.10–0.64)  0.54  (0.18–1.62)  0.99  (0.29–3.36)  0.63  (0.30–1.30)  0.93  (0.38–2.05)  Technicians  0.70  (0.34–1.46)  0.55  (0.23–1.31)  1.04  (0.40–2.71)  0.84  (0.28–2.53)  0.90  (0.43–1.91)  0.83  (0.38–1.84)  Administrative staff  0.70  (0.38–1.29)  0.68  (0.33–1.41)  0.39  (0.13–1.15)  0.32  (0.10–1.04)  1.57  (0.86–2.89)  1.52  (0.80–2.89)  Physicians  0.42  (0.23–0.79)  0.52  (0.25–1.11)  1.13  (0.51–2.47)  1.42  (0.57–3.54)  0.58  (0.30–1.12)  0.67  (0.33–1.36)    High burnout levelsa    Emotional exhaustion  Depersonalization  Personal accomplishment    Crude OR (95% CI)  Adjusted OR (95% CI)b  Crude OR (95% CI)  Adjusted OR (95% CI)b  Crude OR (95% CI)  Adjusted OR (95% CI)b  Nurses  1    1    1    1    1    1    Healthcare assistants  0.34  (0.16–0.69)  0.26  (0.10–0.64)  0.54  (0.18–1.62)  0.99  (0.29–3.36)  0.63  (0.30–1.30)  0.93  (0.38–2.05)  Technicians  0.70  (0.34–1.46)  0.55  (0.23–1.31)  1.04  (0.40–2.71)  0.84  (0.28–2.53)  0.90  (0.43–1.91)  0.83  (0.38–1.84)  Administrative staff  0.70  (0.38–1.29)  0.68  (0.33–1.41)  0.39  (0.13–1.15)  0.32  (0.10–1.04)  1.57  (0.86–2.89)  1.52  (0.80–2.89)  Physicians  0.42  (0.23–0.79)  0.52  (0.25–1.11)  1.13  (0.51–2.47)  1.42  (0.57–3.54)  0.58  (0.30–1.12)  0.67  (0.33–1.36)  aVersus low and average levels. bAdjusted for sex, age, use of anxiolytic/antidepressant drugs and job satisfaction. Due to possible collinearity, the final model was not adjusted for considered changing job and considered changing workplace, assuming that these variables may represent a proxy for job satisfaction. View Large Table 2. Crude and adjusted OR for the association between professional category and high burnout levels (emotional exhaustion, depersonalization and lack of personal accomplishment)   High burnout levelsa    Emotional exhaustion  Depersonalization  Personal accomplishment    Crude OR (95% CI)  Adjusted OR (95% CI)b  Crude OR (95% CI)  Adjusted OR (95% CI)b  Crude OR (95% CI)  Adjusted OR (95% CI)b  Nurses  1    1    1    1    1    1    Healthcare assistants  0.34  (0.16–0.69)  0.26  (0.10–0.64)  0.54  (0.18–1.62)  0.99  (0.29–3.36)  0.63  (0.30–1.30)  0.93  (0.38–2.05)  Technicians  0.70  (0.34–1.46)  0.55  (0.23–1.31)  1.04  (0.40–2.71)  0.84  (0.28–2.53)  0.90  (0.43–1.91)  0.83  (0.38–1.84)  Administrative staff  0.70  (0.38–1.29)  0.68  (0.33–1.41)  0.39  (0.13–1.15)  0.32  (0.10–1.04)  1.57  (0.86–2.89)  1.52  (0.80–2.89)  Physicians  0.42  (0.23–0.79)  0.52  (0.25–1.11)  1.13  (0.51–2.47)  1.42  (0.57–3.54)  0.58  (0.30–1.12)  0.67  (0.33–1.36)    High burnout levelsa    Emotional exhaustion  Depersonalization  Personal accomplishment    Crude OR (95% CI)  Adjusted OR (95% CI)b  Crude OR (95% CI)  Adjusted OR (95% CI)b  Crude OR (95% CI)  Adjusted OR (95% CI)b  Nurses  1    1    1    1    1    1    Healthcare assistants  0.34  (0.16–0.69)  0.26  (0.10–0.64)  0.54  (0.18–1.62)  0.99  (0.29–3.36)  0.63  (0.30–1.30)  0.93  (0.38–2.05)  Technicians  0.70  (0.34–1.46)  0.55  (0.23–1.31)  1.04  (0.40–2.71)  0.84  (0.28–2.53)  0.90  (0.43–1.91)  0.83  (0.38–1.84)  Administrative staff  0.70  (0.38–1.29)  0.68  (0.33–1.41)  0.39  (0.13–1.15)  0.32  (0.10–1.04)  1.57  (0.86–2.89)  1.52  (0.80–2.89)  Physicians  0.42  (0.23–0.79)  0.52  (0.25–1.11)  1.13  (0.51–2.47)  1.42  (0.57–3.54)  0.58  (0.30–1.12)  0.67  (0.33–1.36)  aVersus low and average levels. bAdjusted for sex, age, use of anxiolytic/antidepressant drugs and job satisfaction. Due to possible collinearity, the final model was not adjusted for considered changing job and considered changing workplace, assuming that these variables may represent a proxy for job satisfaction. View Large Discussion We observed high levels of burnout, mainly due to emotional exhaustion, in all professional categories of hospital employees. Healthcare assistants were less likely than nurses to score highly for burnout due to emotional exhaustion. To the best of our knowledge, this is the only Portuguese study of an entire hospital workforce. However, the small numbers, low response rate and over-/under-representation of some professional categories limit generalization of our findings. In our study, nurses scored high levels of burnout in all dimensions, which is consistent with previous research reporting prevalence estimates in nurses above 50% [3,7]. Administrative staff and technicians also scored highly for burnout, mainly due to emotional exhaustion and lack of personal accomplishment. A recent study also reported high risks of work-related burnout in different hospital staff, with prevalences above 60% in nurses and physician assistants and between 30% and 40% in physicians, administrative staff and medical technicians [7]. In this study, administrative staff had similar levels of burnout to healthcare professionals, suggesting that administrative staff may also be a high-risk group for burnout. Emotional exhaustion has been reported as the most prevalent dimension of burnout [8]. Our study adds that this applies to all employees in the hospital setting. It has been proposed that emotional exhaustion may be considered the first phase of burnout, which can lead to depersonalization and reduced personal accomplishment [9]. Although our study cannot confirm this assumption, the higher prevalence of emotional exhaustion observed supports this hypothesis. Future studies should use larger and more representative samples of entire hospital workforces and perform longitudinal analyses to clarify the existence of sequential stages in burnout. Different strategies to increase participation should be considered, such as face-to-face interviews to achieve higher response rates [7,10]. Also, data on the specifics of each professional category and other factors that could mediate the association between professional category and burnout, such as diet, exercise and painkiller use, should be analysed. Key points We observed high levels of burnout due to emotional exhaustion in all professional categories of a hospital workforce. Healthcare assistants scored lower levels of burnout due to emotional exhaustion than nurses, independently of their job satisfaction, intention of changing jobs or workplace and the use of anxiolytic/antidepressant drugs. Future studies should use larger and more representative samples of hospital staff, perform longitudinal analyses and collect data on other potential confounders, taking into account the specifics of each professional category. Funding This study was institutional and realized under the coordination of the Occupational Health Department of the Centro Hospitalar de São João. It was funded by FEDER through the Operational Programme Competitiveness and Internationalization and national funding from the Foundation for Science and Technology—FCT (Portuguese Ministry of Science, Technology and Higher Education), under the Unidade de Investigação em Epidemiologia—Instituto de Saúde Pública da Universidade do Porto (EPIUnit) (POCI-01-0145-FEDER-006862; Ref. UID/DTP/04750/2013) and also by a Postdoc Grant (SFRH/BPD/103562/2014), co-funded by the FCT and the POPH/FSE Program. Acknowledgement We thank all participants for their collaboration in the study. Competing interests None declared. References 1. Carod-Artal F, Vázquez-Cabrera C. Burnout syndrome in an international setting. In: Bährer-Kohler S, ed. Burnout for Experts: Prevention in the Context of Living and Working . Boston, MA: Springer US, 2013; 15– 35. Google Scholar CrossRef Search ADS   2. Consiglio C. Interpersonal strain at work: a new burnout facet relevant for the health of hospital staff. Burnout Res  2014; 1: 69– 75. Google Scholar CrossRef Search ADS   3. Galletta M, Portoghese I, Ciuffi M, Sancassiani F, Aloja E, Campagna M. Working and environmental factors on job burnout: a cross-sectional study among nurses. Clin Pract Epidemiol Ment Health  2016; 12: 132– 141. Google Scholar CrossRef Search ADS PubMed  4. Rothenberger DA. Physician burnout and well-being: a systematic review and framework for action. Dis Colon Rectum  2017; 60: 567– 576. Google Scholar CrossRef Search ADS PubMed  5. Maslach C, Jackson S. MBI-Human Services Survey. http://www.mindgarden.com/products/mbi.htm ( 4 January 2018, date last accessed). 6. Maslach C, Jackson SE, Leiter MP. Maslach Burnout Inventory . Palo Alto, CA: Consulting Psychologists Press, 1986. 7. Chou LP, Li CY, Hu SC. Job stress and burnout in hospital employees: comparisons of different medical professions in a regional hospital in Taiwan. BMJ Open  2014; 4: e004185. Google Scholar CrossRef Search ADS PubMed  8. Gomez-Urquiza JL, Monsalve-Reyes CS, San Luis-Costas C, Fernandez-Castillo R, Aguayo-Estremera R, Canadas-de la Fuente GA. Risk factors and burnout levels in primary care nurses: a systematic review. Aten Primaria  2017;49:77–85. 9. Leiter MP, Maslach C. The impact of interpersonal environment on burnout and organizational commitment. J Organ Behav  1988; 9: 297– 308. Google Scholar CrossRef Search ADS   10. Gorgulu O, Akilli A. The determination of the levels of burnout syndrome, organizational commitment, and job satisfaction of the health workers. Niger J Clin Pract  2017; 20: 48– 56. Google Scholar CrossRef Search ADS PubMed  © The Author(s) 2018. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices)

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Occupational MedicineOxford University Press

Published: Mar 13, 2018

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