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Burnout in nursing: a theoretical review

Burnout in nursing: a theoretical review
Burnout in nursing: a theoretical review
Background: workforce studies often identify burnout as a nursing ‘outcome’. Yet burnout itself - what constitutes it, what factors contribute to its development, and what the wider consequences are for individuals, organisations or their patients – is rarely made explicit. We aimed to provide a comprehensive summary of research that examines theorised relationships between burnout and other variables, in order to determine what is known (and not known) about the causes and consequences of burnout in nursing, and how this relates to theories of burnout. Methods: we searched MEDLINE, CINAHL and PsycINFO. We included quantitative primary empirical studies (published in English) which examined associations between burnout and work-related factors in the nursing workforce. Results: 91 papers were identified. The majority (n=87) were cross-sectional studies; 39 studies used all three subscales of the Maslach Burnout Inventory (MBI) scale to measure burnout. As hypothesised by Maslach we identified high workload, value incongruence, low control over the job, low decision latitude, poor social climate/social support, and low rewards as predictors of burnout. Maslach suggested that turnover, sickness absence and general health were effects of burnout; however we identified relationships only with general health and sickness absence. Other factors that were classified as predictors of burnout in the nursing literature where low/inadequate nurse staffing levels, ≥12-hour shifts, and low schedule flexibility, time pressure, high job & psychological demands, low task variety, role conflict, low autonomy, negative nurse-physician relationship, poor supervisor/leader support, poor leadership, negative team relationship, job insecurity. Among the outcomes of burnout we found: reduced job performance, poor quality of care, poor patient safety, adverse events, patient negative experience, medication errors, infections, patient falls, and intention to leave. Conclusions: the patterns identified by these studies consistently show that adverse job characteristics - high workload, low staffing levels, long shifts, low control are associated with burnout in nursing. The potential consequences for staff and patients are severe. The literature on burnout in nursing partly supports Maslach’s theory, but some areas are insufficiently tested, in particular the association between burnout and turnover, and relationships were found for some MBI dimensions only.
Burnout, Job demands, Maslach Burnout Inventory, Nursing, Practice environment
1478-4491
Dall'ora, Chiara
4501b172-005c-4fad-86da-2d63978ffdfd
Ball, Jane
85ac7d7a-b21e-42fd-858b-78d263c559c1
Reinius, Maria
357b9270-8c6b-4c57-87ff-a8cf50d6118b
Griffiths, Peter
ac7afec1-7d72-4b83-b016-3a43e245265b
Dall'ora, Chiara
4501b172-005c-4fad-86da-2d63978ffdfd
Ball, Jane
85ac7d7a-b21e-42fd-858b-78d263c559c1
Reinius, Maria
357b9270-8c6b-4c57-87ff-a8cf50d6118b
Griffiths, Peter
ac7afec1-7d72-4b83-b016-3a43e245265b

Dall'ora, Chiara, Ball, Jane, Reinius, Maria and Griffiths, Peter (2020) Burnout in nursing: a theoretical review. Human Resources for Health, 18 (1), [41].

Record type: Article

Abstract

Background: workforce studies often identify burnout as a nursing ‘outcome’. Yet burnout itself - what constitutes it, what factors contribute to its development, and what the wider consequences are for individuals, organisations or their patients – is rarely made explicit. We aimed to provide a comprehensive summary of research that examines theorised relationships between burnout and other variables, in order to determine what is known (and not known) about the causes and consequences of burnout in nursing, and how this relates to theories of burnout. Methods: we searched MEDLINE, CINAHL and PsycINFO. We included quantitative primary empirical studies (published in English) which examined associations between burnout and work-related factors in the nursing workforce. Results: 91 papers were identified. The majority (n=87) were cross-sectional studies; 39 studies used all three subscales of the Maslach Burnout Inventory (MBI) scale to measure burnout. As hypothesised by Maslach we identified high workload, value incongruence, low control over the job, low decision latitude, poor social climate/social support, and low rewards as predictors of burnout. Maslach suggested that turnover, sickness absence and general health were effects of burnout; however we identified relationships only with general health and sickness absence. Other factors that were classified as predictors of burnout in the nursing literature where low/inadequate nurse staffing levels, ≥12-hour shifts, and low schedule flexibility, time pressure, high job & psychological demands, low task variety, role conflict, low autonomy, negative nurse-physician relationship, poor supervisor/leader support, poor leadership, negative team relationship, job insecurity. Among the outcomes of burnout we found: reduced job performance, poor quality of care, poor patient safety, adverse events, patient negative experience, medication errors, infections, patient falls, and intention to leave. Conclusions: the patterns identified by these studies consistently show that adverse job characteristics - high workload, low staffing levels, long shifts, low control are associated with burnout in nursing. The potential consequences for staff and patients are severe. The literature on burnout in nursing partly supports Maslach’s theory, but some areas are insufficiently tested, in particular the association between burnout and turnover, and relationships were found for some MBI dimensions only.

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Published date: 10 March 2020
Keywords: Burnout, Job demands, Maslach Burnout Inventory, Nursing, Practice environment

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Local EPrints ID: 438498
URI: http://eprints.soton.ac.uk/id/eprint/438498
ISSN: 1478-4491
PURE UUID: 9f6fe58c-c153-4f2c-b614-dc2f22235c1c
ORCID for Chiara Dall'ora: ORCID iD orcid.org/0000-0002-6858-3535
ORCID for Jane Ball: ORCID iD orcid.org/0000-0002-8655-2994
ORCID for Peter Griffiths: ORCID iD orcid.org/0000-0003-2439-2857

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Date deposited: 11 Mar 2020 17:32
Last modified: 28 Apr 2022 02:21

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Contributors

Author: Chiara Dall'ora ORCID iD
Author: Jane Ball ORCID iD
Author: Maria Reinius
Author: Peter Griffiths ORCID iD

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