The Association of Work Overload with Burnout and Intent to Leave the Job Across the Healthcare Workforce During COVID-19.
Journal
Journal of general internal medicine
ISSN: 1525-1497
Titre abrégé: J Gen Intern Med
Pays: United States
ID NLM: 8605834
Informations de publication
Date de publication:
Jun 2023
Jun 2023
Historique:
received:
03
02
2023
accepted:
09
03
2023
medline:
19
6
2023
pubmed:
25
3
2023
entrez:
24
3
2023
Statut:
ppublish
Résumé
Burnout has risen across healthcare workers during the pandemic, contributing to workforce turnover. While prior literature has largely focused on physicians and nurses, there is a need to better characterize and identify actionable predictors of burnout and work intentions across healthcare role types. To characterize the association of work overload with rates of burnout and intent to leave (ITL) the job in a large national sample of healthcare workers. Cross-sectional survey study conducted between April and December 2020. A total of 206 large healthcare organizations. Physicians, nurses, other clinical staff, and non-clinical staff. Work overload, burnout, and ITL. The sample of 43,026 respondents (mean response rate 44%) was comprised of 35.2% physicians, 25.7% nurses, 13.3% other clinical staff, and 25.8% non-clinical staff. The overall burnout rate was 49.9% (56.0% in nursing, 54.1% in other clinical staff, 47.3% in physicians, and 45.6% in non-clinical staff; p < 0.001 for difference). ITL was reported by 28.7% of healthcare workers, with nurses most likely to report ITL (41.0%), followed by non-clinical staff (32.6%), other clinical staff (32.1%), and physicians (24.3%) (p < 0.001 for difference). The prevalence of perceived work overload ranged from 37.1% among physicians to 47.4% in other clinical staff. In propensity-weighted models, work overload was significantly associated with burnout (adjusted risk ratio (ARR) 2.21 to 2.90) and intent to leave (ARR 1.73 to 2.10) across role types. Organizations' participation in the survey was voluntary. There are high rates of burnout and intent to leave the job across healthcare roles. Proactively addressing work overload across multiple role types may help with concerning trends across the healthcare workforce. This will require a more granular understanding of sources of work overload across different role types, and a commitment to matching work demands to capacity for all healthcare workers.
Sections du résumé
BACKGROUND
BACKGROUND
Burnout has risen across healthcare workers during the pandemic, contributing to workforce turnover. While prior literature has largely focused on physicians and nurses, there is a need to better characterize and identify actionable predictors of burnout and work intentions across healthcare role types.
OBJECTIVE
OBJECTIVE
To characterize the association of work overload with rates of burnout and intent to leave (ITL) the job in a large national sample of healthcare workers.
DESIGN
METHODS
Cross-sectional survey study conducted between April and December 2020.
SETTING
METHODS
A total of 206 large healthcare organizations.
PARTICIPANTS
METHODS
Physicians, nurses, other clinical staff, and non-clinical staff.
MEASURES
METHODS
Work overload, burnout, and ITL.
RESULTS
RESULTS
The sample of 43,026 respondents (mean response rate 44%) was comprised of 35.2% physicians, 25.7% nurses, 13.3% other clinical staff, and 25.8% non-clinical staff. The overall burnout rate was 49.9% (56.0% in nursing, 54.1% in other clinical staff, 47.3% in physicians, and 45.6% in non-clinical staff; p < 0.001 for difference). ITL was reported by 28.7% of healthcare workers, with nurses most likely to report ITL (41.0%), followed by non-clinical staff (32.6%), other clinical staff (32.1%), and physicians (24.3%) (p < 0.001 for difference). The prevalence of perceived work overload ranged from 37.1% among physicians to 47.4% in other clinical staff. In propensity-weighted models, work overload was significantly associated with burnout (adjusted risk ratio (ARR) 2.21 to 2.90) and intent to leave (ARR 1.73 to 2.10) across role types.
LIMITATIONS
CONCLUSIONS
Organizations' participation in the survey was voluntary.
CONCLUSIONS
CONCLUSIONS
There are high rates of burnout and intent to leave the job across healthcare roles. Proactively addressing work overload across multiple role types may help with concerning trends across the healthcare workforce. This will require a more granular understanding of sources of work overload across different role types, and a commitment to matching work demands to capacity for all healthcare workers.
Identifiants
pubmed: 36959522
doi: 10.1007/s11606-023-08153-z
pii: 10.1007/s11606-023-08153-z
pmc: PMC10035977
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1920-1927Informations de copyright
© 2023. The Author(s).
Références
Office of the Surgeon General. New surgeon general advisory sounds alarm on health worker burnout and resignation. HHS.gov. Published May 23, 2022. Accessed June 12, 2022. https://www.hhs.gov/about/news/2022/05/23/new-surgeon-general-advisory-sounds-alarm-on-health-worker-burnout-and-resignation.html
Rotenstein LS, Torre M, Ramos MA, et al. Prevalence of burnout among physicians a systematic review. JAMA. 2018; 320(11):1131-1150.
doi: 10.1001/jama.2018.12777
pubmed: 30326495
pmcid: 6233645
Shah MK, Gandrakota N, Cimiotti JP, Ghose N, Moore M, Ali MK. Prevalence of and factors associated with nurse burnout in the US. JAMA Network Open. 2021;4(2):e2036469.
doi: 10.1001/jamanetworkopen.2020.36469
pubmed: 33538823
pmcid: 7862989
Muir KJ, Wanchek TN, Lobo JM, Keim-Malpass J. Evaluating the costs of nurse burnout-attributed turnover: a Markov modeling approach. J Patient Saf. 2022;18(4):351-357.
doi: 10.1097/PTS.0000000000000920
pubmed: 35617593
Tawfik DS, Scheid A, Profit J, et al. Evidence relating health care provider burnout and quality of care. Ann Intern Med. 2019;171(8):555-567.
doi: 10.7326/M19-1152
pubmed: 31590181
pmcid: 7138707
Sinsky CA, Shanafelt TD, Dyrbye LN, Sabety AH, Carlasare LE, West CP. Health care expenditures attributable to primary care physician overall and burnout-related turnover: a cross-sectional analysis. Mayo Clinic Proceedings. 2022;97(4):693-702.
doi: 10.1016/j.mayocp.2021.09.013
pubmed: 35227508
Han S, Shanafelt TD, Sinsky CA, et al. Estimating the attributable cost of physician burnout in the United States. Ann Intern Med. 2019;170(11):784.
doi: 10.7326/M18-1422
pubmed: 31132791
Sinsky CA, Dyrbye LN, West CP, Satele D, Tutty M, Shanafelt TD. Professional satisfaction and the career plans of US physicians. Mayo Clin Proc. 2017;92(11):1625-1635.
doi: 10.1016/j.mayocp.2017.08.017
pubmed: 29101932
Prasad K, McLoughlin C, Stillman M, et al. Prevalence and correlates of stress and burnout among U.S. healthcare workers during the COVID-19 pandemic: a national cross-sectional survey study. EClinical Medicine. 2021;35:100879. https://doi.org/10.1016/j.eclinm.2021.100879
Staff Shortages Choking U.S. Health Care System | Healthiest Communities Health News | U.S. News. Accessed October 19, 2022. https://www.usnews.com/news/health-news/articles/2022-07-28/staff-shortages-choking-u-s-health-care-system
Linzer M, Stillman M, Brown R, et al. Preliminary report: US physician stress during the early days of the COVID-19 pandemic. Mayo Clinic Proceedings: Innovations, Quality & Outcomes. 2021;5(1):127-136.
Sinsky CA, Brown RL, Stillman MJ, Linzer M. COVID-related stress and work intentions in a sample of US health care workers. Mayo Clinic Proceedings and Innovations. 2021;5(6):1165-1173.
Rohland BM, Kruse GR, Rohrer JE. Validation of a single-item measure of burnout against the Maslach Burnout Inventory among physicians. Stress and Health. 2004;20(2):75-79.
doi: 10.1002/smi.1002
Brady KJS, Ni P, Carlasare L, et al. Establishing crosswalks between common measures of burnout in US physicians. J Gen Intern Med. 2021; 37(4):777-784.
doi: 10.1007/s11606-021-06661-4
pubmed: 33791938
pmcid: 8904666
Griffeth RW, Hom PW, Gaertner S. A meta-analysis of antecedents and correlates of employee turnover: update, moderator tests, and research implications for the next millennium. Journal of Management. 2000;26(3):463-488.
doi: 10.1177/014920630002600305
Norton EC, Miller MM, Kleinman LC. Computing adjusted risk ratios and risk differences in Stata. The Stata Journal. 2013;13(3):492-509.
doi: 10.1177/1536867X1301300304
McCaffrey DF, Ridgeway G, Morral AR. Propensity score estimation with boosted regression for evaluating causal effects in observational studies. Psychol Methods. 2004;9(4):403-425.
doi: 10.1037/1082-989X.9.4.403
pubmed: 15598095
McCaffrey DF, Griffin BA, Almirall D, Slaughter ME, Ramchand R, Burgette LF. A tutorial on propensity score estimation for multiple treatments using generalized boosted models. Stat Med. 2013;32(19):3388-3414.
doi: 10.1002/sim.5753
pubmed: 23508673
pmcid: 3710547
Pérez-Francisco DH, Duarte-Clíments G, del Rosario-Melián JM, Gómez-Salgado J, Romero-Martín M, Sánchez-Gómez MB. Influence of workload on primary care nurses’ health and burnout, patients’ safety, and quality of care: integrative review. Healthcare. 2020;8(1):12.
doi: 10.3390/healthcare8010012
pubmed: 31947761
pmcid: 7151231
Gregory ME, Russo E, Singh H. Electronic health record alert-related workload as a predictor of burnout in primary care providers. Appl Clin Inform. 2017;08(3):686-697.
doi: 10.4338/ACI-2017-01-RA-0003
Watson AG, McCoy JV, Mathew J, Gundersen DA, Eisenstein RM. Impact of physician workload on burnout in the emergency department. Psychology, Health & Medicine. 2019;24(4):414-428.
doi: 10.1080/13548506.2018.1539236
Basner M, Asch DA, Shea JA, et al. Sleep and alertness in a duty-hour flexibility trial in internal medicine. New England Journal of Medicine. 2019;380(10):915-923.
doi: 10.1056/NEJMoa1810641
pubmed: 30855741
Desai SV, Asch DA, Bellini LM, et al. Education outcomes in a duty-hour flexibility trial in internal medicine. New England Journal of Medicine. 2018; 378:1494-1508
doi: 10.1056/NEJMoa1800965
pubmed: 29557719
Silber JH, Bellini LM, Shea JA, et al. Patient safety outcomes under flexible and standard resident duty-hour rules. New England Journal of Medicine. 2019;380(10):905-914.
doi: 10.1056/NEJMoa1810642
pubmed: 30855740
Sinsky CA, Privitera MR. Creating a “manageable cockpit” for clinicians: a shared responsibility. JAMA Internal Medicine. 2018;178(6):741-742.
doi: 10.1001/jamainternmed.2018.0575
pubmed: 29582080
DeChant PF, Acs A, Rhee KB, et al. Effect of organization-directed workplace interventions on physician burnout: a systematic review. Mayo Clinic Proceedings: Innovations, Quality & Outcomes. 2019; 3(4): 384-408.
Briatte I, Allix-Béguec C, Garnier G, Michel M. Revision of hospital work organization using nurse and healthcare assistant workload indicators as decision aid tools. BMC Health Services Research. 2019;19(1):554.
doi: 10.1186/s12913-019-4376-7
pubmed: 31391052
pmcid: 6686463
Portoghese I, Galletta M, Coppola RC, Finco G, Campagna M. Burnout and workload among health care workers: the moderating role of job control. Safety and Health at Work. 2014;5(3):152-157.
doi: 10.1016/j.shaw.2014.05.004
pubmed: 25379330
pmcid: 4213899
Arapovic-Johansson B, Wåhlin C, Hagberg J, Kwak L, Björklund C, Jensen I. Participatory work place intervention for stress prevention in primary health care. A randomized controlled trial. European Journal of Work and Organizational Psychology. 2018;27(2):219-234.
doi: 10.1080/1359432X.2018.1431883
Sexton JB, Adair KC, Proulx J, et al. Emotional exhaustion among US health care workers before and during the COVID-19 pandemic, 2019-2021. JAMA Network Open. 2022;5(9):e2232748.
doi: 10.1001/jamanetworkopen.2022.32748
pubmed: 36129705
pmcid: 9494188
Matsuo T, Kobayashi D, Taki F, et al. Prevalence of health care worker burnout during the coronavirus disease 2019 (COVID-19) pandemic in Japan. JAMA Network Open. 2020;3(8):e2017271
doi: 10.1001/jamanetworkopen.2020.17271
pubmed: 32749466
pmcid: 7403916
Apaydin EA, Rose DE, Yano EM, et al. Burnout among primary care healthcare workers during the COVID-19 pandemic. J Occup Environ Med. 2021;63(8):642-645.
pubmed: 33990531
pmcid: 8327767
Guastello AD, Brunson JC, Sambuco N, et al. Predictors of Professional Burnout and Fulfilment in a Longitudinal Analysis on Nurses and Healthcare Workers in the COVID-19 Pandemic. Journal of Clinical Nursing. https://doi.org/10.1111/jocn.16463 .
Lasalvia A, Amaddeo F, Porru S, et al. Levels of burn-out among healthcare workers during the COVID-19 pandemic and their associated factors: a cross-sectional study in a tertiary hospital of a highly burdened area of north-east Italy. BMJ Open. 2021;11(1):e045127.
doi: 10.1136/bmjopen-2020-045127
pubmed: 33455940
pmcid: 7813385