Taking Action Against Clinician Burnout A Systems Approach to Professional Well-Being (2019) / Chapter Skim
Currently Skimming:
4 Factors Contributing to Clinician Burnout and Professional Well-Being
4 Factors Contributing to Clinician Burnout and Professional Well-Being
Pages 81-126
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 81... ...
In addition to the direct negative impact of high job demands and low job resources on burnout, the job demands–resources model suggests that job resources can offset the adverse effects of increased 1 Excerpted from the National Academy of Medicine's Expressions of Clinician Well-Being: An Art Exhibition. To see the complete work by Zohal Ghulam-Jelani, visit https://nam.edu/ expressclinicianwellbeing/#/artwork/347 (accessed January 30, 2019)
|
From page 82... ...
the system elements at each of the three levels of the system. Job demands include workload and time pressure, various intrinsic aspects of clinical work (e.g., moral distress)
|
From page 83... ...
JOB DEMANDS When job demands require sustained physical or psychological effort or skills, individuals experience physiological or psychological costs, including burnout. Job demands can exceed an individual's available capacity or skills when the work is inefficient (and especially when it requires numerous tasks that are considered by the clinician to be lower priority than or a distraction from direct patient care)
|
From page 84... ...
An imbalance between job demands and resources can also occur when there is inadequate job control or insufficient professional support, particularly during challenging and demanding work. When the overall job resources available (supply)
|
From page 85... ...
Yet, despite compelling positive associations between job demands and burnout, as discussed in the remainder of this chapter, the "demand side" of the equation is not the entire story; the nature of m odern clinical work is as important as, if not more important than, the ctual work hours. For example, a number of studies across professions show a that other factors, such as job control (Pisanti et al., 2016a; Portoghese et al.,
|
From page 86... ...
However, a number of factors that have been shown to be associated with less burnout likely act, at least in part, on these relationships; such as for a given level of job demands, the workload will be perceived as lower when a clinician finds greater meaning in work; experiences greater job control, rewards, or sense of community; or works in a supportive organizational culture. Globally considered, the evidence for an association between job demands and clinician burnout is arguably the strongest for any independent variable.
|
From page 87... ...
nurses' job demands to burnout. Led by pioneering work by Linda Aiken and her colleagues, there is an extensive literature relating higher nurse-topatient ratios to nurse burnout as well as to other clinician, patient, and organizational outcomes.
|
From page 88... ...
(2018) in a study of 1,523 nurses in 23 hospitals in China, found that lower day shift patient–nurse ratios and better work environments correlated with fewer nursing care tasks left undone, less nurse burnout (using the emotional exhaustion sub-scale of the Maslach Burnout Inventory [MBI]
|
From page 89... ...
Among pharmacy practice faculty, greater emotional exhaustion scores were associated with longer working hours (El-Ibiary et al., 2017) , but another study of inpatient pharmacists failed to find a significant relationship between work hours and burnout (Jones et al., 2017)
|
From page 90... ...
Workflow that is poorly designed to meet clinicians' needs leads to frustration and creates time pressure. In a study of 422 family practitioners and general internists, adverse workflow, defined in terms of time pressure and chaotic environments, was associated with symptoms of emotional exhaustion (Linzer et al., 2009)
|
From page 91... ...
. In an observational study of 57 physicians in four specialties, 47.2 percent of clinic time was spent on the EHR and desk work, nearly double the amount of time spent doing direct patient care tasks (Sinsky et al., 2016)
|
From page 92... ...
Time Pressure and Encroachment on Personal Time Although it has always been the case that many health care professionals work long hours, a number of changes to the practice environment
|
From page 93... ...
. This often results in professionals having to perform many professional tasks outside of regular work hours by remotely accessing the EHR to complete professional work on personal time.
|
From page 94... ...
Moral Distress Moral distress is a factor that contributes to burnout, particularly among critical care clinicians (Johnson-Coyle et al., 2016a; Moss et al., 2016b)
|
From page 95... ...
. Data from a revised instrument to measure moral distress among health care professionals indicated that the most common sources of moral distress among physicians were related to excessive documentation, a lack of resources that compromised patient care, and lack of administrative action (Epstein et al., 2019)
|
From page 96... ...
, as well as among critical care clinicians, with those having higher moral distress scores being more likely to experience burnout (Fumis et al., 2017)
|
From page 97... ...
. Exposure to violence was also significantly associated with increased emotional exhaustion and decreased job satisfaction.
|
From page 98... ...
For example, a better person–job match in six areas of work–life (manageable workload, control, reward, community, fairness, and values) had a direct negative effect on burnout (emotional exhaustion and cynicism in a cross-sectional survey of 215 registered nurses)
|
From page 99... ...
. For example, having inadequate time for professional development was an independent predictor of burnout in a multi-variate analysis performed on a national sample of 783 neurosurgeons (McAbee et al., 2015)
|
From page 100... ...
. In contrast, healthy work environments have been positively associated in nuses with job satisfaction, retention, and better patient outcomes and negatively correlated with emotional strain (emotional exhaustion, burnout, compassion fatigue, and stress)
|
From page 101... ...
. A small longitudinal study of primary care physicians indicated that job control played a central role in physicians' experience of burnout and emphasized the need for physicians to be involved in practice-related decisions as a key strategy for reducing burnout (Gregory and Menser, 2015)
|
From page 102... ...
In one small longitudinal study of 217 nurses working in Italy, decreases in perceived job control predicted increased emotional exhaustion scores 14 months later, after controlling for baseline job characteristics (Pisanti et al., 2016b)
|
From page 103... ...
. Similarly, a small longitudinal study of primary care physicians found that workload and job control -- but not rewards -- predicted burnout (Gregory and Menser, 2015)
|
From page 104... ...
Interestingly, in a longitudinal study of 2,100 critical care nurses and physicians, measures of teamwork did not predict subsequent emotional exhaustion, although
|
From page 105... ...
In two longitudinal studies of nurses in Western Europe, emotional exhaustion was negatively correlated with improvements in social support over more than 1 year (Adriaenssens et al., 2015a; Pisanti et al., 2016b)
|
From page 106... ...
. A longitudinal study of physicians working in Norway found that a failure to experience a reduction in work–home interference over a 5-year time span after medical school graduation was an independent predictor of emotional exhaustion 15 years after medical school graduation (Hertzberg et al., 2016)
|
From page 107... ...
There are some data on the mediating role of personality on burnout in clinicians. Several studies have reported small associations between high neuroticism and burnout among physicians and nurses (McManus et al., 2004; Shimizutani et al., 2008; van der Wal et al., 2016; Yao et al., 2018; Zellars et al., 2004)
|
From page 108... ...
When physicians took more responsibility for decision making, greater acceptance of death was correlated with the physician experiencing less emotional exhaustion (Moreno-Jiménez et al., 2008)
|
From page 109... ...
Mealer and colleagues (2012) , in a national survey of 744 critical care nurses, found that high resilience was also associated with a lower likelihood of burnout as well as a lower likelhood of posttraumatic stress dis order, anxiety, and depression.
|
From page 110... ...
. Other studies have reported that low spousal support and spousal occupation was associated with high emotional exhaustion (Gabbe et al., 2002; Golub et al., 2008; Johns and Ossoff, 2005; Oskrochi et al., 2016)
|
From page 111... ...
2015. Impact of ethical climate on moral distress revisited: Multidimensional view.
|
From page 112... ...
2013. CNE article: Moral distress and psychological empowerment in critical care nurses caring for adults at end of life.
|
From page 113... ...
2016. Moral distress in intensive care unit profes sionals is associated with profession, age, and years of experience.
|
From page 114... ...
2019. Enhancing understanding of moral distress: The measure of moral distress for health care professionals.
|
From page 115... ...
2017. Moral distress and its contribution to the development of burnout syndrome among critical care providers.
|
From page 116... ...
sample of critical care nurses. American Journal of Critical Care 27(1)
|
From page 117... ...
2016a. Moral distress and burnout among cardiovascular surgery intensive care unit healthcare professionals: A prospective cross-sectional survey.
|
From page 118... ...
2018. Hospital nursing organizational factors, nursing care left undone, and nurse burnout as predictors of patient safety: A structural equation modeling analysis.
|
From page 119... ...
2016b. An official Critical Care Societies Collaborative statement: Burnout syndrome in critical care healthcare professionals: A call for action.
|
From page 120... ...
2009. Registered nurses' perceptions of moral distress and ethical climate.
|
From page 121... ...
American Journal of Respiratory and Critical Care Medicine 175(7)
|
From page 122... ...
2015. Assessing and addressing moral distress and ethical climate, part II: Neonatal and pediatric perspec tives.
|
From page 123... ...
2018. Nurse staffing and nurse outcomes: A systematic review and meta-analysis.
|
From page 124... ...
2016. The interplay between teamwork, clinicians' emotional exhaustion, and clinician-rated patient safety: A longitudinal study.
|
From page 125... ...
2015. Moral distress among healthcare professionals: Report of an institution-wide survey.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.