Occupational stress and burnout, low job satisfaction and efficacy among health professionals. Does research have a role to play?
The prevalence and effects of occupational stress, burnout and low job satisfaction are poorly understood in the health workforce.
This article gives a brief overview of occupational stress, burnout and job satisfaction among health professionals, and examines whether engagement in research can contribute to job satisfaction and efficacy, and thereby to reducing stress and burnout.
Definitions of occupational stress, burnout and job satisfaction
Although definitions of stress vary between academic disciplines, generally speaking the term ‘stress’ is used to refer to thoughts, feelings and physiological reactions that occur in response to stressful events.1
A physical response to stress may result in or facilitate acute illnesses, such as colds, ‘flu and migraine headaches, or chronic conditions such as sleep disturbance, hypertension, cardiovascular disease and asthma.2–4
Mental stress, including irritation, nervousness and difficulty concentrating, can lead to mental health disorders such as anxiety, depression and ‘burnout’, which is defined as a state of high emotional exhaustion that is characterised by extreme tiredness and feelings of failure and frustration.5–6
One of the most researched variables in workplace psychology, ‘job satisfaction’, is another hotly debated term in the literature. Traditional models describe it as the feelings an individual has regarding their job and the extent to which it fulfils a need. Contemporary theories define job satisfaction from the perspective of the person’s affective orientation towards their work – a range of attitudes about various aspects of the job.8
In this article we use a combination of the two most common definitions described by the European Agency for Safety and Health at Work: ‘the pleasurable emotional state resulting from the appraisal of one’s job as achieving or facilitating the achievement of one’s job values … and the extent to which people like (satisfaction) or dislike (dissatisfaction) their jobs’.
Occupational stress and burnout in the health professions.
Health professionals who work in emergency and oncology9–11 are at high risk of occupational stress and burnout, but levels of stress among other specialists in health service provision – including in palliative care, aged care and paediatrics – can also be high.
You might imagine that certain medical professionals, such as surgeons and anaesthetists, face high levels of stress because they typically work in contexts such as emergency and critical care that seem inherently stressful. Certainly, these jobs have high stakes in terms of patient lives and health outcomes that one would expect to increase stress.
Some evidence suggests otherwise. Belgian researchers reported ‘a moderate level of stress in anaesthetists that was no higher than in other professional groups’, positing that the effects of stress can be mitigated by ‘having high control, high satisfaction, high empowerment… and high work commitment in the job.6
This does not mean stress levels are uniformly mild in these roles. Nyssen and colleagues6 demonstrated that among the 40 per cent of anaesthetists suffering from high emotional exhaustion, the highest rate was in residents under 30 years of age, particularly among trainees in their third year. Conversely, senior male anaesthetists reported the highest levels of empowerment and control over time management, work planning and risks, and the lowest levels of stress. This pattern concurs with findings from similar studies across disciplines and sectors.
Nurses are one of the groups at highest risk of occupational stress and burnout.12–13 A systematic review of research on work-related stress and burnout among nurses revealed that high levels of stress and burnout and poor job satisfaction and health were common, and more so than for other health care professionals.14
The nursing profession worldwide has undergone enormous change over the past century, and this change continues as the scope of professional practice in nursing increases with changing approaches to health service delivery, including in Australia.15–17 Uncertainty and ambiguity in nurses’ roles have been identified as key factors contributing to occupational stress; others include long working hours, workload, patient care, interpersonal relationships and lack of professional latitude.14–15
However, the adage that context is everything applies perfectly to nursing, with nursing specialty, setting, tasks, responsibilities, predictability, resources and exposure to potentially traumatic situations leading to stress and burnout. Emergency and oncology nurses appear to be at highest risk.12
In the published literature on the health workforce, more is known about the harmful effects of work stress among medical and nursing professions than among allied health professions. For example, until 2000, there was no published Australian research on the prevalence, risk factors and effects of occupational stress among radiographers.18
Eslick and Raj18 found that occupational stress was extremely common among radiographers, with 90 per cent of participants reporting stress in the workplace and 20 per cent experiencing severe or very severe stress. Radiographers identified patients, workload and on-call or overtime work as the three major causes of stress.
Determinants of stress and burnout among health professionals.
The determinants of the likelihood of experiencing stress and burnout differ according to occupational group and professionals’ individual characteristics. For example, in Eslick and Raj’s18 study of radiographers, women were twice as likely to experience stress-related fatigue, four times as likely to experience stress-related depression and three times as likely to use eating as a form of stress release as men.
A systematic review covering 25 years of research on stress and burnout compared determinants of burnout in general populations with those in emergency nurses. In general populations, individual factors such as younger age, female gender, higher levels of education, personality characteristics, coping strategies and job attitudes were associated with stress and risk of burnout. Work-related factors associated with stress and burnout included exposure to traumatic events, job characteristics such as psychological demands and job control, and organisational factors such as communication, collaboration and staffing issues.12
In studies of emergency nurses, Adriaenssens and colleagues12 reported no significant relationships between age, seniority, gender, personality characteristics or job attitudes and burnout, but coping strategies were found to be related to well-being and performance. Work-related factors contributed strongly to emergency nurses’ stress and burnout, including exposure to traumatic events, job characteristics such as job demand, job control (decision latitude) and psychological demands, and organisational factors such as the quality of communication and collaboration, as well as staffing problems, lack of material resources and organisational culture.
Effects of occupational stress and burnout.
The evidence shows that stress and burnout have direct and damaging consequences for the health and productivity of the health workforce, and indirect consequences for the delivery of health services and the health outcomes of consumers.
As outlined above, stress and burnout can lead to physical and psychological problems such as headache, respiratory infection, gastrointestinal infection, neck pain, sleep disturbance, impairment in memory, anxiety and depressive disorders, and alcohol dependence.19 Other factors associated with burnout include decreased leisure time, decreased social activity and difficulties with the patient–physician relationship and in dealing with patients’ families.10
Staff experiencing stress and burnout often display withdrawal behaviours such as lateness and absence, and staff turnover can be high. Clinical burnout should dictate leave of absence from work but instead can result in ‘presenteeism’, which is when staff who should be on sick leave are determined to remain at work even though they may be ineffective or need more time than usual to complete tasks.19
Eslick and colleagues18 reported that 20 per cent of radiographers had missed work due to stress or a stress-related illness; of these, 60 per cent had 1–3 days off work.
Turnover rates have been reported as higher among nurses experiencing stress and burnout,20 and this in turn has implications for organisational stability, cost, recruitment and quality and safety.21
Responding to occupational stress and burnout among health professionals.
Health professionals commonly report exercise, alcohol consumption and eating as means of relieving stress.
Researchers have studied methods of preventing or alleviating stress and burnout, including:
- structural burnout interventions, such as developing a more positive organisational culture, and appropriate training, resources and supervision for the provision of constructive feedback and job crafting
- smartphone applications that monitor fluctuations in engagement and give feedback on causes of peaks and lows in engagements
- recovery activities such as social activities, low-effort activities (e.g. listening to music) and physical activities that foster relaxation and psychological detachment from work (e.g. sport, dancing).19
The role of leadership.
Although much has been written about both stress and leadership, there is little empirical evidence to support the common assumption that leaders’ stress spills over to employees. However, the literature indicates that leadership style is important: abusive leadership styles are associated with high levels of employee burnout, while transformational leadership and positive leader behaviours – such as support, feedback, trust, confidence and integrity – are associated with low employee stress and positive employee affective wellbeing.22
The limited available evidence suggests that job satisfaction can act as a mediator in the relationship between an employee’s job demands and their health and wellbeing.23
For example, despite reporting high levels of stress among radiographers, Eslick and colleagues 18 found that 85 per cent of their participants were satisfied with their work, and 72 per cent felt moderate, high or very high levels of motivation at work.
Job satisfaction and engagement in research.
Interesting and challenging work is commonly associated with job satisfaction. An Australian study examining job satisfaction, burnout and turnover intention among occupational therapists working in mental health settings reported that ‘keeping occupational therapists stimulated is central to their job satisfaction’.24
Many readers might have contemplated leaving or may have left a job due to feeling bored or stale. To help maintain staff interest and engagement, Western Alliance encourages its members to participate in research. This involvement may be minimal, such as ensuring accurate recording of data, or may increase along a continuum of engagement to leadership of large-scale studies, including clinical trials. As well as enabling staff to participate in the discovery of new knowledge relevant to their work, involvement in research can mean they develop new collaborations and skills.
A relatively recent development in the health sector is the role of the health professional who specialises in research. One such is the research coordinator, who manages research undertaken in the clinical setting, such as the hospital ward.
Research coordinators are mostly nurses who specialise in a particular field of clinical research, such as endocrinology or oncology, and whose day-to-day work typically involves a mix of clinical, academic, administrative and (sometimes) laboratory tasks. A study of research coordinators in Australian and New Zealand intensive care settings reported high levels of job satisfaction, and concluded that the research coordinator role is ‘an attractive position for those looking to specialize in research but remain in the clinical setting’.25
Health professionals who wish to actively engage in research, whether to optimise their efficiency or to enhance their job satisfaction, need to develop skills in research and to have sufficient interest and aptitude in order to do so.26 Western Alliance has an active program to develop and enhance research skills among health professionals in western Victoria, and to promote networks with academic researchers who are willing to act as mentors, collaborators and co-investigators.
Good health and wellbeing is critical for an effective health workforce
Stress and burnout are common across the health workforce, but this need not be the case. The literature indicates that stress is both an individual and an organisational phenomenon, and this suggests that individuals and their employers would do well to take a combined approach to strategies that mediate stress and burnout and enhance job satisfaction. Engagement in clinical research offers opportunities for health professionals to inject interest and challenge into their everyday tasks, and thereby to enhance their job satisfaction and contribute to the knowledge base that drives their clinical practice as well as innovation in health service delivery.
- Lazarus RS and Folkman S (1984) Stress, appraisal and coping, New York: Springer.
- Setterlind S and Larsson G (1995) The stress profile: A psychosocial approach to measuring stress, Stress Med, 11: 85–92.
- Wilkins K and Beaudet MP (1998) Work stress and health, Health Reports, 10(3): 47–62.
- Nixon AE, Mazzola JJ, Bauer J, Krueger JR and Spector PE (2011) Can work make you sick? A meta-analysis of the relationships between job stressors and physical symptoms, Work and Stress, 25(1): 1–22.
- Duquette A, Kerouac S, Sandhu BK and Beaudet L (1994) Factors related to nursing burnout: A review of empirical knowledge, Issues in Mental Health Nursing, 15: 337–58.
- Nyssen AS, Hansez I, Baele P, Lamy M and De Keyser V (2003) Occupational stress and burnout in anaesthesia, British Journal of Anaesthesia, 90: 333–7.
- Hart PM and Cooper CL (2001) Occupational stress: Toward a more integrated framework, in N Anderson, Handbook of industrial, work and organizational psychology, volume 2, Sage(ebook).
- Lu H, While AE and Barriball KL (2005) Job satisfaction among nurses: A literature review, International Journal of Nursing Studies, 42(2): 211–27.
- Guveli H, Anuk D, Oflaz S, Guveli ME, Yildirim NK, Ozkan M and Ozkan S (2015) Oncology staff: burnout, job satisfaction and coping with stress Psycho-Oncology, 24: 926–31.
- Trufelli DC, Bensi CG, Garcia JB, Narahara JL, Abrão MN, Diniz RW, Da Costa Miranda V, Soares HP and Del Giglio A (2008) Burnout in cancer professionals: A systematic review and meta-analysis, European Journal of Cancer Care 17: 524–31.
- Toh SH, Ang E and Devi MK (2012) Systematic review on the relationship between the nursing shortage and job satisfaction, stress and burnout levels among nurses in oncology/haematology settings, International Journal of Evidence-Based Healthcare, 10: 126–41.
- Adriaenssens J, De Gucht V and Maes S (2015) Determinants and prevalence of burnouts in emergency nurses: A systematic review of 25 years of research, International Journal of Nursing Studies, 52: 649–61.
- Canadas-De la Fuente GA, Vargas C, San Luis C, Garcia I, Canadas GR and De la Fuente EI (2015) Risk factors and prevalence of burnout syndrome in the nursing profession, International Journal of Nursing Studies, 52: 240–9.
- Khamisa N, Peltzer K and Oldenburg B (2013) Burnout in relation to specific contributing factors and health outcomes among nurses: A systematic review, International Journal of Environmental Research and Public Health, 10:2214–40.
- Clegg A (2001) Occupational stress in nursing: A review of the literature, Journal of Nursing Management, 9: 100–6.
- Brady AM, Fealy G, Casey M, Hegarty J, Kennedy C, McNamara M, O’Reilly P, Prizeman G and Rohde D (2015) ‘Am I covered?’: An analysis of a national enquiry database on scope of practice, Journal of Advanced Nursing, 71(10): 2402–12.
- Schluter J, Seaton P and Chaboyer W (2011) Understanding nursing scope of practice: A qualitative study, International Journal of Nursing Studies, 48(10): 1211–22.
- Eslick GD and Raj VV (2000) Occupational stress amongst Australian radiographers: Prevalence, risk factors, job satisfaction and impact, The Radiographer: The Official Journal of the Australian Institute of Radiography, 47(3): 129–33.
- Bakker AB and Costa PC (2014) Chronic job burnout and daily functioning: A theoretical analysis, Burnout Research, 1:112–19.
- Miller JF (2011) Burnout and its impact on good work in nursing, Journal of Radiology Nursing, 30(4): 146–9.
- Hayes LJ, O’Brien-Pallas L, Duffield C, Shamian J, Buchan J, Hughes F, Spence Laschinger HK and North N (2012) Nurse turnover: A literature review – an update, International Journal of Nursing Studies, 49(7): 887–905.
- Skakon J, Nielsen K, Borg V and Guzman J (2010) Are leaders’ well-being, behaviours and style associated with the affective well-being of their employees? A systematic review of three decades of research, Work & Stress, 24(2): 107–39.
- Silla I and Gamero N (2014) Shared time pressure at work and its health-related outcomes: Job satisfaction as a mediator, European Journal of Work and Organizational Psychology, 23(3): 405–18.
- Scanlan JN and Still M (2013) Job satisfaction, burnout and turnover intention in occupational therapists working in mental health, Australian Occupational Therapy Journal, 60: 310–18.
- Rickard CM, Roberts BL, Foote J and McGrail MR (2007) Job satisfaction and importance for intensive care unit research coordinators: Results from binational survey, Journal of Clinical Nursing 16: 1640–50.
- Howard AJ, Ferguson M, Wilkinson P and Campbell KL (2013) Involvement in research activities and factors influencing research capacity among dietitians, Journal of Human Nutrition and Dietetics, 26 (Suppl.1): 180–7.