Predictors of professional burnout and fulfilment in a longitudinal analysis on nurses and healthcare workers in the COVID-19 pandemic

Abstract

Aims and objectives: (1) To investigate the vulnerability of nurses to experiencing professional burnout and low fulfilment across 5 months of the COVID-19 pandemic. (2) To identify modifiable variables in hospital leadership and individual vulnerabilities that may mitigate these effects.

Background: Nurses were at increased risk for burnout and low fulfilment prior to the COVID-19 pandemic. Hospital leadership factors such as organisational structure and open communication and consideration of employee opinions are known to have positive impacts on work attitudes. Personal risk factors for burnout include symptoms of depression and anxiety.

Methods: Healthcare workers (n = 406 at baseline, n = 234 longitudinal), including doctors (n = 102), nurses (n = 94), technicians (n = 90) and non-clinical administrative staff (n = 120), completed 5 online questionnaires, once per month, for 5 months. Participants completed self-report questionnaires on professional fulfilment and burnout, perceptions of healthcare leadership, and symptoms of anxiety and depression. Participants were recruited from various healthcare settings in the southeastern United States. The STROBE checklist was used to report the present study.

Results: Both at baseline and across the 5 months, nurses working during the COVID-19 pandemic reported increased burnout and decreased fulfilment relative to doctors. For all participants, burnout remained largely steady and fulfilment decreased slightly. The strongest predictors of both burnout and fulfilment were organisational structure and depressive symptoms. Leadership consideration and anxiety symptoms had smaller, yet significant, relationships to burnout and fulfilment in longitudinal analyses.

Conclusions: Burnout and reduced fulfilment remain a problem for healthcare workers, especially nurses. Leadership styles and employee symptoms of depression and anxiety are appropriate targets for intervention.

Relevance to clinical practice: Leadership wishing to reduce burnout and increase fulfilment among employees should increase levels of organisational support and consideration and expand supports to employees seeking treatment for depression and anxiety.

Keywords: anxiety; burnout; depression; health personnel; hospital administration; leadership; nurses; patient health questionnaire; psychological.

FIGURE 1

Distributions of outcomes. Distribution of outcome (Burnout and Fulfilment) scores at each timepoint (survey) of the study period. Only participants who completed at least any 4 surveys are included, though the results are qualitatively equivalent when all participants are included.

FIGURE 2

Estimates of interaction effect between nursing occupation and organisational structure on fulfilment. Each line represents level of fulfilment for nurses only and doctors only at one standard deviation above, below and at the mean of organisational structure as measured at baseline.

FIGURE 3

Alluvial plot of survey participation. The height of the bar above the abscissa at each timepoint is the number of participants who completed the survey at that timepoint, while the depth of the bar below is the number of baseline participants who did not. Each participant is represented by a thin ribbon that tracks their participation at each timepoint, and like ribbons are joined for readability. These ribbons are colour‐coded by occupation. Each ribbon remains opaque until the first survey not completed.

FIGURE 4

Standardised effect estimates and three standard deviation confidence intervals from the nested sequence of longitudinal regression models of burnout and fulfilment. Effects of dummy indicators for categorical predictors are unadjusted, effects of continuous predictors are multiplied (equivalent to having divided the predictors) by twice the standard deviations of the predictors, and distributions of random effects are represented by twice their standard deviations.