|Year : 2019 | Volume
| Issue : 1 | Page : 61-68
Burnout among doctors and nurses at university of Port Harcourt Teaching Hospital, South-South Nigeria
Lillian Ngozi Ozumba, Ibidabo David Alabere
Department of Community Medicine, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
|Date of Web Publication||12-Jun-2019|
Dr. Lillian Ngozi Ozumba
Department of Community Medicine, University of Port Harcourt Teaching Hospital, Port Harcourt
Source of Support: None, Conflict of Interest: None
Background: Burnout is an occupational hazard prevalent in people-oriented services and is characterized by emotional exhaustion (EE), depersonalization (DP), and reduced sense of personal accomplishment (PA). Objective: The research was conducted to determine the occurrence of burnout and its associated factors among doctors and nurses at the University of Port Harcourt Teaching Hospital, South-South Nigeria. Materials and Methods: A descriptive, cross-sectional study design was used on a sample of 320 doctors and nurses at the University of Port Harcourt Teaching Hospital that were selected using a multistage sampling technique. A self-administered questionnaire containing the Maslach Burnout Inventory Survey among others was used to collect data. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 22 and statistical significance was set at 0.05. Results: Of 320 respondents, 76 (23.8%), 90 (28.1%), and 154 (48.1%) had high, moderate, and low EE, respectively. Furthermore, 47 (14.7%), 67 (20.9%), and 206 (64.4%) had high, moderate, and low DP, respectively while 96 (30%), 77 (24.1%), and 147 (45.9%) had low, moderate, and high PA, respectively. The prevalence of burnout syndrome was 4.7%. Significant factors associated with burnout included monthly earning (P = 0.020), professional grouping (P = 0.008) and days off work (P = 0.037). Specifically, doctors had higher levels of EE in comparison to the nurses (P = 0.005). Furthermore, those that were not satisfied with their jobs had high EE and high DP compared to those that had job satisfaction (P < 0.05). Conclusion: The prevalence of burnout syndrome was low and work-related characteristics played a significant role in the development of the phenomemon of burnout syndrome. Employers of health workers will need to create an enabling workplace environment where undue stress is minimal.
Keywords: Burnout, depersonalization, emotional exhaustion, personal accomplishment
|How to cite this article:|
Ozumba LN, Alabere ID. Burnout among doctors and nurses at university of Port Harcourt Teaching Hospital, South-South Nigeria. Arch Med Health Sci 2019;7:61-8
|How to cite this URL:|
Ozumba LN, Alabere ID. Burnout among doctors and nurses at university of Port Harcourt Teaching Hospital, South-South Nigeria. Arch Med Health Sci [serial online] 2019 [cited 2019 Dec 6];7:61-8. Available from: http://www.amhsjournal.org/text.asp?2019/7/1/61/260009
| Introduction|| |
Burnout has been recognized as an occupational hazard for different professionals involved in people-oriented services. Health-care professionals in all spheres of medicine are very crucial in the development of any society, and their well-being will basically affect the quality of services they render to the health sector. However, the medical profession is associated with a lot of stress arising from work overload and low level of job satisfaction which can lead to psychological distress and burnout among health professionals.
Burnout usually begins with a period of chronic stress characterized by a gradual loss of idealism, energy, enterprise, and future aim, resulting in emotional overload and exhaustion. If left unresolved, this period of stress predisposes health-care professionals to the burnout syndrome characterized by three elements namely emotional exhaustion (EE), depersonalization (DP), and reduced sense of personal accomplishment (PA).
EE is the central quality of burnout and the most obvious manifestation of this syndrome., It is the feelings of being depleted, over-exerted and fatigued by one's work. DP (also called cynicism) is the negative attitude and a dehumanizing treatment of one's clients in the workplace while reduced PA is the negative appraisal of one's behavior and performance in one's work.
The reported prevalence of burnout among health-care givers showed varied results globally, ranging from 25% to 60% among physicians and 15%–85% among nurses and midwives. A study conducted among doctors in Egypt reported a high prevalence of high EE 81%, high DP 64.3%, and low PA 58.2%. Similarly, a study carried out on burnout among health workers in North East Nigeria, found a high prevalence of EE 77.4%, high DP 37.1%, and low personalization 54%.
Professionally, burnout can lead to poor patient care, treatment errors, presenteeism, and absenteeism, all leading to reduced performance at work. Health-care professionals, therefore, require continuous education with a focus on stressors and emotional intelligence, to prevent or ameliorate burnout. There was a paucity of scientific data of burnout among doctors and nurses in the state of study, i.e., Rivers State and in the region of study, i.e., South-South of Nigeria. This study aimed to determine the prevalence of burnout and its associated factors among doctors and nurses at University of Port Harcourt Teaching Hospital, South-South Nigeria.
| Materials And Methods|| |
The study was conducted at the University of Port Harcourt Teaching Hospital which is located in Alakahia community, in Obio-Akpor Local Government Area of Rivers State, South-South Nigeria. It was carried out among doctors and nurses. Those included in the study were the doctors and nurses who have been in the employment of the hospital for more than 1 year but those absent from duty at the period of study were excluded.
Descriptive, cross-sectional study design was used in carrying out this research which lasted for 6 weeks. The sample size was calculated to be 324 using the Cochran formula, considering a 95% confidence level, 5% relative precision, and additional 20% nonresponse rate.
The selection of the study respondents was done using a multistage sampling technique. The first stage involved stratification of the clinical staff into doctors and nurses followed by allocation of proportionate subsamples based on their population and the last stage was a simple random sampling of the study participants in the various subunits according to proportionate sampling until the sample size was reached.
Data were obtained using a semi-structured self-administered questionnaire consisting of sociodemographic and work-related characteristics and the validated Maslach Burnout Inventory (MBI) survey which was adopted for this study to assess the level of burnout. The MBI survey is a self-administered, 22-item questionnaire comprised of three subscales namely: EE, DP, and PA. The EE subscale has 9 questions, DP has 5 questions, and PA has 8 questions. The MBI survey measures levels of burnout as either high, moderate, or low for each of the three subscales. The level of burnout is high if EE is ≥27, PA is ≤31, and DP is ≥13; moderate if EE is 17–26, PA is 38–32, and DP is 7–12; and low if EE is ≤16, PA is ≥39, and DP is ≤6. For both the EE and DP subscales, higher mean scores correspond to higher degrees of perceived burnout. Conversely, lower mean scores on the PA subscale correspond to higher degrees of perceived burnout. The psychometric properties of the MBI have been established in Nigeria. The obtained reliability coefficients are as follows: Cronbach alpha of 0.86 and split-half of 0.57 and a convergent validity of 0.01–0.36.
The sociodemographic variables included sex, age, marital status, and family size. Work-related variables included the years since qualification, number of years in practice, professional group, monthly salary, satisfaction with job, number of days off work, and consideration of changing job.
The data were analyzed using Statistical Package for Social Sciences (SPSS) version 22 (IBM, Armonk, New York, USA). Bivariate analysis was performed using Pearson's Chi-square. P ≤ 0.05 was considered statistically significant.
After obtaining ethical clearance from the institutional ethics committee and permission from the concerned authorities, written informed consent was obtained from each participant following a detailed explanation of the study objectives to them. Anonymity and confidentiality of the information were maintained.
| Results|| |
Out of the 324, 320 eligible respondents returned properly completed a questionnaire giving a response rate of 98.8%. The mean age of the respondents was 36.55 ± 7.23 years with 236 females (73.8%) and 188 married (58.8%). Respondents with up to 5 years since qualification numbered 117 (36.6%), with 129 (40.3%) having up to 5 years of practice experience, 191 (59.7%) were nurses, 117 (53.4%) had <1 week off duty, 210 (65.6%) were dissatisfied with their jobs, and 211 (65.9%) considered changing jobs.
Burnout level of respondents
[Table 1] shows that 170 (53.1%) had no burnout while 96 (30%) had burnout in one subscale only. The criteria for burnout syndrome is fulfilled when high scores are obtained in EE subscale (≥27–54), high scores in DP subscale (≥13–30), and low scores in PA subscale (0–31). Fifteen (4.7%) respondents fulfilled the criteria for burnout syndrome when the three subscales were considered together. Only 76 (23.8%) of the respondents had high EE, 47 (14.7%) had high DP, and 96 (30%) had low PA.
[Table 2] shows that there was a statistically significant relationship between monthly earning and burnout syndrome. Those who earned more than two hundred and fifty thousand naira had the highest proportion of burnout syndrome (P = 0.020). Furthermore, there was a statistically significant relationship between professional group and days off work with burnout syndrome. From the table, 11 (8.5%) doctors had a statistically significantly higher proportion of burnout syndrome compared to the nurses 4 (2.1%). Similarly, respondents who had burnout observed some days off work due to sickness experienced a greater degree of burnout syndrome compared to those who had less (10.6% vs. 3.7%; P = 0.037). There was no statistically significant relationship between years of qualification, years in practice, considered changing job and job satisfaction with burnout syndrome (P > 0.05).
|Table 2: Relationship between sociodemographic- and work-related characteristics and burnout syndrome|
Click here to view
[Table 3] shows that there was a statistically significant relationship between monthly earning, professional group, days off work, job satisfaction, and change of job consideration with EE (P < 0.05).
|Table 3: Relationship between sociodemographic- and work-related characteristics and emotional exhaustion among respondents|
Click here to view
[Table 4] shows that there is a statistically significant relationship between consideration of job change and job satisfaction with DP (P < 0.05).
|Table 4: Relationship between sociodemographic- and work-related characteristics and depersonalization among respondents|
Click here to view
[Table 5] shows that there is a statistically significant relationship between sex, professional group, days off work, years of qualification, consideration of job change, and job satisfaction with PA (P < 0.05).
|Table 5: Relationship between sociodemographic- and work-related characteristics and personal accomplishment among respondents|
Click here to view
| Discussion|| |
In this study, burnout syndrome was defined as high scores in EE (≥27), high scores on DP (≥13), and low scores in PA (≤31). The three subscales were combined into one variable known as high degree of burnout or burnout syndrome. This combination was used in a previous study. A high degree of burnout on all three subscales simultaneously was found in 4.7% of the respondents, whereas 53.1% of the respondents had only low-to-moderate levels of burnout on all three subscales. The remaining 42.2% showed a high level of burnout on at least one, possibly two, of the three subscales (in fact, exactly 30% showed high burnout on only one dimension). The level of high burnout in a study done among health workers in South-West Nigeria was higher than the rate found in this study (21.7% vs. 4.7%). This may be due to the inclusion of both clinical and nonclinical health workers in that study.
Neither the male or female gender were spared when it came to experiencing high degrees of burnout as there was no significant difference (4.8 vs. 4.7%) between them. This can be explained by the similar job stress faced daily by both gender at their workplace and the stance by women to prove their capability. The medical profession is no respecter of gender. However several studies have consistently found that the female health practitioners were at a higher risk of burnout.,, This was explained to be the result of females having to cope with the dual responsibilities of being a homekeeper and a health worker.
Overall, this study result showed that males had higher EE than their female colleagues as was noted in another study. The females may have experienced lower levels of EE because involvement with family and home organization tends to prepare them for challenges. The same cannot be said for men who spend more time fending for the family rather than bonding with them.
Furthermore, men were found to have higher PA than the females in this study. This conformed to the findings in a study where the females were found to experience reduced levels of PA. This may be due to the role of women in the society where it is their sole task of keeping the home front. This may delay or prevent their advancement in their chosen careers leading to reduced accomplishment. Furthermore, some women face and endure discrimination at their workplaces leading to stunted growth in their careers. Their greater responsibilities outside the workplace may explain their lower PA levels. A different study, however, found the opposite, that is, male health-care workers were at a higher risk of reduced PA than females.
In this study, being married and having a family size of more than four was shown to have higher burnout than those unmarried or with a lesser family size. This finding supports the assumption of the family workload as a factor of stress. Another possible explanation might be related to increased responsibilities associated with marital life and the possibilities of marital problems which may have negative emotional and behavioral changes on individuals. On the other hand, this finding disagrees with that of other studies, which found that being married was associated with low burnout.,, Married persons were likely to have support from their spouse or partner, and this invariably enhances their coping mechanism. They are generally older and more experienced making them likely to cope with stress in a more efficient manner.
Younger age (and also a lesser time of practice) was associated with higher levels of burnout in this study. This may be because the younger doctors and nurse are more likely to be the doctors-in-training (residents) and low cadre nurses, respectively. This group is exposed to longer working hours, high workload, and sleep deprivation. The older age group are more likely to be experienced and play supervisory roles in the workplace., accounting for their lower burnout scores. Contrastingly, a study found that older age and longer time of practice was significantly associated with high burnout.
Respondents who were dissatisfied with their jobs had significantly higher EE and DP scores than those who were content with their jobs. This conforms with findings of previous studies which have reported that burnout is significantly associated with low job satisfaction., This may be due to being in a stressful work environment, and the inability to control the workspace.
Furthermore, among the respondents with high burnout, a higher number of them expressed their intention to leave the job though this finding was not statistically significant (5.2% vs. 3.7%). Burnout, when considered with the MBI, particularly with the EE dimension, correlates significantly with the worker's intentions to leave the organization.
In this study, those who spent days away from work were found to have high burnout compared to those who spent none (10.6% vs. 3.7%). This result is similar to findings of some studies which reported that burnout was significantly associated with absenteeism attitudes and behaviors and presenteeism which compromises the quality of service.,, Those with burnout are likely to become ill and require sick leave to recover.
Doctors in this study showed high burnout levels than nurses (8.5% vs. 2.1%), which may be an indication that the higher intensive workload borne by the doctors leads not only to physical exhaustion but also to burnout. Specifically, doctors scored higher on EE and DP subscales, 32.6% and 15.5% when compared with nurses 17.8% and 14.1%, respectively. This finding was inconsistent with previous reports which demonstrated that nurses suffer higher burnout when compared to other hospital professionals., The higher burnout rates observed among doctors in this study were probably due to their long working hours, the burden of making life-saving decisions for their patients, shift duties and their emotional attachment to their patients.
The limitations in this study include the failure to compare burnout among specialties or departments which may have given a functional data for the management of the institution to work with. Therefore, our proposal for further research is to examine the differences in burnout and coping with burnout in the workplace among different specialties and departments in clinical practice. The study will, however, allow for comparison with data available in sub-Saharan Africa and serve as a source of information for comparison with other future studies on burnout to be conducted in Nigeria.
| Conclusion|| |
This study revealed a low occurrence of burnout (4.7%) among doctors and nurses in the study setting. In addition, it showed that work-related characteristics played a more significant role in the development of burnout than the sociodemographic characteristics. This finding further laid credence to the available research evidence that burnout is a product of work-related stress. There is therefore the need for health-care manager to provide an appropriate path in planning effective strategies that will further reduce the occurrence of burnout among doctors and nurses to enable them to provide better patient care.
The findings of this study may have important implications for intervention because the three dimensions of occupational burnout reflect professional specificity. This intervention includes the introduction of occupational health practices in health-care work settings or strengthening of existing occupational health practices where they are already established.
We would like to acknowledge the respondents who agreed to partake in this study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Welcome MO. The Nigerian Health Care System: Need for integrating adequate medical intelligence and surveillance systems. J Pharm Bioallied Sci 2011;3:470-8.
Lasebikan VO, Oyetunde MO. Burnout among nurses in a Nigerian general hospital: Prevalence and associated factors. ISRN Nurs 2012;2012:402157.
Ibikunle PO, Amah E, Useh U. Prevalence and pattern of burnout syndrome among healthcare professionals in a university teaching hospital. Trop J Med Res 2016;19:144. [Full text]
Okwaraji F, Aguwa E. Burnout, psychological distress and job satisfaction among secondary school teachers in Enugu, South East Nigeria. J Psychiatry 2015;18198:2.
Abayomi O, Emmanuel B, Gbolagade A, Peter O, Kofoworola O. Burnout syndrome and anxiety disorders among hospital nurses in a tertiary health center in Nigeria. Int Neuropsychiatr Dis J 2018;11:1-11.
Thorsen VC, Tharp AL, Meguid T. High rates of burnout among maternal health staff at a referral hospital in Malawi: A cross-sectional study. BMC Nurs 2011;10:9.
Mohammed K, Ali E, Youssef I, Fahmy M, Haggag W. Burnout and personality among Egyptian residents. Arab J Psychiatry 2013;44:1-13.
Pindar S, Coker A, Wakil M, Morakinyo O, Coker A. Comparison of burnout syndrome among clinical and non-clinical staff of two tertiary health institutions in Maiduguri, Nigeria. Transnatl J Sci Technol 2012;2:57-73.
Charan J, Biswas T. How to calculate sample size for different study designs in medical research? Indian J Psychol Med 2013;35:121-6.
] [Full text]
Leiter MP, Maslach C. Latent burnout profiles: A new approach to understanding the burnout experience. Burn Res 2016;3:89-100.
Al-Dubai SA, Rampal KG. Prevalence and associated factors of burnout among doctors in Yemen. J Occup Health 2010;52:58-65.
Stanetić K, Tesanović G. Influence of age and length of service on the level of stress and burnout syndrome. Med Pregl 2013;66:153-62.
Cishahayo E, Nankundwa E, Sego R, Bhengu B. Burnout among nurses working in critical care settings: A case of a selected tertiary hospital in Rwanda. Int J Res Med Sci 2017;5:5121-8.
Ashkar K, Romani M, Musharrafieh U, Chaaya M. Prevalence of burnout syndrome among medical residents: Experience of a developing country. Postgrad Med J 2010;86:266-71.
Marcelino G, Cerveira JM, Carvalho I, Costa JA, Lopes M, Calado NE, et al.
Burnout levels among Portuguese family doctors: A nationwide survey. BMJ Open 2012;2. pii: e001050.
Adekola B. Work burnout experience among university non teaching staff: A gender approach. Int J Acad Res Bus Soc Sci 2012;2:128.
Che XX, Zhou ZE, Kessler SR, Spector PE. Stressors beget stressors: The effect of passive leadership on employee health through workload and work – Family conflict. Work Stress 2017;31:338-54.
Maslach C, Leiter MP. Understanding the burnout experience: Recent research and its implications for psychiatry. World Psychiatry 2016;15:103-11.
Aguwa EN, Nduka I, Arinze-Onyia SU. Assessment of burnout among health workers and bankers in Aba South local government area, Abia state, South East Nigeria. Niger J Clin Pract 2014;17:296-302.
] [Full text]
Rodrigues H, Cobucci R, Oliveira A, Cabral JV, Medeiros L, Gurgel K, et al.
Burnout syndrome among medical residents: A systematic review and meta-analysis. PLoS One 2018;13:e0206840.
Zubairi AJ, Noordin S. Factors associated with burnout among residents in a developing country. Ann Med Surg (Lond) 2016;6:60-3.
Kosan Z, Calikoglu EO, Guraksin A. Levels of burnout and their associated factors among physicians working in Northeast Anatolia. Niger J Clin Pract 2018;21:875-81.
] [Full text]
Sirsawy U, Steinberg W, Raubenheimer J. Levels of burnout among registrars and medical officers working at bloemfontein public healthcare facilities in 2013. S Afr Fam Pract 2016;58:213-8.
Olivares-Faúndez VE, Gil-Monte PR, Mena L, Jélvez-Wilke C, Figueiredo-Ferraz H. Relationships between burnout and role ambiguity, role conflict and employee absenteeism among health workers. Ter Psicol 2014;32:111-20.
de Paiva LC, Canário AC, de Paiva China EL, Gonçalves AK. Burnout syndrome in health-care professionals in a university hospital. Clinics (Sao Paulo) 2017;72:305-9.
Suñer-Soler R, Grau-Martín A, Flichtentrei D, Prats M, Braga F, Font-Mayolas S, et al
. The consequences of burnout syndrome among healthcare professionals in Spain and Spanish speaking Latin American countries. Burnout Res 2014;1:82-9.
Belita A, Mbindyo P, English M. Absenteeism amongst health workers – Developing a typology to support empiric work in low-income countries and characterizing reported associations. Hum Res Health 2013;11:34.
Kumar S. Burnout and doctors: Prevalence, prevention and intervention. Healthcare (Basel) 2016;4. pii: E37.
Al-Turki HA, Al-Turki RA, Al-Dardas HA, Al-Gazal MR, Al-Maghrabi GH, Al-Enizi NH, et al.
Burnout syndrome among multinational nurses working in Saudi Arabia. Ann Afr Med 2010;9:226-9.
] [Full text]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]