Author(s) year Country Title |
| Sample:
| Contributors to stress/BO | Mitigators against stress/BO |
1. Cañadas De La Fuente et al 20178 Spain Prevalence of burn-out syndrome in oncology nursing: A meta-analytic study |
| Across 17 included studies:
| Workload (volume and nature) Impact of relationship with patients and investment of care – long term but also terminal in many cases. Work location ((treatment centres vs palliative care) Investment in relationships and development of long-term relationships with patients Emotional commitment: Dealing with death (patients, and heightened awareness of own mortality); communicating bad news; supporting relatives; complex ethical decision-making PA: reported here as low, caused by a sense of ‘failure’ when patients die. | Not specifically studied in this paper, but suggestions by authors include: Orientation to role Specific ‘resilience’ training Managerial support/mentorship Supervision/individual and group as part of clinical workload |
2. Glover-Stief et al 202017 USA An exploratory descriptive study of compassion fatigue and compassion satisfaction: Examining potential risk and protective factors in advanced nurse practitioners |
|
| Time in role: participants practicing 5–10 years and>20 years had highest rate of CS, suggesting those new to role, or in mid-career (10–20 years in role) have lower CS scores and may therefore be at greater risk of BO. | Mindfulness practices=lower BO (statistically significant), meditative practices; support from family, co-workers, and administration=lower BO and CF, and higher CS. Presence and amount of support significant. Greater age=better CS; between 5 and 10 years, and over 20 years in practice=better CS; mid-range (10–20 years)=lower CS. Working hours/pattern, education & qualifications did not seem to impact. Professional relationships important; mentor relationships for new specialist nurses recommended |
3. Harris et al 201822 Canada/USA Estimating the association between burn-out and electronic health record-related stress among advanced practice registered nurses |
|
| Using EHRs decreases job satisfaction; EHR use is significantly associated with increasing frustration, having insufficient time for documentation, and spending time on EHRs at home, thus increasing BO. Remote EHR access significantly associated with BO. After adjusting for variables, insufficient time for documentation and increased frustration remain significantly associated with BO. High need to access EHRs remotely as unable to complete work in regular hours; use of EHGRs in outpatients setting=higher OR for BO, but not significant. | Medical scribes (UK equivalent=admin/med secretary) might mitigate BO associated with documentation. Authors comment that recognition of BO and widespread support available for physicians, but not for APNs |
4. Hayes et al 20157 Australia /NZ Work environment, job satisfaction, stress and burn-out among haemodialysis nurses |
|
| Higher BO levels among in-centre (ie, Hospital-based) haemodialysis nurses, when compared with nurses in satellite centres and in patient’s homes; work environment and job satisfaction scores deteriorate as patient numbers rise, but no obvious link to BO. BO positively correlated to lack of support, workload, conflict with physicians (BO rises as each of these factors increases), and negatively correlated with ‘getting things done, task requirements and feeling valued (BO rises as each of these factors decrease) Job satisfaction high, except in relation to pay. Job Stress is mostly generated by workload | Work environment (tertiary, satellite, rural or home) affects job satisfaction and stress and BO levels. Satisfaction scores increased with longer duration in the role, and when working as a home dialysis nurse (not satellite or hospital based). Greater satisfaction with work environment correlates with greater job satisfaction, lower job stress, and lower EE. Supportive work environment is important. Flexible management (fair, equitable managerial support, clinical support, fair rostering). Professional status, interactions with others, and autonomy increase job satisfaction. Nurses with more time in the role (16-20) years had higher job satisfaction than nurses with 3–5 years in the role. Support, workload management and reduced peer to peer conflict recommended to reduce BO and increase retention |
5. Kapu et al 201918 USA Assessing and addressing practitioner burn-out: Results from an advanced practice registered nurse health and well-being study |
|
| High EE and DP scores were associated with current BO. Lower health function scores are detrimental. Caring strongly for patients. Limited opportunities for advancement. Lower work–life balance. High reliance on peers. Working hard without recognition, no energy to commit to PA or exercise. No control over workload, poor support from supervisors who do not understand daily work-related struggles and barriers. Social withdrawal. | Older nurses reported less BO. Those with high PA scores were less likely to have current BO. Supportive relationships with peers/ colleagues, being appreciated, opportunities for career advancement. Breaks from work/leave/holidays, talking to others, seeking support. Personal hobbies, destress activities. PA can overcome previous episodes of BO. Changing work schedule, exercise, self-care measures, healthy eating, meditation, seeking therapy. Report recommends: * Self-care * Career development * Leadership support * Community and provides details of what each should entail |
6. Klein et al 202019 USA Exploring burn-out and job stressors among advanced practice providers |
|
| Contributors to BO-EE, DP, work pressure, lack of autonomy, role ambiguity. High correlation between job stressors and BO, and negative effect of job stress and work engagement. BO affects work engagement. Younger professionals experience higher levels of job stress. Role ambiguity, work pressures, lack of autonomy contribute to BO. High levels of EE and DP=lower PA. | Mitigators to BO-PA, vigour, dedication, absorption. Higher levels of work–family balance=lower job stress levels. Older professionals experience higher levels of engagement. Support needed for younger professionals transitioning into the role. Resolving work–family conflict. Social relationships are important. |
7. Neumann et al 201820 USA |
| APP group data only:
| Moral distress significant contributing factor to BO. BO more likely with inadequate work-life balance and low level of career satisfaction. High demand for direct patient care and related admin tasks leaves little time for personal and professional development activities and contributes to increased BO. | Identifies strategies recommended in other literature, including counselling, mindfulness, stress-reduction confidence-building, exercise, team building, adjustments to rostering, |
8. White 201821 Unpublished Masters thesis USA |
|
| Suggests that despite personal and work-related challenges, commitment to patients remains high. Also suggests that CNSs do not have significant BO or risk factors, but that BO appears to be more likely in experienced nurses (counter to all other evidence) BUT very small sample size. | No mitigating factors identified |
.ANOVA, analysis of variance; APN, advanced practice nurses; APP, advanced practice provider; BO, burn-out; BPEM, Brisbane Practice Environment Scale; BSS, Burn-out Status Survey; CBI, Copenhagen burn-out Inventory; CF, Compassion fatigue; CNS, Clinical Nurse Specialist; CS, compassion satisfaction; DP, depersonalisation; EE, emotional exhaustion; EHR, electronic health record; IWS, Index for Work Satisfaction; JSM, Job Stressors Measure; MBI, Maslach burn-out Inventory; MDS-R, Moral Distress Scale-Revised; NSS, Nursing Stress Scale; PA, Personal Accomplishment/Personal Achievement; SSCS, Social Support and Coping Scale ; UWES, Utrecht Work Engagement Scale; WFB, Work Family Balance.