Occupational Burnout among Nursing Professionals: A Comparative Analysis of 1103 Polish Female Nurses across Different Hospital Settings

Abstract

Burnout is common in public trust professions that help people, particularly in healthcare. Professional burnout is a psychological syndrome of emotional exhaustion, depersonalization, and a lowered sense of personal achievement in individuals who work with other people. Research has also shown that occupational burnout can result from the incompetence of employees. This study aimed to examine the occupational burnout and coping strategies among nurses working in different hospital settings. A study group consisted of 1103 Polish female nurses working in non-invasive, intensive care, and surgical units. The following validated tools were used: the Maslach Burnout Inventory (MBI) and the Mini-COPE questionnaire. The largest contribution in occupational burnout was depersonalization (mean score of 51.57) and, to a lesser extent, emotional exhaustion (mean score of 47). The smallest impact was recorded for job satisfaction (mean score of 28.76). Nurses in surgical departments were younger, less burned out, and dealt with stress better than nurses in non-invasive and intensive care units. Nurses in non-invasive wards were the most burned out among the study sample. Nurses in intensive care experienced the least satisfaction from work. In conclusion, professional burnout in nurses depends on the hospital settings, and this specification should be considered in recognizing this problem among nurses. Considering coping strategies, the results suggest a need for tailored coping interventions and support programs specifically designed for nurses working in high-stress environments such as the intensive care unit and non-invasive ward. Given that surgical nurses demonstrated better coping strategies, there is an opportunity to share their best practices with nurses in the intensive care unit and non-invasive ward. In the long-term perspective, investing in the well-being of healthcare workers can lead to a more sustainable healthcare system. By reducing turnover rates and improving the quality of care, sustainable practices can improve the efficiency and effectiveness of healthcare systems.

1. Introduction

Occupational burnout occurs most often in professions of public trust that involve helping other people, which is especially the case in nursing [1]. Nurses work with many people, including patients, families, and co-workers, which exposes them to occupational burnout [2,3]. Therefore, occupational burnout is a pressing problem for health services worldwide [3], contributing significantly to employee departure [4]. Possible causes of professional burnout may include handling additional requests from patients and families, feelings of disrespect, a lack of teamwork and cooperation with other healthcare professionals, and poor coping skills [5].

Burnout is a psychological syndrome of emotional exhaustion and depersonalization that leads to a reduced sense of personal achievement, which often occurs in professionals working with other people [6]. According to Maslach’s concept, occupational burnout results from a disrupted relationship between an individual and the work environment and an employee’s maladjustment to such an environment [7,8,9]. Christina Maslach is the author of a multidimensional approach to burnout and co-author of the most popular burnout questionnaire—the Maslach Burnout Inventory (MBI) [10]. The World Health Organization (WHO) has also described burnout, defining occupational burnout as a syndrome of exhaustion, negativity, and reduced personal effectiveness because of long-term untreated work stress [11].

People affected by professional burnout often lose commitment and experience a sense of purposelessness. They are characterized by ambivalence between a sense of omnipotence and complete incompetence. The source of burnout may be too strong a commitment to the work performed (often without expectation of increased pay or prestige), especially observed in young people [12,13]. Without a doubt, nurses experience the highest levels of stress among medical staff. Nurses are exposed to additional stressors at work. These stressors include long working hours, personnel shortages, emotional burden, conflicts, and insufficient financial and emotional support [14,15].

Previous studies confirmed that nursing is the most stressful job among the 40 analyzed professions [16]. Perceived stress has the most significant impact on nurses’ burnout than any other factor [17]. Lazarus and Folkman [18] defined perceived stress as a reaction to the environment that threatens mental health and abilities of the individual. The term “perceived stress” refers to the subjective experience of stress rather than a quantifiable measure. The individual’s subjective perception of a stressful situation holds greater significance in influencing their performance [19].

The nursing profession is a high-demand field that necessitates the ability to work under physically and emotionally demanding circumstances. Previous studies emphasize the need for programs that prevent burnout and compassion fatigue by enhancing compassion satisfaction and addressing work-related risk exposure [20]. Therefore, the effective management of burnout can be achieved through psychological empowerment, which can be facilitated by enhancing the quality of work life [21].

Occupational burnout causes employees to no longer feel satisfied with the work performed. This situation is accompanied by constant fatigue, irritability, and anxiety. Burned out employees perceive no positive results from their duties as a result of stressful working conditions, and the individual’s strength is exhausted. The occurrence of burnout in nurses is negatively associated with work-related variables, such as spending more time with colleagues and patients and reporting good-quality relationships. Psychological variables such as stress factors (e.g., conflict, social acceptance, irritability, tension, and fatigue) and communication (informative) are identified as burnout risk factors. Conversely, communication skills, empathy, energy, and joy have a protective effect against burnout [22].

Therefore, preventing burnout among healthcare professionals is not only important for the well-being of individual healthcare workers but also for the sustainability of healthcare systems [23]. Burnout can lead to high turnover rates, which can result in the loss of experienced and skilled healthcare workers, as well as increased recruitment and training costs. Moreover, healthcare workers who experience burnout may exhibit decreased productivity and provide lower-quality care to patients, which can ultimately affect patient outcomes and satisfaction.

So far, there is limited research on burnout and coping strategies among nursing professionals [24,25,26]. There is a need for comprehensive studies that specifically examine burnout and coping strategies within the nursing profession. While burnout is recognized as a significant issue, there may be gaps in the understanding of the specific factors contributing to burnout and the effectiveness of the coping strategies employed by nurses. In addition, there is a lack of comparative analysis across different nursing settings [27,28]. Understanding the variations in burnout levels among nurses working in different units, such as intensive care units, non-invasive wards, and surgical wards, remains limited. Comparative analysis can shed light on the unique challenges and stressors faced by nurses in each unit, as well as the coping strategies utilized to manage those challenges.

Therefore, this study aimed to assess occupational burnout and coping strategies among nursing professionals. We also aimed to compare the differences in the levels of burnout among nurses working in intensive care units, non-invasive wards, and surgical wards. Based on the main aim of the study, two research hypotheses were formulated: (i) nurses working in non-invasive wards experience higher levels of burnout compared to nurses in other hospital settings and (ii) nurses working in intensive care units report lower levels of job satisfaction compared to nurses in other hospital settings.

2. Materials and Methods

2.1. Design and Settings

This cross-sectional study was carried out in Poland using an online survey conducted from May to October 2021. The online data collection mode was used primarily due to the COVID-19 pandemic and the associated restrictions on in-person interactions. Moreover, online data collection offered convenience and flexibility for participants, enabling them to complete the surveys at their own convenience, which likely increased the response rate. The study used authorized questionnaires that collected sociodemographic data and standardized instruments such as the Maslach Burnout Inventory (MBI) and the Mini-COPE questionnaire. The study group consisted of 1103 female nurses, 362 of whom worked in non-invasive wards, 543 in surgical wards, and 198 in intensive care units.

2.2. Ethical Considerations

The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the independent Bioethics Committee of the Wroclaw Medical University, protocol no. KB-521/2014. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guidelines were followed.

2.3. Burnout Syndrome

The MBI questionnaire measures occupational burnout in three aspects (subscales): emotional exhaustion, depersonalization, and job dissatisfaction. The subscales are expressed from 0 to 100, where a higher score indicates a higher level of occupational burnout. The overall occupational burnout is also given, which is the mean calculated from the three subscales. In this study, the average general burnout score was 42.44 points out of 100 possible points [29].

2.4. Coping Strategies

The Mini-COPE questionnaire assesses coping strategies with stress in healthy adults and patient populations. The Mini-COPE questionnaire measures the frequency of using 14 coping strategies. The frequency of coping strategy was expressed by the respondents on a scale of 0–3, where “0” indicates “I almost never do this”, “1” indicates “I rarely do this”, “2” indicates “I often do this”, and “3” indicates “I almost always do that” [30,31].

2.5. Statistical Analysis

The mean, standard deviation, median, and quartiles were calculated for the quantitative variables. In the case of non-normal distributions (as we have in our study), median and quartiles are more robust than mean and SD (less sensitive to outliers) measures of central tendency and dispersion. The analysis of qualitative variables was performed using the frequency (numbers and percentages were given). The comparison of qualitative variables in the groups was performed using the chi-square test (with Yates’s correction for 2 × 2 tables) or Fisher’s exact test for tables with low expected values. The comparison of quantitative variables in the three groups was performed using the Kruskal–Wallis test. Omnibus Kruskal–Wallis test only shows if there are some significant differences among groups. Dunn’ test tells us exactly which groups differ. Significant differences between the groups were analyzed with a post-hoc Dunn test. A significance level of 0.05 was adopted in the analyses. The R program, version 4.1.2, was used for the calculations.

3. Results

In the surgical ward nurses (n = 543), 47 completed medical studies, 84 completed secondary medical schools, 312 finished undergraduate nursing school, and 100 respondents were graduate nurses. Among intensive care nurses (n = 198), 21 completed medical studies, 33 finished medical secondary schools, and 144 equally graduated from undergraduate and graduate studies. Among intensive care nurses (n = 362), 27 completed medical studies, 118 finished medical secondary schools, 98 finished undergraduate nursing school, and 119 respondents were graduate nurses. Nurses from the surgical ward were most likely to work 8 h shifts (n = 183, 33.70%), while nurses from the non-invasive ward were most likely to work 12 h shifts (n = 313, 86.46%). The city was definitely most often inhabited by nurses from the surgical ward (n = 484, 89.13%), while the village was most often inhabited by nurses from the non-invasive ward (n = 128, 35.36%). Nurses from the surgical ward most often worked in a specialized hospital (n = 332, 61.14%), nurses from the intensive care unit most often worked in university hospitals (n = 96, 48.48%), and nurses from non-invasive wards most often worked in provincial hospitals (n = 172, 47.51%). The sociodemographic data of the participants are shown in

Table 1. Sociodemographic characteristics of the group.

Parameter		Unit			p
		Surgical Ward—A	Intensive Care Unit—B	Non-Invasive Ward—C
Age (years)	mean SD	32.22 ± 13.36	37.96 ± 12.65	39.03 ± 12.78	<0.001 *
	median	24	35	38
	quartiles	22–45	26–49	26–51	C, B > A
Marital status	Single	94 (17.31%)	57 (28.79%)	115 (31.77%)	<0.001 *
	In relation with	449 (82.69%)	141 (71.21%)	247 (68.23%)
Education	Study	47 (8.66%)	21 (10.61%)	27 (7.46%)	<0.001 *
	Medium	84 (15.47%)	33 (16.67%)	118 (32.60%)
	Bachelor’s degree	312 (57.46%)	72 (36.36%)	98 (27.07%)
	Master’s	100 (18.42%)	72 (36.36%)	119 (32.87%)
Work system	8 h shifts	183 (33.70%)	36 (18.18%)	49 (13.54%)	<0.001 *
	12 h shifts	360 (66.30%)	162 (81.82%)	313 (86.46%)
Place of residence	City	484 (89.13%)	157 (79.29%)	234 (64.64%)	<0.001 *
	Village	59 (10.87%)	41 (20.71%)	128 (35.36%)
Workplace	District Hospital	75 (13.81%)	59 (29.80%)	172 (47.51%)	<0.001 *
	Specialistic hospital	332 (61.14%)	43 (21.72%)	70 (19.34%)
	University Hospital	136 (25.05%)	96 (48.48%)	120 (33.15%)

p—Kruskal–Wallis test and post-hoc analysis (Dunn’s test) for quantitative variables, chi-square test, or Fisher’s exact test for qualitative variables; * Statistically significant difference (p < 0.05). A—Surgical ward; B—Intensive Care Unit; C—Non-invasive Ward.

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The overall MBI score was the highest in nurses from intensive care units and non-invasive wards than in nurses from surgical wards (p < 0.001). At the same time, in all MBI domains, including emotional exhaustion (p < 0.001), depersonalization (p < 0.001), and lack of personal accomplishments (p < 0.001), nurses working in the surgical ward represented lower scores, indicating lower occupational burnout than nurses from intensive care units and non-invasive wards. Detailed results of the MBI are presented in

Table 2. MBI Burnout Questionnaire—comparison of clinical wards.

MBI		Unit			p
		Surgical Ward—A (n = 543)	Intensive Care Unit—B (n = 198)	Non-Invasive Ward—C (n = 362)
Overall MBI Score	mean SD	36.08 ± 30.29	47.1 ± 30.88	49.44 ± 33.45	<0.001 *
	median	17.04	39.72	40.56
	quartiles	17.04–53.43	17.04–77.01	17.04–93.33	C, B > A
Emotional exhaustion	mean SD	37.38 ± 38.78	55.95 ± 40.04	56.54 ± 41.81	<0.001 *
	median	11.11	55.56	66.67
	quartiles	11.11–88.89	11.11–100	11.11–100	C, B > A
Depersonalization	mean SD	48.58 ± 19.15	52.83 ± 25.39	55.36 ± 23.69	<0.001 *
	median	40	40	40
	quartiles	40–60	40–80	40–80	C, B > A
Job dissatisfaction	mean SD	22.28 ± 38.46	32.51 ± 40.14	36.43 ± 44.03	<0.001 *
	median	0	12.5	0
	quartiles	0–25	0–62.5	0–100	C, B > A

p—Kruskal–Wallis test and post-hoc analysis (Dunn’s test). * statistically significant relationship (p < 0.05). A—Surgical ward; B—Intensive Care Unit; C—Non-invasive Ward.

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Overall, the Mini-COPE score was the lowest in nurses from the intensive care unit and non-invasive ward than in nurses from the surgical ward (p = 0.001). In all coping strategies (besides the “Venting” strategy, p = 0.478), surgical nurses obtained higher scores and presented statistically significantly better coping strategies than nurses from the intensive care unit and non-invasive wards: Substance Use, Behavioral Disengagement, Self-blame (p < 0.001), Active Coping, Planning, Positive Re-evaluation, Acceptance, Sense of h=Humor, Turning to Religion, Seeking Emotional Support, Seeking Instrumental Support, Self-distraction (p = 0.001), and Denial (p = 0.003). Detailed results of the Mini-COPE are presented in

Table 3. Mini-COPE questionnaire—comparison of clinical wards.

Mini-COPE		Unit			p
		Surgical Ward—A (n = 543)	Intensive Care Unit—B (n = 198)	Non-Invasive Ward—C (n = 362)
Active Coping	mean SD	2.47 ± 0.82	2.18 ± 0.84	2.14 ± 0.92	0.001 *
	median	3	2.5	2.5
	quartiles	2–3	1–3	1–3	A > B, C
Planning	mean SD	2.57 ± 0.66	2.26 ± 0.73	2.27 ± 0.75	0.001 *
	median	3	2	2.5
	quartiles	2–3	1.5–3	1.5–3	A > C, B
Positive Re-evaluation	mean SD	2.43 ± 0.87	2.02 ± 0.91	2.03 ± 0.94	0.001 *
	median	3	2	2
	quartiles	1.75–3	1–3	1–3	A > C, B
Acceptance	mean SD	2.63 ± 0.58	2.26 ± 0.73	2.37 ± 0.64	0.001 *
	median	3	2	2
	quartiles	2–3	2–3	2–3	A > C, B
Sense of Humor	mean SD	0.34 ± 0.58	0.64 ± 0.69	0.62 ± 0.67	0.001 *
	median	0	0.5	0.5
	quartiles	0–1	0–1	0–1	B, C > A
Turning to Religion	mean SD	0.48 ± 0.86	0.8 ± 0.99	0.91 ± 1.01	0.001 *
	median	0	0	0
	quartiles	0–0.5	0–2	0–2	C, B > A
Seeking Emotional Support	mean SD	1.6 ± 0.81	1.4 ± 0.88	1.32 ± 0.95	0.001 *
	median	2	2	2
	quartiles	1.5–2	1–2	0–2	A > B, C
Seeking Instrumental Support	mean SD	1.6 ± 0.79	1.4 ± 0.87	1.3 ± 0.94	0.001 *
	median	2	2	2
	quartiles	1.5–2	1–2	0–2	A > B, C
Self-distraction	mean SD	2.47 ± 0.83	2.06 ± 0.92	2.04 ± 0.95	0.001 *
	median	3	2	2
	quartiles	2–3	1–3	1–3	A > B, C
Denial	mean SD	0.91 ± 0.37	0.86 ± 0.51	0.85 ± 0.45	0.003 *
	median	1	1	1
	quartiles	0.75–1	0.5–1	0.5–1	A > B, C
Venting	mean SD	1.49 ± 0.32	1.45 ± 0.45	1.48 ± 0.38	0.478
	median	1.5	1.5	1.5
	quartiles	1.5–1.5	1.5–1.5	1.5–1.5
Substance Use	mean SD	0.38 ± 0.66	0.53 ± 0.77	0.63 ± 0.84	<0.001 *
	median	0	0	0
	quartiles	0–0.5	0–1.38	0–1.5	C, B > A
Behavioral Disengagement	mean SD	0.42 ± 0.66	0.71 ± 0.71	0.68 ± 0.72	<0.001 *
	median	0	0.5	0.5
	quartiles	0–1	0–1.5	0–1.5	B, C > A
Self-blame	mean SD	2.43 ± 0.89	1.94 ± 0.97	1.92 ± 1.02	<0.001 *
	median	3	2	2
	quartiles	1.5–3	1–3	1–3	A > B, C

p—Kruskal–Wallis test and post-hoc analysis (Dunn’s test). * Statistically significant relationship (p < 0.05). A—Surgical ward; B—Intensive Care Unit; C—Non-invasive Ward.

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4. Discussion

The present study examined professional burnout in the population of Polish nurses; 1103 women working in the surgical (n = 543), intensive care (n = 198), and non-invasive (n = 362) wards participated in the study. Christina Maslach’s questionnaire was used to determine occupational burnout. We found that overall occupational burnout was 42.44 points (SD = 32.07). The research results obtained here are consistent with the overall burnout index of 36.98 (SD = 21.94) reported in other studies [29].

The MBI showed that depersonalization was the main cause of occupational burnout in Polish nurses. In contrast, emotional exhaustion contributed to a lesser extent to professional burnout in nurses, and job dissatisfaction had the least impact on this phenomenon. Similar relationships were obtained by Wilczek-Rużyczka et al. [32]. In their study, a significant correlation was found between work stress and occupational burnout.

Nurses in the intensive care unit had better education than nurses from the non-invasive ward, and the least educated nurses were from the surgical unit. This may be due to the fact that ICU nurses are relatively young, so they have the strength and desire to improve their skills. The components of occupational burnout were significantly lower in nurses in surgical wards (17.4 points) and in those who felt fully satisfied with their profession. In the intensive care and non-invasive wards, nurses felt burnout to a greater extent (39.72 points and 40.56 points, respectively) than in the surgical departments, and emotional exhaustion was the most experienced emotion by these two groups. Despite their better education, nurses from intensive care units reported the lowest job satisfaction (12.5 points). Kędra et al. [33] stated that the main cause of occupational burnout is the feeling of dissatisfaction with the work performed, as confirmed by the present study. The study demonstrated that nurses with higher education were more burned out at work, as indicated by Falba et al. [34], who suggested that this effect may result from increased feelings of responsibility and overburdening with duties.

The present results led us to the conclusion that nurses from surgical departments may have better coping strategies for handling burnout than nurses working in non-invasive and intensive care units. It is worth noting that nurses from surgical units were significantly younger than nurses from other units. The study used the Mini-COPE questionnaire to evaluate 14 stress coping strategies. We found that nurses in surgical units coped best with stress by actively using positive strategies. Similar results were observed in a previous study [35], emphasizing the relationship between coping strategies and the age of nurses.

The above-mentioned study suggested that younger nurses more often chose strategies of positive re-evaluation, a sense of humor, and self-distraction, similar to the research findings we presented here. To sum up, sustainable practices that support the well-being of healthcare workers, especially nursing professionals, can help mitigate the negative effects of burnout and promote a healthier and more resilient workforce. These practices can include providing adequate resources, such as staffing and equipment, to reduce workload and prevent burnout. Additionally, offering education and training programs to healthcare workers can help them develop coping strategies and resilience to stressors in the workplace.

4.1. Study Limitations

In our study, we are not able to conclude which work system influences professional burnout among Polish nurses. In Poland, nurses have only two employment options. The 8 h on-call system is worked in the morning, usually starting from 7 a.m., and nurses in this system work from Monday to Friday. Nurses on 12 h shifts work both night and day, regardless of the day of the week. There is usually the same amount of day duty as night duty throughout the month. In this study, we could not compare how gender affects burnout and stress management because only women participated in the study. The study was conducted during the height of the COVID-19 pandemic. It was a tough time for all professions, but it was especially tough for medics, including nurses. Working in hazmat suits, staff shortages, and illnesses of loved ones and themselves may have affected the results obtained from the questionnaires.

4.2. Practical Implications

In our study, nurses in behavioral health units showed the highest levels of burnout. It is important to pay attention to what causes this condition and to improve it. The lowest job satisfaction was reported by nurses working in intensive care units. The results may have been influenced by the period in which the surveys were collected. During the COVID-19 pandemic, many patients who ended up in the intensive care unit died. Due to the shift from intensive care units to COVID-19 wards, there was little variation in the number of single diseases. Routine and lack of therapeutic success may have affected the results. It is worth repeating the study in more favorable times to compare the results.

Considering coping strategies, the results suggest a need for tailored coping interventions and support programs specifically designed for nurses working in high-stress environments such as the intensive care unit and non-invasive ward. These programs can focus on providing strategies for active coping, planning, positive re-evaluation, acceptance, sense of humor, seeking emotional support, and seeking instrumental support. By equipping nurses with effective coping techniques and resources, such programs can help enhance their resilience, reduce stress levels, and promote their overall well-being.

Given that surgical nurses demonstrated better coping strategies, there is an opportunity to share their best practices with nurses in the intensive care unit and non-invasive ward. Creating opportunities for inter-departmental collaboration and knowledge exchange can allow nurses to learn from one another’s experiences and coping strategies. This can involve organizing workshops, seminars, or peer support groups where surgical nurses can share their effective coping techniques and experiences, providing valuable insights and inspiration for other nurses to develop their coping skills.

In the long-term perspective, investing in the well-being of healthcare workers can lead to a more sustainable healthcare system. By reducing turnover rates and improving the quality of care, sustainable practices can improve the efficiency and effectiveness of healthcare systems. This can lead to improved patient outcomes, increased patient satisfaction, and ultimately, a healthier and more productive population.

5. Conclusions

In conclusion, the study highlights the importance of addressing occupational burnout among nurses, particularly in the context of different hospital settings. The findings demonstrate that nurses working in non-invasive units experience higher levels of burnout, while surgical nurses present better coping strategies and lower levels of occupational burnout. These differences in burnout levels emphasize the importance of considering the clinical environment and implementing sustainable practices that support the well-being of healthcare workers.

The COVID-19 pandemic likely played a significant role in the observed associations, as it imposed increased work demands and heightened stress levels on healthcare professionals. The unique challenges and stressors faced by nurses in different units during the COVID-19 pandemic may have contributed to the variations in burnout levels and coping strategies identified in the study, highlighting the need for targeted interventions and support systems to promote the well-being of nursing professionals in such high-stress environments.

By implementing tailored coping interventions and facilitating knowledge sharing, healthcare organizations can promote a supportive work environment, enhance nurses’ coping abilities, and ultimately contribute to their resilience and well-being in high-stress healthcare settings. Preventing burnout and promoting the well-being of healthcare workers is essential for ensuring the long-term sustainability of healthcare systems. By investing in sustainable practices that support the well-being of healthcare workers, healthcare organizations can reduce turnover rates, increase productivity, and improve the quality of care provided to patients. Ultimately, sustainable healthcare systems are those that prioritize the well-being of healthcare workers and patients alike, ensuring a healthier and more productive workforce and population.