Burnout among dirty healthcare workers during the COVID-19 pandemic

Burnout entre trabalhadores sujos na área da saúde durante a pandemia de Covid-19

Abstract

Purpose:  With chronic stressors and elevated interpersonal risks, the healthcare industry has witnessed a significant increase in burnout during the COVID-19 pandemic.

Originality/value:  The study represents an original effort to understand the burnout experience of Brazilian healthcare workers during the COVID-19 pandemic from the perspective of Boundary Theory. By adding specifics about the Brazilian context, it expands on the knowledge gene-rated by previous studies on burnout and boundary management.

Design/methodology/approach:  We constructed a grounded theory from interviews with 46 Brazilian nurses.

Findings:  The generated grounded theory found that the pandemic increased the incidence of boundary violations and unwanted disruptions between work and other important areas of life. Results demonstrate that such violations can be physical, temporal, or knowledge-based and are associated with reports of burnout. The study also identified specific patterns regarding boundary violations, where intrusion events are related to increased work demands while distancing events are related to reduced work resources. Furthermore, the interviewees employed specific tactics in response to different types of violations to redefine boundaries and seek to avoid or minimize burnout.

Keywords:
nurses; burnout; Boundary Theory; COVID-19; grounded theory

Resumo

Objetivo:  Este artigo tem como objetivo analisar a conexão entre o burnout e as violações das fronteiras entre trabalho e lar vivenciada por enfermeiros durante a pandemia de COVID-19 no Brasil.

Originalidade/valor:  O estudo representa um esforço inicial e original no sentido de compreender a experiência de burnout vivenciada por trabalhadores sujos brasileiros no contexto da pandemia da COVID-19 sob a ótica da Teoria das Fronteiras. Nesse sentido, expande-se o conhecimento gerado por estudos anteriores sobre burnout e gestão de fronteiras, adicionando especificidades do contexto brasileiro.

Design/metodologia/abordagem:  Foi construída uma Grounded Theory a partir de entrevistas com 46 enfermeiros brasileiros.

Resultados:  A Grounded Theory constatou que a pandemia gerou um aumento na incidência de violações de fronteiras, que são interrupções indesejadas entre o trabalho e outras áreas importantes da vida. Os resultados demonstram que tais violações podem ser físicas, temporais ou baseadas em conhecimento, estando associadas aos relatos de burnout. Identificou-se, também, que padrões específicos em relação às violações de fronteiras, nos quais eventos de intrusão estão relacionados a demandas de trabalho aumentadas, enquanto eventos de distanciamento estão relacionados a recursos de trabalho reduzidos. Além disso, os entrevistados utilizaram táticas específicas em resposta a diferentes tipos de violações para redefinir as fronteiras e buscar evitar ou minimizar o burnout.

Palavras-chave:
enfermeiros; burnout; Teoria das Fronteiras; COVID-19; teoria fundamentada

INTRODUCTION

Disruptive events, such as the COVID-19 pandemic, have profoundly impacted how individuals manage their roles across multiple professions (Campbell & Gavett, 2021). Consequently, frequent changes have occurred during and post-pandemic, with many workers experiencing simultaneous transformations in their work environments, leading to shifts in the interface between personal and professional life (Moss, 2021). Recent research indicates a significant decrease in home and workplace quality of life during this period (Ferreira et al., 2021; Rapp et al., 2021). Within this context, health issues related to work intensification, such as burnout, fatigue, emotional problems, and diminished perception of work meaning, are observed phenomena (Kandula & Wake, 2021; Moss, 2021).

In this context, Campbell and Gavett (2021) associate the increase in work demands as a contributing factor to reducing the perceived well-being in the workplace. Among the main reasons cited is the clear segregation between professional and personal life and the unintentional intensification of work (Campbell & Gavett, 2021). Overall, the pandemic has produced a perception of stress and destabilization in life organization (Shek, 2021). It is particularly relevant considering professionals engaged in dirty work, defined as activities or occupations characterized by negative stigmas despite their necessity for society (Hughes, 1962).

Individuals who work in stigmatized activities are equally tainted by the stigma, a condition that characterizes them as “dirty” workers (Pereira et al., 2022; Ashforth & Kreiner, 2014). Stigmatization is a socially constructed process related to contextual aspects (historical, social, moral) that render certain types of work or activities socially repulsive in some way (Hughes, 1962). In this sense, nursing professionals are considered dirty workers due to both physical stigmas-characteristic of occupations in direct contact with death-and social stigmas, which are related to contact with stigmatized individuals such as patients with contagious diseases (Ashforth & Kreiner, 2014). In Brazil, there was also observed moral stigmatization (Ashforth & Kreiner, 2014) due to the political context experienced during the Bolsonaro Government, which fostered disbelief in the severity-or even denial of the existence-of the COVID-19 pandemic (Folha de S. Paulo, 2020). This condition of extreme stigmatization (physical, social, and moral stigma) (Ashforth & Kreiner, 2014; Kreiner et al., 2022) tends to be compensated by intense dedication to work as a form of involuntary search for social legitimacy, which would increase the incidence of burnout (Felix et al., 2023c).

Healthcare workers are highly susceptible to burnout, a problem that tends to cause absenteeism and turnover (Farid et al., 2020; King et al., 2020). Nurses, in particular, experience high levels of physical and mental symptoms (Barello et al., 2020; Duarte et al., 2020) due to their proximity to patients and acute care environments, factors that contribute to burnout in terms of both frequency and intensity (Morgantini et al., 2020). During the COVID-19 pandemic, nurses were concerned about transmitting the virus to their families in addition to the fear of contracting the virus at work (Rapp et al., 2021). Similarly, there is evidence of a significant association between work that spills over into family life and nurses’ burnout in the pandemic scenario (Morgantini et al., 2020).

Given this issue, there is a recognized need to understand how the ambiva-lent experiences of being simultaneously seen as “heroes” and “vectors of virus transmission” (Sayılan et al., 2021) generate consequences for their mental and physical health, specifically burnout. Despite the contributions of studies conducted on the subject, we see opportunities to advance the discussion of burnout through the analysis of nursing as dirty work in Brazil’s context of the COVID-19 pandemic.

To address the emerging findings, this study adopted grounded theory, which allows for the discovery of new concepts and relationships through the voices of the participants studied (Charmaz, 2014). Thus, we adapted data collection efforts, and participants were systematically questioned about burnout, boundaries, and strategies adopted by healthcare professionals to prevent or reduce it. During the abductive analytical process, we observed that the pandemic had an unprecedented effect on the boundaries between work and personal life. Therefore, we used Boundary Theory (Ashforth et al., 2000; Felix & Bento, 2018; Nobrega & Felix, 2021) as a sensitizing concept (Felix et al., 2023a) to evaluate the factors related to work and personal life that contribute to burnout.

Thus, this article aimed to analyze the connection between burnout and violations of the boundaries between work and home experienced by nurses during the COVID-19 pandemic in Brazil. To this end, we conducted interviews with 46 Brazilian nurses. The study contributes to the burnout literature by challenging the hegemonic view that workers valued by society experience a resource increase that leads to better physical and mental health conditions (Hennekam et al., 2020).

Drawing from the Job Demands-Resources (JD-R) occupational stress model and the theory of boundaries (Ashforth et al., 2000; Nobrega & Felix, 2021), this study explains why nurses, despite being considered heroes, experienced an increase in burnout during the COVID-19 pandemic (Sayılan et al., 2021). The JD-R model has gained recognized credibility and widespread acceptance from the scientific community and in organizational practices for understanding burnout (Rattrie et al., 2019; Bakker & Demerouti, 2017). Its proven applicability makes it suitable for adoption in different occupational contexts (Rattrie et al., 2019; Bakker & Demerouti, 2014). In turn, the concept of dirty work (Pereira et al., 2022; Ashforth & Kreiner, 2014) brings an innovative perspective to understand the experience of burnout in nurses facing stigmas produced by the peculiarities of the Brazilian context during the COVID-19 pandemic.

The study emphasizes the importance of considering the boundary dynamics between work and home for nurse management, especially in ambivalent societal judgment contexts (Cavalcanti et al., 2022). Furthermore, it informs about the impacts of a macro-level structural shock (the COVID-19 pandemic) (Akkermans et al., 2020) on the relationships between the management dynamics of work-home boundaries and burnout.

LITERATURE REVIEW

Burnout among nurses: A perspective based on the JD-R model

Healthcare professionals face emotional and interpersonal challenges at work, especially when dealing with needy individuals and limited resources (Rapp et al., 2021). These demands can result in burnout, characterized by a response to mental and emotional stress characterized by three dimensions: overwhelming emotional exhaustion (being emotionally “burned out” of resources, with nothing left to give), detachment and cynicism (cognitive distancing to disengage from work), and inefficacy (a sense of worker failure) (Maslach, 1982; Maslach & Jackson, 1981). During the COVID-19 pandemic, healthcare professionals experienced burnout related to increased work demands and the loss of valuable resources (Rapp et al., 2021). In this sense, the Job Demands-Resources (JD-R) occupational stress model explains why burnout is more likely when work demands are excessively high or work resources are threatened or lost (Maslach, 1982).

For the JD-R model, work demands involve organizational, physical, psychological, and social components that require physical and mental effort (Mansur & Felix, 2021). Work resources represent components that support goal achievement and reduce the burdens associated with work demands (Maslach & Jackson, 1981; Maslach & Jackson, 1984). Burnout occurs when there is an imbalance between these two conditions (Maslach et al., 2001), and excessive work demands overload individuals, leading to chronic fatigue and emotional exhaustion (Felix & Papaleo, 2021). Conversely, the lack of resources can reduce employee motivation and engagement with work (Mansur & Felix, 2021), which is associated with increased employee disengagement and cynicism (Maslach, 1982). Therefore, employers must provide adequate resources to help reduce excessive work demands and prevent burnout (Rapp et al., 2021). It may include access to training and professional development, emotional and psychological support, and the implementation of healthy work policies and practices (Felix et al., 2023c).

The dominant argument in the literature is that, under conditions of positive reputation, such as the hero status nurses have acquired during the COVID-19 pandemic, the possibility of burnout could be reduced (Hennekam et al., 2020). However, alternative perspectives suggest that the possibility of social and intrapersonal valorization may lead to voluntary work intensification, as this mechanism can become a source of self-esteem (Deery et al., 2019). This dynamic tends to be experienced by a specific group of professionals: dirty workers.

Dirty work, stigma overcoming and burnout: What do we know so far

“Dirty work” is a relevant yet underexplored theoretical approach to understanding the experience of healthcare professionals regarding burnout. It refers to activities or professions deemed necessary but are stigmatized and considered degrading or disgusting (Hughes, 1962). Society, while demanding the execution of essential activities for the common good, also stigmatizes them, attributing a derogatory label to the work performed (Pereira et al., 2022). In the literature, those who work in these occupations are referred to as “dirty workers” (Pereira et al., 2022). In this article, we believe that delving into this concept will allow for a broader understanding of the implications of the COVID-19 pandemic for healthcare workers (Sharma et al., 2022), especially in professions such as nursing, where stigma is common.

Hughes’s classic work (1962) presents three reasons an occupation could be considered dirty: physical, social, or moral stigma. Physical stigma occurs when the typical activity of an occupation is commonly associated with death or debris or when it is performed in risky or dangerous contexts, as is the case with soldiers and mine workers (Tallberg & Jordan, 2021). Social stigma, on the other hand, originates from professions involving frequent contact with stigmatized collectivities or individuals, such as correctional officers and workers providing support to individuals infected with the AIDS virus, or occupations characterized by servile relationships with others, such as domestic workers and chauffeurs (Clarke & Ravenswood, 2019). Finally, moral stigma is related to professions associated with questionable virtues or the idea of sin, as in the case of strippers and casino workers, or when the worker employs approaches seen as inconvenient, such as debt collectors, celebrity photographers, and telemarketers (Ashforth et al., 2007).

Boundaries between the dirty work physical, social, and moral dimensions are not mutually exclusive (Ashforth & Kreiner, 2014). The nursing profession, especially in the context of the COVID-19 pandemic, can be considered an extreme case of dirty work, as it includes physical elements (dealing with virus-infected individuals), social elements (servile activities involving contact with stigmatized individuals), and even moral elements (because in the Brazilian context nurses were often seen as part of a conspiracy promoting a fake disease) (Mejia et al., 2021; Pereira et al., 2020a; 2020b).

Dirty workers often develop intergroup mechanisms to create a positive occupational identity and better cope with the negative judgments they receive (Ashforth & Kreiner, 1999). These psychological and social mechanisms tend to help dirty workers reduce their propensity for burnout by finding support and assistance within the occupational group to build a posi-tive outlook and a stronger support structure for work (Morales & Lambert, 2013). However, it is also possible to observe a tendency to voluntary work intensification and, consequently, burnout in cases of high levels of occupational identification (Felix et al., 2023a). In this study, we aim to expand the understanding of this phenomenon through the sensitizing approach of Boundary Theory (Ashforth et al., 2000).

Boundary Theory and boundary management: An alternative lens

The Boundary Theory is widely used to understand the dynamics between different life domains and the connection between different work-related identities (Nobrega & Felix, 2021). This perspective aids in understanding how individuals simplify the world in which they interact, establishing or deconstructing mental barriers between different spheres, such as “work” and “home”, “the company I work for”, or even “self” and “other” (Choroszewicz & Kay, 2020; Felix & Bento, 2018). From this perspective, boundaries can have different degrees of thickness and permeability. Thick and impermeable boundaries are characterized by the difficulty of one domain influencing another, while thinner and more permeable boundaries allow for more significant interaction between domains (Park et al., 2020).

Individuals can create boundaries with different degrees of thickness and permeability, such as between the domains of work and home, and they have preferences regarding this permeability (Leslie et al., 2019). However, when interacting with different domains that demand integration or segregation, individuals may encounter situations where their preferences are not congruent with those of others (Felix et al., 2023b). These situations can occur when the demands of one domain negatively affect the other or when undesired aspects of one domain encroach upon another (Leslie et al., 2019).

Consequently, workers tend to experience boundary violations, which involve the interpretation that an interaction disregards or ignores the desired degrees of permeability and thickness of the boundary between two domains (Kreiner et al., 2009). These violations are problematic as they generate stress in individuals, culminating in the imbalance between fundamental elements of their lives (Grotto & Lyness, 2022). Therefore, boundary management refers to individual or group actions that influence social, material, temporal, or symbolic delineations between two or more domains (Kreiner et al., 2009; Eller et al., 2016; Felix & Cavazotte, 2019).

Research context

The context of the COVID-19 pandemic in Brazil was marked by controversial statements from then-President Jair Bolsonaro, who frequently downplayed the severity of the disease and minimized the importance of public health measures such as mask-wearing and social distancing. Additionally, the former president also criticized the work of healthcare professionals, going as far as calling them “cowards” for fearing the disease (Folha de S. Paulo, 2020), which, in our analysis, intensified the stigmatization of these professionals. Bolsonaro also questioned the effectiveness of field hospitals built in several cities to address the growing demand for hospital beds (BBC News Brazil, 2020). These statements contributed to political polarization around the pandemic, making it difficult to coordinate efforts to control the spread of the disease and increase the death toll (The Lancet, 2021).

Brazilian nurses faced unprecedented challenges in combating the COVID-19 pandemic. Many experienced extended work hours, inadequate personal protective equipment, poor working conditions, and uncertainty regarding their health and well-being (Oliveira et al., 2020). Additionally, misinformation and lack of leadership from the federal government left many nurses and other healthcare workers without clear guidance on handling the pandemic (Sobreira & Juruena 2021). This lack of institutional support may have contributed to the emotional and physical exhaustion experienced by nurses and other healthcare workers in Brazil during the pandemic (Oliveira et al., 2020).

METHODS

Due to the lack of prior consistent theorization on the phenomenon of interest in this study, we adopted the grounded theory method (Charmaz, 2014). It entails an iterative approach where data collection and analysis co-occur in waves of fieldwork and data interpretation to formulate a substantive theory (Araujo & Álvaro-Estramiana, 2011). Choosing this methodological perspective facilitated obtaining insights into the interviewees’ experiences, as the iterative dynamics of data collection and analysis led to a constant restructuring of the interview protocol, formulation of follow-up questions, and deepening of emerging themes during the coding stages. To streamline the theorization process, we selected the nursery as a dirty work considered extreme because it entails physical, social, and moral stigmatizations. This choice allowed for the analysis of a context where the properties of the phenomenon were amplified, which is crucial for theory development (Eisenhardt, 2021).

We collected the research data in January 2021 and January 2022, culminating in 51 interviews after six waves of data collection and analysis. In addition to interviews, the analyzed data also included secondary sources such as institutional and personal communications shared by the participants. These communications encompassed social media posts and e-mails that were selected based on requests made to the interviewees and searches on search engines using the keywords “nurses” and “pandemic.” We collected 23 e-mails, 53 media articles, and seven institutional communications. They were all deemed relevant for field sensitization. Data triangulation provided greater clarity on contextual elements related to the phenomenon of interest, a strategy suggested by Gioia et al. (2013).

The access to the field was facilitated through theoretical sampling (Glaser & Strauss, 2017; Felix et al., 2023a), whereby the selection of new participants was guided by theoretical inquiries made in previous rounds of data analysis. The search for new interviewees involved a combination of convenience and snowball sampling methods (Morse, 2007; von Borell de Araujo et al., 2014) after each wave of collection and analysis. All participants voluntarily agreed to participate in the research. Their identities were kept anonymous. Table 1 shows the dominant demographic profile of the interviewees.

Table 1
Demographic profile of the interviewees

Demographic categories	n	%
State of residence
Espírito Santo	10	20%
São Paulo	8	16%
Rio de Janeiro	8	16%
Minas Gerais	8	16%
Maranhão	7	14%
Rio Grande do Sul	5	10%
Amazonas	5	10%
Gender
Female	35	69%
Male	16	31%
Age
Mean	34
Median	35
Range	21 to 65
Living arrangements with children	42	82%
Living arrangements with spouse or equivalent partner	17	33%
Minority ethnicities
Years of nursing experience	8
Mean	6
Median	0-27
Range	39	76%
Had COVID-19 infection?	38	75%
Was in frontline involvement in COVID-19 combat?	28	55%
Leadership role

The interviews lasted an average of 63 minutes, were recorded, and subsequently transcribed. During the analysis process, several steps were followed, as commonly practiced in grounded theory (Felix et al., 2023a; Byron & Laurence, 2015; Harrison & Rouse, 2014). In the first wave of data collection, we conducted 11 interviews, generating 113 initial codes. Our initial focus was to faithfully adhere to the informants’ expressions, avoiding extensive refinement of categories in this preliminary analysis. As the investigation progressed, we dedicated ourselves to discerning similarities and disparities among the various categories, resulting in a gradual reduction to a manageable number of 23 relevant categories.

Subsequently, we proceeded to assign labels or phrase descriptors to the second-order codes that were generated earlier. During this iterative process, our goal was to theoretically address the crucial question: “What is the underlying essence?” This inquiry generated additional questions and guided subsequent interviews, progressively focusing on emerging concepts and associations.

In the second-order analysis, we assessed whether the developing themes provided conceptual insights to clarify the research objective. We focused on emerging concepts that lack sufficient theoretical counterparts in the current literature. Once we established a viable set of themes and concepts, we followed the principle of theoretical saturation, transitioning from emerging second-order themes to more theoretical “aggregated dimensions” of second-order.

With the complete set of first-order expressions, second-order themes, and aggregated dimensions, we advanced in the analysis to develop our theo-retical model-a crucial phase in our research approach. This model orga-nizes our data visually and illustrates the progression from raw data to terms and themes throughout the analysis process. Figure 1 in the results section follows the guidelines of Gioia et al. (2013) and demonstrates the construction of first-and second-order codes, along with aggregated dimensions.

Figure 1
Dynamics of the work-home boundaries during the COVID-19 pandemic according to nurses

RESULTS AND DISCUSSION

A grounded theory generated from the data found that the pandemic increased boundary violations, understood as unwanted interruptions between work and other important life domains. The incongruity of bounda-ries between the individual’s preferred permeability and the environment led to boundary violations by intrusion, intensifying work demands, and boundary violations by distance, reducing nurses’ resources, thus favoring the incidence of burnout. Boundary management tactics of segmentation and integration were adopted to mitigate these impacts.

Figure 1 represents these relationships. The following sections present evidence for each category and the relationships that form the theorization proposed in this research.

The influence of an exogenous event on conflict predisposition

The data analyzed suggest that the COVID-19 pandemic can be con-sidered a macro exogenous event that intensely affected the ‘preferred permeability by the individual,’ which refers to the degree to which the interviewed nurses prefer thicker or thinner boundaries between work and home. Such events also influenced the “preferred permeability by the environment,” which is the degree to which family members, employers, and other significant individuals with whom the interviewees interact show that they live better by adopting thicker or thinner boundaries between work and home. In the following account, one interviewee highlights this finding.

I believe the pandemic has changed a lot in how I deal with the division between work and my home. I started to separate them much more. I want to protect my family because I do not want to be thinking about work when I am at home, especially since the number of deaths has increased so much. The hospital itself also began to expect me to separate more, to sanitize myself when entering there fully. Even my daughter started to demand more of this separation (E18, 39 years old, male, married, lives with wife and daughter).

Thus, similar accounts indicate that the macro event, represented by the COVID-19 pandemic, increased the necessity for nurses and other significant individuals with whom they interact to segment the work and home domains. When these workers’ preferences were like those of the other significant individuals who interacted (environment), it is characterized as “boundary congruence,” and the opposite led to “boundary incongruence.” This latter category leads to “boundary violations,” which is the perception that other significant individuals interacted in a way that disrupted the prefe-rence for segmenting or integrating work and home.

One of the interviewees reported that “I needed to sanitize myself when I entered the house, but my wife, a Bolsonaro supporter, got annoyed because she thought I was exaggerating” (E13, 31 years old, man, married, lives with wife and son). In this case, the violation reflects a preference of the wife to adopt thinner boundaries between work and home than those preferred by the worker (violation by intrusion). Another interviewee reported that “sometimes I was tired of so many protocols, and my boss kept nagging me, asking me to use hand sanitizer even on my soul; that was stressing me out” (E50, 27 years old, single, lives with mother and children). In this case, the violation shows a preference of the leader to adopt thicker boundaries between work and home than those preferred by the worker (violation by distance). The following topics discuss the three forms of boundary violations (cognitive, physical, and temporal) and their consequences for burnout.

Cognitive boundary violations

The first categorized form of boundary violation is cognitive. In these cases, the violation, whether by intrusion or distance, occurs because the nurse and the other significant individual with whom they interact (such as a family member, leader, or colleague) have different interpretations or knowledge regarding how to deal with the COVID-19 pandemic. The following sections present evidence for cognitive violations by intrusion and distance.

Cognitive boundary violation through intrusion and distance

Cognitive boundary violations by intrusion are those in which the interviewees reported that other significant individuals disagreed with the importance of adopting hygiene protocols recommended by the World Health Organization (WHO) and considered the adopted precautions exaggerated. In the various cases of “cognitive boundary violations by the intrusion,” the interviewed nurses said that their spouses mainly argued that there was an exaggeration in adopting hygiene protocols because it was a “manipulation of the global media” (E41), a “little flu” (E3), and an invention of communism (E30), for example. On the other hand, in the cases of “cognitive boundary violations by distance,” the participants reported a perception that different interpretations regarding health protocols led other significant individuals to demand greater care than what they had adopted, leading to an unwanted distance. Table 2 presents some statements from the interviewees that illustrate the cognitive boundary violations by intrusion and distance.

Table 2
Cognitive boundary violation through intrusion and distance

Cognitive boundary violations	Examples of evidence
Intrusion	“It’s very difficult because my husband doesn’t understand what COVID is, he doesn’t agree. He thinks it’s just a little flu, that it’s all made up by the media. Thinks that the field hospitals are an excuse for governors to steal. He doesn’t believe me when I tell him that there are a lot of people there. Then he ends up fighting with me, thinking that I’m being fussy about hygiene precautions” (E10, 26 years old, woman, married, lives with spouse).
	“The biggest problem for me is my father, who is a political fanatic and thinks COVID is a hoax. He criticizes me for wearing a mask, says it’s all lies. This upsets me a lot, makes me feel undervalued because I’m there seeing people suffering, dying. Sacrificing myself to follow the protocols and he not only doesn’t understand but criticizes me” (E16, 35 years old, man, single, lives alone).
Distance	My wife also works in a hospital, she’s a doctor and takes this pandemic thing very seriously. I do too, but she’s exaggerated! She ends up preventing me from touching her. We haven’t had sexual intercourse for months because of the pandemic, afraid of transmitting it to each other. I think it’s too much. I’m very upset about it” (E18, 39 years old, man, married, lives with wife and daughter).
	“I try to sanitize everything, but my son learns various things at school and has become my enforcer. He scolds me directly when I go to hug him, saying that at school they told him that I can’t touch him. The problem is that it’s been months like this. I can’t take it anymore. This is destroying me emotionally. How am I going to tell him that he’s wrong?” (E43, 25 years old, woman, divorced, lives with two children).

Cognitive boundary management tactics

In response to such violations, we identified that the interviewees adopted what we categorized as “cognitive boundary management tactics”. These tactics refer to weakening or strengthening the boundaries between work and home in response to different cognitions related to other significant individuals regarding hygiene protocols associated with COVID-19. The tactic “confronting violators” referred to actions aimed at explicitly showing the disagreement of the interviewed nurse with those who ignore the protocols of the World Health Organization (WHO) regarding the pandemic. On the other hand, the tactic “pretending dementia” refers to ignoring the observations of boundary violators upon realizing that it would not be possible to persuade them. Table 3 presents evidence that supported the creation of both tactics. As noted in the statements presented, these tactics are reported as a way to reduce boundary violations.

Table 3
Cognitive boundary management tactics

Cognitive boundary management tactics	Description	Examples of evidence
Confronting violators	Explicitly showing disagreement towards those who ignore the scientific viewpoint of the pandemic.	“I was feeling bad because I’ve always respected my father, but at one point I said: Wait a minute! It’s not like that! I was being criticized, called a liar, and I started showing testimonials from the WHO, from scientists, and confronting, even” (E38, 45 years old, woman, divorced, lives alone).
“Pretending to be oblivious”	Ignoring the remarks of violators when realizing that persuading them wouldn’t be possible.	“I pretend to be oblivious! It’s no use. My wife exaggerates and wants me to wear a mask even to sleep. Meanwhile, my mother doesn’t believe that what happens in the hospital is real. She thinks COVID is a invention of the globalist media. At a certain point, I started ignoring, because I was going crazy with so much pressure” (E42, 34 years old, man, married, lives with wife and two children).

Physical boundary violations

The second form of boundary violation is physical. In cases categorized under this code, the violation, whether by intrusion or distance, occurred when the nurse perceived that the person they interacted with did not respect their demand to restrict or increase physical contact. In the subsequent subtopics, we will show evidence of physical violations by intrusion and distance.

Physical boundary violations through intrusion and distance

The statements from the interviewees categorized as physical boundary violations by intrusion are those in which they reported that other significant individuals disregarded the degree of separation or proximity that they considered ideal regarding hygiene protocols recommended by the World Health Organization (WHO). In some cases, participants stated that they were “afraid” of contaminating family members and patients, primarily (intrusion), and that they would like to have more contact with children, spouses, parents, and patients (distance). Both situations were recurrent in the data, and the interviewees reported that their recurrence caused them high emotional distress, making it difficult for them to remain focused on their professional activities during the pandemic period. Table 4 shows some empirical evidence obtained from the participants’ statements that exemplify physical boundary violations by intrusion and distance.

Table 4
Physical boundary violations through intrusion and distance

Physical boundary management tactics	Description	Examples of evidence
Creating symbols of connection	Building an environment with photos and music that evoke emotional bonds with patients and their families to compensate for physical barriers.	“The people being treated here are possibly experiencing their last days of life, and they can’t even receive visits from their families in this difficult time. So, I did something I had never done before in my life as a nurse. I asked the family to send me photos, voice messages on WhatsApp, and other things that reminded them of their family. This made a difference. For some, it was a dignified farewell. For others, it gave them strength to fight. At home, I did the same thing. I send voice messages to my children, send them music, things to play at home so they can feel me there” (E1, 30 years old, man, married, lives with wife and children).
Creating transition rituals	Establishing hygiene routines that facilitate for oneself and others the need to physically segment spaces between home and work.	“I have a whole ritual now when I come home from work. I take off all my clothes at the door, sanitize my glasses, phone, everything with alcohol. This ritual is not just something physical, it has a psychological effect too because it helps me feel like I’m leaving all that tension, that environment of despair and crying that the hospital has become, outside. It’s a ritual that also helps my children clearly understand the boundaries for interacting with me. Until I do this, the care is multiplied by a thousand” (E50, 27 years old, woman, single, lives with mother and children).

Physical boundary management tactics

To minimize these violations, the interviewees adopted what we categorized as physical boundary management tactics. These techniques aim to segment or integrate the domains of work and home in response to the need to maintain distance from family members or to insert themselves more frequently than desired in the work environment. The tactic “creating symbols of connection” refers to constructing an environment with photos and music that remind patients and family members of their relational affective bonds to compensate for the physical distance imposed by the pandemic. Through this tactic, the interviewees sought to alleviate the suffering of those involved, employing an imaginative symbolic presence of patients’ family members in the hospital and themselves in their homes. The tactic “creating transition rites,” on the other hand, refers to establishing hygiene routines that facilitate for oneself and others the act of segmenting the spaces of home and work. Table 5 presents statements that underpin these two tactics that function as a mechanism to reduce boundary violations.

Table 5
Physical boundary management tactics

Physical boundary management tactics	Description	Examples of evidence
Creating symbols of connection	Building an environment with photos and music that evoke emotional bonds with patients and their families to compensate for physical barriers.	“The people being treated here are possibly experiencing their last days of life, and they can’t even receive visits from their families in this difficult time. So, I did something I had never done before in my life as a nurse. I asked the family to send me photos, voice messages on WhatsApp, and other things that reminded them of their family. This made a difference. For some, it was a dignified farewell. For others, it gave them strength to fight. At home, I did the same thing. I send voice messages to my children, send them music, things to play at home so they can feel me there” (E1, 30 years old, man, married, lives with wife and children).
Creating transition rituals	Establishing hygiene routines that facilitate for oneself and others the need to physically segment spaces between home and work.	“I have a whole ritual now when I come home from work. I take off all my clothes at the door, sanitize my glasses, phone, everything with alcohol. This ritual is not just something physical, it has a psychological effect too because it helps me feel like I’m leaving all that tension, that environment of despair and crying that the hospital has become, outside. It’s a ritual that also helps my children clearly understand the boundaries for interacting with me. Until I do this, the care is multiplied by a thousand” (E50, 27 years old, woman, single, lives with mother and children).

Temporal boundary violations

Finally, temporal boundary violations refer to situations where the violation, occurring by intrusion or distance, involved an unwanted boundary between work and home that impacted the interviewees’ time management. Table 6 presents examples of statements from the interviewees that supported the creation of the categories of temporal boundary violations by intrusion and distance.

Table 6
Temporal boundary violations through intrusion and distance

Temporal boundary violations	Examples of evidence
Intrusion	“Being a nurse was never something that received much attention from friends, neighbors. But suddenly, I found myself in the spotlight. In my free time, everyone asks me about how to prevent, if this is real, if it’s exaggerated, what the symptoms are, how many have died. So, work keeps intruding into my personal life all the time. It’s exhausting because I never seem to escape from this state of mental and emotional exhaustion” (E33, 51 years old, man, divorced, lives alone).
Intrusion	“Several times during the pandemic, I had to be called in emergency at the hospital. I did a lot of overtime, and I didn’t want to. I couldn’t take it anymore! I was exhausted!” (E40, 24 years old, woman, single, lives with spouse).
Distance	“I told my husband that if my daughters or my parents showed symptoms, he should call me. But when that happened, I was caught up in the chaos of the hospital, and he didn’t call me. At the end of the day, when I got home, they were there with a fever, with all the symptoms, and I was very upset. He wanted to spare me, but I was annoyed because that wasn’t the agreement. It made me even more worried in my day-to-day life” (E46, 34 years old, woman, married, lives with spouse, daughters, and parents).
	“You know, from seeing so many people dying, I lost my limit. I dehumanized myself and started to go into automatic mode of being available for work all the time. I even spent a week sleeping at the hospital during the most critical period. I would wake up and start working. A week without coming home. But to keep up with this pace, I went into autopilot. I didn’t feel anything for people anymore, they became numbers to me” (E39, 26 years old, woman, single, living with parents and brother).

Temporal boundary violations by intrusion are those in which the interviewees reported that significant others demanded their action at times that theoretically would not be related to the demanding domain (emergency calls to go to the hospital on days off, for example) or that forced them to be absent from a domain differently than desired. In several cases categorized as “temporal boundary violations by intrusion,” nurses reported being called into the hospital to attend emergencies caused by spikes in demand, so they needed to interrupt participation in vacation activities (E13), periods of sleep (E39), and teaching activities to their children at home (E23), for example. On the other hand, regarding “temporal boundary violations by other distance,” participants stated that they felt violated by not being able to spend the time they desired with their children, spouses, and parents, primarily. In some cases, it was necessary to sleep in the hospital for more than a week without going home (E37) and even to sleep in a hotel for a month to minimize the risks of contagion to family members.

Temporal boundary management tactics

To minimize these violations, participants reported adopting what we refer to as “temporal boundary management tactics.” These actions may mitigate the discomfort caused by boundary violations between work and home when demands encroach upon personal time for work or when there is insufficient time to be at home with family members.

The tactic of “creating time credits” involves meeting the demands of individuals from one domain to accommodate the high demand for time dedicated to another domain. It was common for participants to report a heightened dedication to children and spouses during vacations, knowing that upon returning to work, there would be limited time to care for them. Conversely, “limiting technological interactions” pertains to setting bounda-ries to avoid the tendency to check instant communication applications and hospital camera systems for patients’ current situations. Table 7 shows examples of empirical evidence supporting both tactics.

Table 7
Temporal boundary management tactics

Temporal boundary management tactics	Description	Examples of evidence
Creating time credits	Meeting demands from individuals in one domain, to accommodate the high demand for time to be dedicated to another domain.	“I was on vacation, and I took the opportunity to stay at home with my son a lot. And hug and kiss him a lot, because I knew that when I went back, I would be exposing myself to the virus again and would need to be careful. The overtime hours would come back, and I was aware of that. So, I knew I had to create an emotional credit with my son because it would be used soon after.” (E6, 25 years old, woman, married, lives with spouse and son).
Limiting technological interactions	Establishing boundaries to avoid the tendency to constantly check instant messaging apps and hospital camera systems to monitor patients’ situations.	“Every day I would come home and couldn’t disconnect. I kept ruminating, thinking if patient X needed something, if their condition had worsened. Everything happens so quickly with COVID. I was trying to learn because it’s something unknown. Especially in the beginning. But I needed to set limits. I set a time limit on my phone for using WhatsApp. I could only check it thirty minutes after I got home. The downside of this was that I started to become less human, I went from one extreme to the other. But if I hadn’t done that, I would have spent the whole day ruminating about what was happening.” (E2, 30 years old, man, single, lives with mother).

Boundary violations and their indirect effects on burnout

As previously described, boundary violations are divided into two categories: distance violations and intrusion violations. Considering distance violations, as evidenced in Tables 3, 5, and 7, respondents reported feeling deprived of interacting with their family members and patients. The lack of physical proximity hindered interaction, although greater closeness could help improve emotional states and dedication to patient recovery. This form of violation depleted individuals’ resources to cope with the demands of family members and patients, leading to states of emotional and physical exhaustion. As exemplified by E50, “I felt powerless, I could not hug my family members, I could not provide the support my patients needed the most. I was dwindling, getting exhausted because of it”. This account demonstrates that distance boundary violations depleted nurses’ resources and led them to experience burnout.

Intrusion boundary violations also contributed to burnout but through a different mechanism. As illustrated in Tables 3, 5, and 7, these violations increased demands on nurses, including being called into the hospital during rest periods, working overtime, and even requests to stay in hotels near the workplace. Furthermore, demands from the home domain also escalated, especially for those with school-age children or sick parents. As reported by E25, “Everyone demanded from me during this period. The hospital called me, and I was sleeping for two to three hours a night. My father contracted COVID-19 and was in the high-risk group, and my son needed support because he was not learning anything at school. I lost it, I crashed.” Accounts like this support the argument that intrusion boundary violations heightened demands on nurses, leading many to experience burnout.

DISCUSSION

This study analyzed the connection between burnout and boundary violations between work and home experienced by nurses during the COVID-19 pandemic in Brazil. The grounded theory revealed that the pandemic is a macro-exogenous event that promoted intrusion or distance boundary violations between work and home among nurses, leading to burnout. For each type of boundary violation (physical, cognitive, and temporal), boundary management tactics were adopted to alleviate the perception of these conditions (Ashforth et al., 2000; Choroszewicz & Kay, 2020).

The JD-R model allows for the analysis of the incidence of burnout based on the intensification of work demands and depletion of resources in these conditions (Ashforth et al., 2000; Choroszewicz & Kay, 2020). This perspective assumes that every organizational environment comprises specific job resources and job demands that either increase or decrease well-being. In this relationship, the reduction in well-being perception is associated with emotional exhaustion, which characterizes burnout (Akkermans et al., 2013; Schaufeli & Taris, 2014). In this sense, the various boundary violations between work and home emerged as a driving factor in the imbalance between demands and resources, leading to burnout due to the conditions imposed by the COVID-19 pandemic. Direct contact with infected patients compelled unwanted distancing by nurses (distance violation), which, although necessary, was equally a source of distress for these individuals. The constant state of fear about the possibility of contaminating close contacts due to work generated a context of “collective fear” (E12), characteri-zed by constant vigilance and tension, compromising nurses’ psychological resources, as demonstrated in numerous reports of mental exhaustion (Maslach, 1982; Maslach & Jackson, 1981).

Temporal violations acted similarly by prolonging the perception of intensified work demands, which, according to the JD-R Model, contributes to individuals’ resource depletion, leading them to exhaustion and possibly burnout (Ashforth et al., 2000; Choroszewicz & Kay, 2020). The use of electronic communication devices impacts the constant blurring of work-home boundaries that dissolve the limits between these two domains, establishing constant contact with work conditions (e.g., colleagues sending work-related messages or family members reaching out during work hours). The severity of the pandemic scenario made this condition especially apparent, requiring nurses’ constant availability, as they were called upon for emergencies during their off-duty hours, interrupting the rare, desired moments of closeness with family (intrusion violation). These findings complement previous studies that associate the unintentional intensification of work with the incidence of burnout during the pandemic (Ferreira et al., 2021; Rapp et al., 2021; Kandula & Wake, 2021; Moss, 2021).

In addition to temporal violations of distance, the state of dehumanization, as described by E39, stands out as a strategy to alleviate the impacts of daily contact with death and suffering. According to the JD-R Model, disengagement and demotivation, when prolonged, lead to burnout (Schaufeli & Taris, 2014; Akkermans et al., 2013). In this relationship, disengagement-mental withdrawal from work-is considered a motivational component of burnout, caused by the loss of resources (demotivation with work), which can lead to mental exhaustion (Schaufeli & Taris, 2014; Choroszewicz & Kay, 2020).

An innovative aspect of the findings lies in recognizing the influence of the particularities of Brazil’s political and social context as a triggering factor for incongruences in the preference for permeability between work and home boundaries among nurses and significant others. Cognitive boundary violations are driven by the dissemination of misinformation and disbelief by the Federal Government regarding the severity, or even the existence, of the COVID-19 pandemic (The Lancet, 2021; Folha de S. Paulo, 2020). In these cases, stressors were triggered by political disagreements between nurses and their spouses, who disregarded social distancing and hygiene protocols (intrusion violation) by underestimating the severity of the pandemic, considered a political disarticulation strategy led by the opposition to the Fede-ral Government. These aspects align with what the JD-R Model understands as a lack of social support, considered a potential trigger for burnout associa-ted with the loss of psychological resources that influence work motivation (a motivational component of burnout) (Demerouti et al., 2001).

Different boundary violations can occur concurrently, thereby intensi-fying the impacts on the resources and demands of the involved nurses. Boundary management tactics have shown to be alternative strategies for cushioning these impacts (Ashforth et al., 2000; Choroszewicz & Kay, 2020). However, the complete elimination of these conditions does not seem feasible due to the contextual nature of burnout, which is affected by factors beyond individual control. Akkermans et al.’s study (2020) on career shocks provides insights, demonstrating the lasting consequences on professional trajectories of disruptive and uncontrollable events such as the COVID-19 pandemic. Management tactics are nonetheless recommended and recognized for their effectiveness in the literature (Choroszewicz & Kay, 2020). Therefore, based on the study’s findings, we suggest adopting similar tactics as organizational practices for burnout prevention, shifting away from placing the total responsibility on individuals to cope with stressors primarily inherent to the organizational environment.

Finally, the manifestations of nursing-related stigma as dirty work add to the impacts of boundary violations, thus contributing to facilitating the occurrence of burnout. The paradox of the social perception of nurses as heroes or heroines while providing positive visibility to the profession highlights the stigmas associated with the occupation’s constant exposure to death and contamination risks-physical and social stigmas (Ashforth & Kreiner, 2014; 1999). In this sense, distance boundary violations can be considered manifestations of the unconscious internalization of these stigmas, reflected in nurses’ movements to distance themselves as vectors of virus transmission, thereby fostering conditions for burnout (Schaufeli & Taris, 2014; Choroszewicz & Kay, 2020).

The analysis of the results also demonstrates that the stigmas of dirty work themselves can drive the occurrence of boundary violations. It is particularly evident in cognitive intrusion violations, motivated by ideological issues related to Brazil’s political context during the COVID-19 pandemic. Such occurrences shed light on a moral dimension to the conception of nursing as dirty work, which is contextually and temporally situated-specific to the Brazilian pandemic scenario (Ashforth & Kreiner, 2014; 1999). In this regard, the literature observes the tendency of dirty workers to seek legitimacy for their occupations (social support) through intense dedication to work, increasing the risk of burnout (Ashforth et al., 2000; Felix et al., 2023c), reinforcing the interplay between the adopted constructs.

In sum, our grounded theory revealed that the pandemic resulted in an increase of boundary violations, characterized as unwanted interferences bIn summary, our grounded theory revealed that the pandemic resulted in an increase in the occurrence of boundary violations, characterized as unwanted interferences between the professional sphere and other crucial areas of life. These violations are related to burnout reports and can manifest physically, temporally, or in terms of knowledge. The study also identified specific patterns regarding boundary violations, showing that intrusive events are linked to job demand growth while distancing events are associa-ted with job resources decrease. Additionally, participants employed specific strategies in response to different types of violations, aiming to redefine their boundaries and seek to avoid or reduce the effects of burnout.

FINAL CONSIDERATIONS

This research has implications for Boundary Theory. Firstly, it contribu-tes to various streams that utilize Boundary Theory, specifically related to the literature on work-nonwork conflict, work identity, and boundary management. While previous research focused on the types of tactics used in response to boundary violations (Kreiner et al., 2009; Araujo et al., 2015; Eller et al., 2016), this study contributes by articulating the sources of bounda-ry violations more precisely. More specifically, it explores the consequences of a contextual shock on boundary violations and the dichotomous types of violations (intrusion vs. distance).

Furthermore, regarding contributions tao Boundary Theory, this research enables advancements in work-nonwork and work-identity boundaries studies by analyzing individuals’ coping responses concerning these bounda-ries. Additionally, this study advances by discussing how knowledge boundaries can directly affect work-nonwork and work-self dynamics, a dimension that has not been explored in studies on the topic (Felix et al., 2023b; Eller et al., 2016; Araujo et al., 2015).

The present study also contributes to the literature on burnout in four main ways. First, the findings informed boundary integration management tactics, providing rich examples of workers who immersed themselves more deeply in work to cope with burnout. This response addresses Maslach et al.’s (2001) call to identify interventions that increase engagement in meaningful interpersonal work, adding nuance and complexity to the understanding of burnout.

Secondly, we contribute by bridging the JD-R model with burnout (Maslach & Jackson, 1981; Maslach & Jackson, 1984). We show how intrusion events can increase work demands, and distancing events can deplete previously maintained resources, exacerbating burnout. Additionally, we provide evidence that social support from family members is a relevant resource for buffering burnout or work-nonwork conflict (Maslach et al., 2001).

Thirdly, our approach examines workers’ experiences at a macro level across domains. Traditional research on burnout focuses on theories about the employee experience within the organizational context (Maslach et al., 2001). However, the workplace is just one facet of social life, meaning that much of the traditional burnout research ignores a significant portion of the worker’s extra organizational life. We presented an innovative approach that integrates individualized causes of burnout with important contextual determinants. In doing so, we also contribute to promising research that links work-nonwork conflict to burnout (Allen et al., 2014; 2020; Rapp et al., 2021), highlighting how specific boundary violations exacerbate burnout.

Fourthly, this work confirms and extends recent quantitative research indicating that the pandemic exacerbated burnout in healthcare professionals and, thus, responds to calls for qualitative investigation into the causal mecha-nisms of burnout (Morgantini et al., 2020). While most related research has focused on measuring the prevalence of burnout (Barello et al., 2020; Duarte et al., 2020; Morgantini et al., 2020), our qualitative findings provide a depth of specific examples, detailing how and why burnout increased and, significantly, what can be done about these issues.

Fifthly, the dirty work as a conceptual lens to analyze Brazilian nurses during the COVID-19 pandemic elucidates the socially constructed nature of occupational stigmas (Ashforth & Kreiner, 2014; 1999) and strengthens existing literature. We present an innovative perspective for understanding dirty work based on the influence of contextual and temporally situated factors in the conception through the interplay of the concept with the adopted constructs. Furthermore, we demonstrate the possibility of paradoxical perceptions of dirty work, reflected in the duality attributed to nurses due to social and political factors. These findings open space to explore similar paradoxical relationships, allowing for understanding different conceptions of dirty workers in Brazilian reality. As a practical implication, a critical aspect to be considered by organizations is how shocks, such as the COVID-19 pandemic, can provoke boundary violations among their employees. Such violations can create additional difficulties in a workforce already overwhelmed with routine activities. For this reason, managers might be aware of these stressors and additional burdens to act with empathy and assertiveness. These actions should be individualized and particularly sensitive to margina-lized or underprivileged groups. Thus, results can help managers facilitate boundary management, mainly when burnout is observed. Offering employees opportunities to separate or integrate work and personal life as desired can alleviate burnout rather than forcing integration or segmentation.

This article has limitations that can be explored in future studies. Subsequent research may explore additional applications of boundary management to address the phenomenon of burnout. By focusing on the macro shocks generated by the COVID-19 pandemic, the study failed to emphasize the micro boundary shocks that individuals experience in their daily lives. Therefore, future work could analyze how work-from-home policies and other forms of remote work, during and after the pandemic, influenced boundary violations and burnout in different occupations and organizations.

Furthermore, we did not analyze dynamics between home domains in the post-pandemic period but rather during its occurrence. Considering the transformations of work arrangements post-COVID (Lake et al., 2022; Hite et al., 2020), future research may examine boundary violations occurring in workplace return and adaptation to these configurations. Specifically, we suggest operationalizing boundary management strategies in work and non-work environments and quantitatively testing which tactics prove most effective in varied circumstances (for example, types of workplaces, individual preferences for integration, or segmentation).

RAM does not have permission from the authors or evaluators to publish this article’s review.

Data availability statement

RAM does not have information about open data regarding this manuscript.

REFERENCES

• Akkermans, J., Brenninkmeijer, V., Huibers, M., & Blonk, R. W. B. (2013). Competencies for the contemporary career: Development and preliminary validation of the career competencies questionnaire. Journal of Career Develop-ment, 40(3), 245-267. https://doi.org/10.1177/0894845312467501
  » https://doi.org/10.1177/0894845312467501
• Akkermans, J., Richardson, J., & Kraimer, M. L. (2020). The COVID-19 crisis as a career shock: Implications for careers and vocational behavior. Journal of Vocational Behavior, 119, 103434. https://doi.org/10.1016/j.jvb.2020.103434
  » https://doi.org/10.1016/j.jvb.2020.103434
• Allen, T. D., Cho, E., & Meier, L. L. (2014). Work-family boundary dynamics. Annual Review of Organizational Psychology and Organizational Behavior, 1(1), 99-121. https://doi.org/10.1146/annurev-orgpsych031413-091330
  » https://doi.org/10.1146/annurev-orgpsych031413-091330
• Allen, T. D., French, K. A., Dumani, S., & Shockley, K. M. (2020). A cross-national meta-analytic examination of predictors and outcomes associated with work-family conflict. Journal of Applied Psychology, 105(6), 539-576. https://doi.org/10.1037/apl0000442
  » https://doi.org/10.1037/apl0000442
• Araujo, B. F. V. B., & Álvaro-Estramiana, J. L. (2011). Ação e estrutura social em Grounded Theory: Reflexões sobre uma psicologia social sociológica. Revista Interamericana de Psicología/Interamerican Journal of Psychology, 45(3), 381-393.
• Araujo, B. F. V. B., Tureta, C. A., & Araujo, D. A. V. B. (2015). How do working mothers negotiate the work-home interface? Journal of Managerial Psychology, 30(5), 565-581.
• Ashforth, B. E., & Kreiner, G. E. (1999). “How can you do it?”: Dirty work and the challenge of constructing a positive identity. Academy of Management Review, 24(3), 413-434. https://doi.org/10.5465/amr.1999.2202129
  » https://doi.org/10.5465/amr.1999.2202129
• Ashforth, B. E., & Kreiner, G. E. (2014). Dirty work and dirtier work: Differen-ces in countering physical, social, and moral stigma. Management and Organization Review, 10(1), 81-108. https://doi.org/10.1111/more.12044
  » https://doi.org/10.1111/more.12044
• Ashforth, B. E., Kreiner, G. E., & Fugate, M. (2000). All in a day’s work: Boundaries and micro role transitions. Academy of Management Review, 25(3), 472-491. https://doi.org/10.2307/259305
  » https://doi.org/10.2307/259305
• Ashforth, B., E., Kreiner, G., E., Clark, M., & Fugate, M. (2007). Normalizing dirty work: Managerial tactics for countering occupational taint. Academy of Management Journal, 50(1), 149-174. https://doi.org/10.5465/amj.2007.24162092
  » https://doi.org/10.5465/amj.2007.24162092
• Bakker, A. B., & Demerouti, E. (2014). Job demands-resources theory. In P. Y. Chen, & C. L. Cooper (Eds.), Work and wellbeing (pp. 37-64). Wiley Blackwell. https://doi.org/10.1002/9781118539415.wbwell019
  » https://doi.org/10.1002/9781118539415.wbwell019
• Bakker, A. B., & Demerouti, E. (2017). Job demands-resources theory: Taking stock and looking forward. Journal of occupational health psychology, 22(3), 273-285. https://doi.org/10.1037/ocp0000056
  » https://doi.org/10.1037/ocp0000056
• Barello, S., Palamenghi, L., & Graffigna, G. (2020). Burnout and somatic symptoms among frontline healthcare professionals at the peak of the Italian COVID-19 pandemic. Psychiatry Research, 290 https://doi.org/10.1016/j.psychres.2020.113129
  » https://doi.org/10.1016/j.psychres.2020.113129
• BBC News Brazil. (2020). Bolsonaro diz que pandemia está ‘no finalzinho’, mas país tem 31 mil internados com Covid-19. BBC News Brazil https://www.bbc.com/portuguese/brasil-55279856
  » https://www.bbc.com/portuguese/brasil-55279856
• Byron, K., & Laurence, G. A. (2015). Diplomas, photos, and tchotchkes as symbolic self-representations: Understanding employees’ individual use of symbols. Academy of Management Journal, 58(1), 298-323. https://doi.org/10.5465/amj.2012.0932
  » https://doi.org/10.5465/amj.2012.0932
• Campbell, M., & Gavett, G. (2021). What COVID-19 has done to our well-being, in 12 charts. Harvard Business Review https://hbr.org/2021/02/what-COVID-19-has-done-to-our-well-being-in-12-charts
  » https://hbr.org/2021/02/what-COVID-19-has-done-to-our-well-being-in-12-charts
• Cavalcanti, A. L., Felix, B., & Mainardes, E. W. (2022). Do tensions lead to positive career satisfaction results? Revista de Administração Mackenzie, 23(3), 2-26. https://doi.org/10.1590/1678-69712021/administracao.v23e51137
  » https://doi.org/10.1590/1678-69712021/administracao.v23e51137
• Charmaz, K. (2014). Constructing grounded theory: A practical guide through qualitative analysis (2nd ed.). Sage Publications.
• Choroszewicz, M., & Kay, F. (2020). The use of mobile technologies for work-to-family boundary permeability: The case of Finnish and Canadian male lawyers. Human Relations, 73(10), 1388-1414. https://doi.org/10.1177/0018726720904322
  » https://doi.org/10.1177/0018726720904322
• Clarke, M., & Ravenswood, K. (2019). Constructing a career identity in the aged care sector: Overcoming the “taint” of dirty work. Personnel Review, 48(1), 76-97. https://doi.org/10.1108/PR-08-2017-0244
  » https://doi.org/10.1108/PR-08-2017-0244
• Deery, S., Kolar, D., & Walsh, J. (2019). Can dirty work be satisfying? A mixed method study of workers doing dirty jobs. Work, Employment and Society, 33(4), 631-647. https://doi.org/10.1177/0950017018802016
  » https://doi.org/10.1177/0950017018802016
• Demerouti, E., Bakker, A. B., Nachreiner, F., & Schaufeli, W. B. (2001). The job demands-resources model of burnout. Journal of Applied Psychology, 86(3), 499-512. https://doi.org/10.1037/0021-9010.86.3.499
  » https://doi.org/10.1037/0021-9010.86.3.499
• Duarte, I., Teixeira, A., Castro, L., Marina, S., Ribeiro, C., Jácome, C., Martins, V., Ribeiro-Vas, I., Pinheiro, H. C., Silva, A. R., Ricou, M., Sousa, B., Alves, C., Oliveira, A., Silva, P., Nunes, R., & Serrão, C. (2020). Burnout among Portuguese healthcare workers during the COVID-19 pandemic. BMC Public Health, 20(1), 1885. https://doi.org/10.1186/s12889-020-09980-z
  » https://doi.org/10.1186/s12889-020-09980-z
• Eisenhardt, K. M. (2021). What is the Eisenhardt method, really? Strategic Organization, 19(1), 147-160. https://doi.org/10.1177/1476127020982866
  » https://doi.org/10.1177/1476127020982866
• Eller, A., Araujo, B. F. V. B. D., & Araujo, D. A. V. B. D. (2016). Balancing work, study and home: A research with master’s students in a Brazilian university. Revista de Administração Mackenzie, 17(3), 60-83. https://doi.org/10.1590/1678-69712016/administracao.v17n3p60-83
  » https://doi.org/10.1590/1678-69712016/administracao.v17n3p60-83
• Farid, M., Purdy, N., & Neumann, W. P. (2020). Using system dynamics modelling to show the effect of nurse workload on nurses’ health and quality of care. Ergonomics, 63(8), 952-964. https://doi.org/10.1080/00140139.2019.1690674
  » https://doi.org/10.1080/00140139.2019.1690674
• Felix, B., & Bento, M. S. (2018). Individual and organizational identities in merger contexts: A boundary perspective. Revista de Administração Mackenzie, 19(4), 1-28. https://doi.org/10.1590/1678-6971/eRAMG170104
  » https://doi.org/10.1590/1678-6971/eRAMG170104
• Felix, B., Botelho, J., & Nossa, V. (2023a). “The Exorcist”: A grounded theory on how individuals avoid unethical requests at work. International Journal of Organizational Analysis, 31(7), 3634-3652. https://doi.org/10.1108/IJOA-06-2022-3315
  » https://doi.org/10.1108/IJOA-06-2022-3315
• Felix, B., & Cavazotte, F. (2019). When a calling goes unanswered: Exploring the role of workplace personalizations as calling enactments. Frontiers in Psychology, 10 https://doi.org/10.3389/fpsyg.2019.01940
  » https://doi.org/10.3389/fpsyg.2019.01940
• Felix, B., Dourado, D., & Nossa, V. (2023b). Algorithmic management, prefe-rences for autonomy/security and gig-workers’ wellbeing: A matter of fit? Frontiers in Psychology, 14 https://doi.org/10.3389/fpsyg.2023.1088183
  » https://doi.org/10.3389/fpsyg.2023.1088183
• Felix, B., Fernandes, T., & Mansur, J. (2023c). Building (and breaking) a vicious cycle formed by extreme working conditions, work intensification, and perceived well-being: A study of dirty workers in Brazilian favelas. The International Journal of Human Resource Management, 1-25. https://doi.org/10.1080/09585192.2023.2237864
  » https://doi.org/10.1080/09585192.2023.2237864
• Felix, B., & Papaleo, J. A. B. (2021). Interpretar o trabalho como um chamado contribui para a empregabilidade ou a atrapalha? Desenvolvimento em Questão, 19(55), 172-188. https://doi.org/10.21527/2237-6453.2021.55.172-188
  » https://doi.org/10.21527/2237-6453.2021.55.172-188
• Ferreira, L. N., Pereira, L. N., da Fé Brás, M., & Ilchuk, K. (2021). Quality of life under the COVID-19 quarantine. Quality of Life Research, 30(5), 1389-1405. https://doi.org/10.1007/s11136-020-02724-x
  » https://doi.org/10.1007/s11136-020-02724-x
• Folha de S. Paulo. (2020). Bolsonaro contrai Coronavírus após minimizar a pandemia. Folha de São Paulo https://www1.folha.uol.com.br/poder/2020/07/bolsonaro-anuncia-que-contraiu-coronavirus.shtml
  » https://www1.folha.uol.com.br/poder/2020/07/bolsonaro-anuncia-que-contraiu-coronavirus.shtml
• Gioia, D. A., Corley, K. G., & Hamilton, A. L. (2013). Seeking qualitative rigor in inductive research: Notes on the Gioia methodology. Organizational Research Methods, 16(1), 15-31. https://doi.org/10.1177/1094428112452151
  » https://doi.org/10.1177/1094428112452151
• Glaser, B. G., & Strauss, A. L. (2017). Theoretical sampling. In N. K. Denzin (Ed.), Sociological methods: A Sourcebook (pp. 105-114). Routledge.
• Grotto, A. R., & Lyness, K. S. (2022). What a week! A moderated-mediation crossover model for daily boundary violations at home and partner evening affect. Stress and Health, 38(2), 261-276. https://doi.org/10.1002/smi.3086
  » https://doi.org/10.1002/smi.3086
• Harrison, S. H., & Rouse, E. D. (2014). Let’s dance! Elastic coordination in creative group work: A qualitative study of modern dancers. Academy of Management Journal, 57(5), 1256-1283. https://doi.org/10.5465/amj 2012.0343.
  » https://doi.org/10.5465/amj.2012.0343
• Hennekam, S., Ladge, J., & Shymko, Y. (2020). From zero to hero: An explora-tory study examining sudden hero status among nonphysician health care workers during the COVID-19 pandemic. Journal of Applied Psychology, 105(10), 1088-1100. https://doi.org/10.1037/apl0000832
  » https://doi.org/10.1037/apl0000832
• Hite, L. M., & McDonald, K. S. (2020). Careers after COVID-19: Challenges and changes. Human Resource Development International, 23(4), 427-437. https://doi.org/10.1080/13678868.2020.1779576
  » https://doi.org/10.1080/13678868.2020.1779576
• Hughes, E. C. (1962). Good people and dirty work. Social Problems, 10(1), 3-11. https://doi.org/10.2307/799402
  » https://doi.org/10.2307/799402
• Kandula, U. R., & Wake, A. D. (2021). Assessment of quality of life among health professionals during COVID-19. Journal of Multidisciplinary Healthcare, 14, 3571-3585. https://doi.org/10.2147/JMDH.S344055
  » https://doi.org/10.2147/JMDH.S344055
• King, A. T., Gontarz, J., & Wei, H. (2020). Employee engagement and absenteeism: A step towards improving patient care. Nursing Forum, 55(3), 356-361. https://doi.org/10.1111/nuf.12435
  » https://doi.org/10.1111/nuf.12435
• Kreiner, G., Mihelcic, C. A., & Mikolon, S. (2022). Stigmatized work and stigmatized workers. Annual Review of Organizational Psychology and Organizational Behavior, 9, 95-120. https://doi.org/10.1146/annurev-orgpsych-012420-091423
  » https://doi.org/10.1146/annurev-orgpsych-012420-091423
• Kreiner, G. E., Hollensbe, E. C., & Sheep, M. L. (2009). Balancing borders and bridges: Negotiating the work-home interface via boundary work tactics. Academy of Management Journal, 52(4), 704-730. https://doi.org/10.5465/AMJ.2009.43669916
  » https://doi.org/10.5465/AMJ.2009.43669916
• Lake, E. T., Narva, A. M., Holland, S., Smith, J. G., Cramer, E., Rosenbaum, K. E. F., French, R., Clark, R. R. S., & Rogowski, J. A. (2022). Hospital nurses’ moral distress and mental health during COVID-19. Journal of Advanced Nursing, 78(3), 799-809. https://doi.org/10.1111/jan.15013
  » https://doi.org/10.1111/jan.15013
• Leslie, L. M., King, E. B., & Clair, J. A. (2019). Work-life ideologies: The contextual basis and consequences of beliefs about work and life. Academy of Management Review, 44(1), 72-98. https://doi.org/10.5465/amr.2016.0410
  » https://doi.org/10.5465/amr.2016.0410
• Mansur, J., & Felix, B. (2021). On lemons and lemonade: the effect of positive and negative career shocks on thriving. Career Development International, 26(4), 495-513. https://doi.org/10.1108/CDI-12-2018-0300
  » https://doi.org/10.1108/CDI-12-2018-0300
• Maslach, C. (1982). Understanding burnout: Definitional issues in analyzing a complex phenomenon. In W. S. Paine (Ed.), Job stress and burnout: Research, Theory and Intervention Perspectives (pp. 29-40). Sage Focus Editions.
• Maslach, C., & Jackson, S. E. (1981). The measurement of experienced burnout. Journal of Organizational Behavior, 2(2), 99-113. https://doi.org/10.1002/job.4030020205
  » https://doi.org/10.1002/job.4030020205
• Maslach, C., & Jackson, S. E. (1984). Burnout in organizational settings. Applied Social Psychology Annual, 5, 133-153.
• Maslach, C., Schaufeli, W. B., & Leiter, M. P. (2001). Job burnout. Annual Review of Psychology, 52, 397-422. https://doi.org/10.1146/annurev.psych.52.1.397
  » https://doi.org/10.1146/annurev.psych.52.1.397
• Mejia, C., Pittman, R., Beltramo, J. M., Horan, K., Grinley, A., & Shoss, M. K. (2021). Stigma & dirty work: In-group and out-group perceptions of essential service workers during COVID-19. International Journal of Hospitality Management, 93, 102772. https://doi.org/10.1016/j.ijhm.2020.102772
  » https://doi.org/10.1016/j.ijhm.2020.102772
• Morales, J., & Lambert, C. (2013). Dirty work and the construction of identity. An ethnographic study of management accounting practices. Accounting, Organizations and Society, 38(3), 228-244. https://doi.org/10.1016/j.aos.2013.01.002
  » https://doi.org/10.1016/j.aos.2013.01.002
• Morgantini, L. A., Naha, U., Wang, H., Francavilla, S., Acar, Ö., Flores, J. M., Crivellaro, S., Moreira, D., Abern, M., Eklund, M., Vigneswaran, H. T., & Weine, S. M. (2020). Factors contributing to healthcare professional burnout during the COVID-19 pandemic: A rapid turnaround global survey. PLOS ONE, 15(9), e0238217. https://doi.org/10.1371/journal.pone.0238217
  » https://doi.org/10.1371/journal.pone.0238217
• Morse, J. M. (2007). Sampling in grounded theory. In A. Bryant, & K. Charmaz (Eds.), The SAGE Handbook of grounded theory (pp. 229-244). SAGE Publications.
• Moss, J. (2021). Beyond burned out. Harvard Business Review https://hbr.org/2021/02/beyond-burned-out
  » https://hbr.org/2021/02/beyond-burned-out
• Nobrega, M. R., & Felix, B. (2021). Managing the boundaries between work and home: A study with expatriates. Cadernos EBAPE.BR, 19(3), 582-594. https://doi.org/10.1590/1679-395170747
  » https://doi.org/10.1590/1679-395170747
• Oliveira, A. C., Lucas, T. C., & Iquiapaza, R. A. (2020). What has the COVID-19 pandemic taught us about adopting preventive measures? Texto e Contexto Enfermagem, 29, 1-15. https://doi.org/10.1590/1980-265X-TCE-2020-0106
  » https://doi.org/10.1590/1980-265X-TCE-2020-0106
• Park, Y., Liu, Y., & Headrick, L. (2020). When work is wanted after hours: Testing weekly stress of information communication technology demands using Boundary Theory. Journal of Organizational Behavior, 41(6), 518-534. https://doi.org/10.1002/job.2457
  » https://doi.org/10.1002/job.2457
• Pereira, J. R., Paiva, K. C. M. D., & Irigaray, H. A. R. (2022). “Trabalho sujo”, significado, sentido e identidade: Proposição de análise integrada e perspectivas de pesquisas. Cadernos EBAPE.BR, 19(4), 829-841. https://doi.org/10.1590/1679-395120210167
  » https://doi.org/10.1590/1679-395120210167
• Pereira, J. R., Santos, J. V. P. D., Silva, A. G. C. D., Paiva, K. C., & Carrieri, A. D. P. (2020a). Entre o sagrado e o profano: Identidades, paradoxos e ambivalências de prostitutas evangélicas do baixo meretrício de Belo Horizonte. Cadernos EBAPE.BR, 18(2), 391-405. https://doi.org/10.1590/1679-395177568
  » https://doi.org/10.1590/1679-395177568
• Pereira, M. D., Torres, E. C., Pereira, M. D., Antunes, P. F. S., & Costa, C. F. T. (2020b). Sofrimento emocional dos Enfermeiros no contexto hospitalar frente à pandemia de COVID-19. Research, Society and Development, 9(8), 1-21. https://doi.org/10.33448/rsd-v9i8.5121
  » https://doi.org/10.33448/rsd-v9i8.5121
• Rapp, D. J., Hughey, J. M., & Kreiner, G. E. (2021). Boundary work as a buffer against burnout: Evidence from healthcare workers during the COVID-19 pandemic. Journal of Applied Psychology, 106(8), 1169. https://doi.org/10.1037/apl0000901
  » https://doi.org/10.1037/apl0000901
• Rattrie, L. T. B., Kittler, M. G., & Paul, K. I. (2019). Culture, burnout, and engagement: A meta-analysis on national cultural values as moderators in JD-R theory. Applied Psychology, 69(1), 176-220. https://doi.org/10.1111/apps.12209
  » https://doi.org/10.1111/apps.12209
• Sayılan, A. A., Kulakac, N., & Uzun, S. (2021). Burnout levels and sleep quality of COVID-19 heroes. Perspectives in Psychiatric Care, 57(3), 949-956. https://doi.org/10.1111/ppc.12764
  » https://doi.org/10.1111/ppc.12764
• Schaufeli, W. B., & Taris, T. W. (2014). A critical review of the job demands-resources model: Implications for improving work and health. In G. F. Bauer, & O. Hämmig (Eds.), Bridging occupational, organizational and public health: A transdisciplinary approach (pp. 43-68). Springer Science Business Media. https://doi.org/10.1007/978-94-007-5640-3_4
  » https://doi.org/10.1007/978-94-007-5640-3_4
• Sharma, D., Ghosh, K., Mishra, M., & Anand, S. (2022). You stay home, but we can’t: Invisible ‘dirty’ work as calling amid COVID-19 pandemic. Journal of Vocational Behavior, 132, 103667. https://doi.org/10.1016/j.jvb.2021.103667
  » https://doi.org/10.1016/j.jvb.2021.103667
• Shek, D. T. (2021). COVID-19 and quality of life: Twelve reflections. Applied Research in Quality of Life, 16(1), 1-11. https://doi.org/10.1007/s11482-020-09898-z
  » https://doi.org/10.1007/s11482-020-09898-z
• Sobreira, R. G., & Juruena, C. G. (2021). Federalismo brasileiro à prova na pandemia da COVID-19. Revista Brasileira de Pesquisas Jurídicas (Brazilian Journal of Law Research), 2(2), 137-163. https://doi.org/10.51284/rbpj.02.rgs
  » https://doi.org/10.51284/rbpj.02.rgs
• Tallberg, L., & Jordan, P. J. (2021). Killing them ‘softly’(!): Exploring work experiences in care-based animal dirty work. Work, Employment and Society, 36(5), 858-874. https://doi.org/10.1177/09500170211008715
  » https://doi.org/10.1177/09500170211008715
• The Lancet. (2021). No end in sight for the Brazilian COVID-19 crisis. The Lancet https://www.thelancet.com/journals/lanmic/article/PIIS2666-5247(21)00095-1/fulltext
  » https://www.thelancet.com/journals/lanmic/article/PIIS2666-5247(21)00095-1/fulltext
• Von Borell de Araujo, B. F., Teixeira, M. L. M., da Cruz, P. B., & Malini, E. (2014). Understanding the adaptation of organisational and self-initiated expatriates in the context of Brazilian culture. The International Journal of Human Resource Management, 25(18), 2489-2509. https://doi.org/10.1080/09585192.2012.743470
  » https://doi.org/10.1080/09585192.2012.743470

Correspondence

concerning this article should be addressed to Ana Flávia Barboza Costalonga, Avenida Fernando Ferrari, 1358, Boa Vista, Vitória, ES, 29075-505, Brazil. E-mail: anaflaviab [e-mail]

EDITORIAL BOARD

Editor-in-chief

Almir Martins Vieira

Associated editor

Vera Cançado

Technical support

Gabriel Henrique Carille

EDITORIAL PRODUCTION

Publishing coordination

Andreia Cominetti

Editorial intern

Bruna Silva de Angelis

Copy editor

Andy Benson and Irina Migliari (Bardo Editorial)

Layout designer

Emap

Graphic designer

Emap

Publication Dates

• Publication in this collection
  25 Apr 2025
• Date of issue
  2025

History

• Received
  04 Sept 2023
• Accepted
  22 Apr 2024