Burnout Syndrome among General Hospital Nurses in Recife

Renata Hirschle Galindo Katia Virginia de Oliveira Feliciano Raitza Araújo dos Santos Lima Ariani Impieri de Souza About the authors

Abstracts

Este estudo descritivo, transversal, censitário, identificou Burnout e alguns fatores associados entre enfermeiros da assistência pediátrica e tocoginecológica de hospital geral do nível terciário de atenção do Recife (PE). Participaram 63 profissionais (98,4% do total) que responderam a um questionário auto-aplicável (aspectos sócio-demográficos, condições laborais e Maslach Burnout Inventory). Na análise utilizou-se qui-quadrado, com nível de confiança de 95%. Predominou o gênero feminino (92,1%), com até cinco anos de profissão (68,2%), sendo 52,5% da área pediátrica. Constataram-se altos níveis de exaustão emocional (49,2%) e despersonalização (27,0%) e baixo nível de realização profissional (4,8%), estando 4,7% com Burnout. Mostraram associação: alto nível de exaustão emocional e realizar frequentemente/sempre tarefas com muita rapidez (p=0,039) e receber salário incompatível com o esforço empregado (p=0,016); altos níveis de despersonalização e ter até cinco anos de profissão (p=0,010) e efetuar frequentemente/sempre tarefas com muita rapidez (p=0,009). Para 19,0% pelo menos duas das três dimensões apontavam alta propensão à síndrome.

Esgotamento profissional; Enfermagem; Enfermagem pediátrica; Saúde do trabalhador


Estudio descriptivo, transversal, censitario, identificó Burnout y factores asociados entre enfermeros de atención pediátrica y tocoginecología de hospital general de nivel terciario de atención en Recife-PE. Participaron 63 profesionales (98,4% del total), que respondieron cuestionario autoaplicable (aspectos sociodemográficos, condiciones laborales y Maslach Burnout Inventary). Analizado según Qui-cuadrado, nivel de confianza 95%. Predominó sexo femenino (92,1%), con hasta cinco años de profesión (68,2%), perteneciendo 52,5% al área pediátrica. Se constataron altos niveles de agotamiento emocional (49,2%) y despersonalización (27,0%), y bajo nivel de realización profesional (4,8%), sufriendo 4,7% de Burnout. Mostraron asociación: altos niveles de agotamiento emocional, realizar frecuentemente/siempre tareas con mucha rapidez (p=0,039), recibir salario incompatible con esfuerzo (p=0,016); alto nivel de despersonalización y tener hasta cinco años de profesión (p=0,010) y efectuar frecuentemente/siempre tareas con mucha rapidez (p=0,009). Para 19,0% al menos dos de las tres dimensiones marcaban alta propensión al síndrome.

Agotamiento profesional; Enfermería; Enfermería pediátrica; Salud laboral


This descriptive, cross sectional, census study identified the occurrence of Burnout and some associated factors among nurses working in obstetrics & gynecology and pediatric care at a general tertiary hospital in Recife. Sixty-three nurses (98.4%) answered a self-administered questionnaire (sociodemographic aspects, working conditions, and Maslach Burnout Inventory). Chi-square was used in the analysis with a 95% confidence level. Most participants were female (92.1%), with up to five years in the career (68.2%), 52.5% in pediatric area. High levels of emotional stress (49.2%) and depersonalization (27.0%) were identified, as well as low professional fulfillment (4.8%), and 4.7% presented Burnout. The following factors wee associated: high levels of emotional stress and often/always perform tasks very quickly (p=0.039) and receiving a salary incompatible to the effort employed (p=0.016); high levels of depersonalization and with up to five years in this career (p=0.010) and often/always perform tasks very quickly (p=0.009). For 19.0%, at least two of the three dimensions pointed to high propensity to the syndrome.

Burnout; professional; Nursing; Pediatric nursing; Occupational health


ARTIGO ORIGINAL

Burnout Syndrome among General Hospital Nurses in Recife

Síndrome de burnout entre enfermeros de un hospital general de la ciudad de Recife

Renata Hirschle GalindoI; Katia Virginia de Oliveira FelicianoII; Raitza Araújo dos Santos LimaIII; Ariani Impieri de SouzaIV

IMedicine undergraduate, Faculdade Pernambucana de Saúde. PIBIC/CNPq/IMIP Fellow. Recife, PE, Brazil. renatahirschle@hotmail.com

IIPhysician. Ph.D. in Preventive Medicine, University of São Paulo. Professor of the Graduate Program in Maternal-Child Health, Instituto de Medicina Integral Professor Fernando Figueira. Recife, PE, Brazil. kvofeliciano@gmail.com

IIIMedicine undergraduate, Faculdade Pernambucana de Saúde. PIBIC/CNPq/IMIP Fellow. Garanhuns, PE, Brasil. raitza05@yahoo.com.br

IVPhysician. Ph.D. in Nutrition, Federal University of Pernambuco. Professor of the Graduate Program in Maternal-Child Health, Instituto de Medicina Integral Professor Fernando Figueira. Recife, PE, Brazil. arianii@terra.com.br

Correspondence addressed

ABSTRACT

This descriptive, cross sectional, census study identified the occurrence of burnout and some associated factors among nurses working in obstetrics & gynecology and pediatric care at a general tertiary hospital in Recife. Sixty-three nurses (98.4%) answered a self-administered questionnaire (sociodemographic aspects, working conditions, and Maslach Burnout Inventory). Chi-square was used in the analysis with a 95% confidence level. Most participants were female (92.1%), with up to five years in the career (68.2%), 52.5% in pediatric area. High levels of emotional stress (49.2%) and depersonalization (27.0%) were identified, as well as low professional fulfillment (4.8%), and 4.7% presented burnout. The following factors wee associated: high levels of emotional stress and often/always perform tasks very quickly (p=0.039) and receiving a salary incompatible to the effort employed (p=0.016); high levels of depersonalization and with up to five years in this career (p=0.010) and often/always perform tasks very quickly (p=0.009). For 19.0%, at least two of the three dimensions pointed to high propensity to the syndrome.

Descriptors: Burnout, professional; Nursing; Pediatric nursing; Occupational health

RESUMEN

Estudio descriptivo, transversal, censitario, identificó Burnout y factores asociados entre enfermeros de atención pediátrica y tocoginecología de hospital general de nivel terciario de atención en Recife-PE. Participaron 63 profesionales (98,4% del total), que respondieron cuestionario autoaplicable (aspectos sociodemográficos, condiciones laborales y Maslach Burnout Inventary). Analizado según Qui-cuadrado, nivel de confianza 95%. Predominó sexo femenino (92,1%), con hasta cinco años de profesión (68,2%), perteneciendo 52,5% al área pediátrica. Se constataron altos niveles de agotamiento emocional (49,2%) y despersonalización (27,0%), y bajo nivel de realización profesional (4,8%), sufriendo 4,7% de Burnout. Mostraron asociación: altos niveles de agotamiento emocional, realizar frecuentemente/siempre tareas con mucha rapidez (p=0,039), recibir salario incompatible con esfuerzo (p=0,016); alto nivel de despersonalización y tener hasta cinco años de profesión (p=0,010) y efectuar frecuentemente/siempre tareas con mucha rapidez (p=0,009). Para 19,0% al menos dos de las tres dimensiones marcaban alta propensión al síndrome.

Descriptores: Agotamiento profesional; Enfermería; Enfermería pediátrica; Salud laboral

INTRODUCTION

Social, economic, judicial, organizational and technical transformations in healthcare work exercise a profound influence over the health-illness process and the quality of life in working contexts(1). Worldwide, a crescent trend is observed in approaching negative aspects of the work experience using the burnout perspective(1-3). The concept used is Christina Maslach and Susan Jackson's: the burnout syndrome results in a sequential process involving three dimensions: (a) emotional exhaustion: emotional stress or loss of emotional resources leading to lack of enthusiasm, frustration and tension; (b) depersonalization: developing negative feelings and attitudes; (c) decreasing personal fulfillment in work: tendency to a negative professional self-evaluation, becoming unhappy and dissatisfied, resulting in feelings of lack of adjustment and failure(1).

Burnout explanation models have gradually become more complex, encompassing individual, work and social organizational conditions. International(1-2,4) and national(3,5-6) studies demonstrate that, despite being multidimensional, this syndrome maintains a narrow relationship with the perception of organizational support, demonstrating the importance of the institution as a mediator for health and well-being at work. Hence, burnout is considered to be a response to perceived working stress arising when strategies used by professionals to deal with stress are inefficient, presenting the organization as the mediating variable between the perceived stress and its consequences(1). In preventing the syndrome it is necessary to emphasize the required transformations of situational aspects, specifically regarding the context of work (7-8).

Although burnout occurs in many different professions, those dealing with other people's suffering demonstrate increased vulnerability(4-5,7-8). Nurses are continually subjected to elements capable of generating work stress associated with the syndrome: lack of personnel (resulting in task accumulation and work overload), necessity of shift work and/or night shifts, dealing with problematic patients, role conflicts and ambiguity, low participation in decision-making, lack of insurance and salary planning, feelings of inequality in work relations and conflicts with colleagues and /or the institution. In addition, continuous task interruptions and the need for reorganization (aggravating work overload), dealing routinely with death, becoming closely involved with patients and their suffering and constant exposure to contamination risks and violence make nurses more vulnerable as a population. The fragile political organization of this professional category and the lack of acknowledgement of the role of nurses in the hospital organization have also enhanced vulnerability(4,8-13).

Although nursing is acknowledged as one of the most stressful professions, there are controversies regarding the relationship between working stress and the expected levels of burnout among nurses(4). Research studies that have used the same criteria to identify the syndrome have demonstrated the important worldwide distribution of burnout in this professional category, with nurses presenting higher levels of exhaustion and depersonalization, emphasizing a higher bias towards developing the syndrome(10-11,14). On the other hand, low occurrences of burnout have also been observed, facilitating questions regarding the reasons that justify such a disparity between what is observed and what is expected and reported in literature regarding the magnitude of the disorder in nurses(4,13,15). In Brazil, a broad variation of burnout values is found, identified in the few studies involving nurses and nursing assistants working in hospitals(9-10,13,15).

After the scientific production review, a low occurrence of burnout and a high level of work stress was found among nurses who are satisfied with their jobs(4) . Satisfaction was associated with informational support, social support at work, learning opportunities and progress in the ability to take part in decision-making. Also, suggestive elements that may contribute to satisfaction are related to the ability to cope with routine stressful situations(16), as well as slowing down the sequential process that culminates in burnout. Abilities to deal with the internal and external demands originating from work stress can promote control (problem-aimed strategies) or escape (regarding emotions: denying the situation, distancing, selective attention). Escape activities are associated with a higher frequency of emotional exhaustion(6,17).

Burnout has consequences over physical and mental health. Cardiovascular alterations, chronic fatigue, headaches, migraines, peptic ulcer disease, insomnia, muscle and joint pain, anxiety, major depressive disorder, irritability, and others are among the symptoms associated with burnout. It can also interfere in domestic life, affecting family relations when there is regret due to the lack of time to care for children and for leisure. Work context is affected by absenteeism, turnover, an increase in violent tendencies and decreasing quality of work(3,8-9). This present study intends to contribute to the search for effective ways to deal with health promotion at work and prevention of burnout, actions of great importance for nurses' work quality of life and the quality of care provided by these professionals(2,6,8).

OBJECTIVE

Identify burnout occurrence, detailing the three dimensions of the syndrome and the socio-demographic factors and working conditions associated with burnout among nurses in a tertiary care general hospital in the city of Recife.

METHOD

A cross sectional, descriptive, census study was performed from October to November of 2009, in a tertiary care general hospital of the Unique Health System, in the city of Recife. This general hospital is a state and regional (Northeast) reference hospital for children and women's health care. From a list provided by the health service, properly updated by means of contacting all other involved sectors, all 64 nurses from the nursing team who provided care in the outpatient clinics, ward and urgency-emergency care center in Pediatrics, Gynecology and Obstetrics were contacted. After the subjects were informed regarding the purpose of the research and signed the Free and Informed Consent Form, they received a self-administered and anonymous questionnaire and booked a date with the field researcher to return the questionnaire. Of the nurses contacted, 63 (98.4% of the total) returned the questionnaire. A professional who stopped working in the hospital was unable to be located.

The questionnaire was composed of two parts: (1) socio-demographic aspects, professional education and working conditions; (2) Maslach Burnout Inventory – MBI, composed of 22 questions using a Likert scale regarding the three syndrome dimensions: nine questions evaluate emotional exhaustion, five questions evaluate depersonalization and eight evaluate professional fulfillment. Increasing degrees of intensity were attributed to each one of the questions in the MBI: 1 (never), 2 (a few times per year), 3 (once a month), 4 (a few times per month), 5 (once a week), 6 (a few times per week) and 7 (every day). The MBI is the most frequently used instrument worldwide to evaluate burnout. It was translated into Portuguese and validated in 1995 with a Cronbach's alpha of 0.86 in the emotional exhaustion sub-scale, 0.69 in depersonalization and 0.76 in professional fulfillment(18). A pilot test study was performed for the necessary adjustments in the first part of the questionnaire.

The Epi Info software 6.04d was used to construct and statistically analyze the data base. In each sub-scale of the MBI, professionals were classified based on Maslach's criteria for emotional exhaustion: high level – equal to or higher than 27; medium level – between 19 and 26; and low level – equal to or less than 18. For depersonalization: high level – equal to or higher than 13; medium level – between 7 and 12; and low level – equal to or less than 6. For personal fulfillment: high level – equal to or higher than 40; medium level – between 34 and 39; and low level – equal to or less than 33. High scores in emotional exhaustion and depersonalization and a low score in personal fulfillment at work indicate burnout(1-2,7).

Socio-demographic, professional and working education variables and their association to the three dimensions of burnout were tested. Frequency of the syndrome and the number of professionals who presented at least one or two of the three dimensions were established, indicating a bias towards burnout. Significant differences were evaluated using the Chi-Square test, with a level of significance of 5%. Tendencies was the term used to describe results in which differences were aligned with a statistical significance between 0.05 and 0.10. The project was approved by the Research Ethics Committee of the Professor Fernando Figueira Integral Medicine Institute - IMIP in Brazilian acronyms, in accordance with statement No 1480 of 08/07/2009.

RESULTS

Nurses researched were predominantly females (92.1%), with a median age of 29 years (interquartis range of 27 and 36 years) and 50.8% lived in common-law marriage. Approximately 68.2% had up to five years in the profession (median of four years and interquartis range of two to nine years); 52.5% worked in pediatrics and 52.5% were considered to be experts in their working area. A percentage of 45.2% were working two different jobs and 85.7% were responsible for more than five nursing/administrative tasks within the service: performing hospital care tasks (95.2%), bureaucracy (66.7%), graduate program teaching (47.6%), clinics care (23.8%), research (23.8%) and teaching in postgraduate degree programs (12.7%). Around 71.0% worked night shifts routinely.

Half of the professionals presented high levels of emotional exhaustion, 27.0% presented with depersonalization and 4.8% demonstrated low levels of personal fulfillment at work. Those with medium levels of emotional exhaustion and depersonalization were high in proportion. About 68.3% of nurses demonstrated at least one of the three dimensions indicating a high bias towards burnout, while 27.0% presented at least two of the three dimensions, pointing to a high bias towards the syndrome. About 4.7% presented all of the dimensions associated with burnout (Table 1).

Regarding the burnout dimension emotional exhaustion, nurses felt burned out after work every day (17.5%) and a few times per week (23.8%). Every day (12.7%) and a few times per week (17.5%) they felt they worked too much. Every day (15.4%) and a few times per week (7.9%) they felt at the edge of their abilities. Once a month they felt they were working too much (41.3%), that work was burning them out (38.1%), felt exhausted in the morning when they thought about work (33.3%) and felt exhausted after work (31.7%). A few times per year, they felt disappointed with their work (39.7%), tired of working every day dealing with people (38.1%), frustrated about work (38.1%) and at the edge of their abilities (34.9%).

Regarding depersonalization, these professionals felt that patients blamed them for their problems every day (4.8%) and a few times per week (11.1%). Every day (6.3%) and a few times per week (6.3%) they have become hardened towards others. Every day they felt they were emotionally hardening (6.3%) and a few times per week they treated people as impersonal objects (4.7%). A few times per year (27.0%) and once a month (27%) they felt they were harder towards people. A few times per year (28.6%) and once a month (22.2%) they felt hardened emotionally. A few times per year (25.4%) and once a month (20.6%) they felt patients blamed them for their problems; 90.5% never lack emotions towards the people they provided services to and never treated people as impersonal objects (65.1%).

None of the nurses answered never to questions regarding personal fulfillment at work. A few times per year (14.3%) and once a month (7.9%) they felt energetic at work. Once a month they felt stimulated after working with people (17.5%), created a favorable environment at work (15.9%), dealt easily with emotional problems (15.9%) and accomplished important things at work (14.3%). A few times per week they felt energetic at work (34.9%), dealt easily with emotional problems (28.6%), created a favorable environment at work (23.8%) and felt stimulated after working with people (23.8%). Every day they easily care for people (77.8%), dealt efficiently with people's problems (74.6%) and exercised a positive influence on people's lives (66.7%).

A significantly larger proportion of professionals who frequently/always performed their tasks too quickly and those who considered their salary below the efforts they employed presented high levels of emotional exhaustion. There is a tendency towards a higher percentage of female professionals, with up to five years in the profession, who demonstrated high emotional exhaustion. We observed that having up to five years in the profession and performing their tasks frequently/always too quickly were associated with high levels of depersonalization. A tendency towards low personal fulfillment at work among nurses who were responsible for performing numerous different functions in the care service and did not envision any possibilities for professional growth was also observed (Table 2).

None of the nurses answered never when asked about how often they had enough time to accomplish all their work tasks and how often they performed them less quickly. There was no statistical association among the three burnout dimensions and the following variables: work area, number of places worked in, overlaid care levels, working hours and time allotted to accomplish tasks.

All three professionals who evidenced burnout were women: two had up to five years in the profession; two worked in the gynecology and obstetrics area; two were connected to two different health care services; one performed different functions within the same care service; two stated they had enough time to accomplish their tasks a few times; all of them frequently/always performed their tasks too quickly and considered their salary incompatible with their work performance. A tendency towards burnout was observed among nurses who had no expectations of professional growth (p=0.090).

DISCUSSION

There is no general agreement in the literature regarding diagnosing burnout. Findings were stated regarding the syndrome in only a small percentage of the studied literature, partially due to the adoption of Maslach criteria, mentioned by various authors(1-2,7), which was considered more strict since the criteria emphasize interrelations among the three burnout dimensions. In a study performed with a nursing team in a hospital in the South of Brazil, employing similar criteria, there was an absence of the syndrome. Hence, other authors(19) diagnosed burnout based on the isolated presence of high levels of emotional exhaustion or depersonalization, or low levels of personal fulfillment at work. According to these criteria, in the present research and the one performed in the South of the country(13), 68.3% of nurses and 35.7% of nursing workers presented burnout, respectively, since they presented at least one dimension of the syndrome at a critical level. This definition minimizes the complexity of the sequential process that results in burnout.

Despite the low frequency of burnout among the evaluated nurses, the high levels of emotional exhaustion and depersonalization found indicate a strong bias towards developing the syndrome. The proportion of nurses with high levels of emotional exhaustion (49.1%) and depersonalization (27.0%) observed in this present research was considerably higher than those found among nursing staff in a hospital in Madrid, in which 11.7% exhibited exhaustion and 9.2% exhibited depersonalization, with the nurses presenting higher levels in both dimensions(12); in Tubarão (SC), 6% presented with high levels of exhaustion and 21.9% presented high levels of depersonalization(13). Results in a hospital in Londrina (PR) also demonstrated a lower number of nursing professionals with high emotional exhaustion (21.3%), but the presence of high depersonalization was higher (32.8%)(15).

The negative consequences of burnout begin with tiredness and continued physical and mental stress, leading the professional to emotional exhaustion(1). When trying to overcome adverse conditions, the gradual tendency to neglect personal needs, together with the denial of problems and repression of conflicts, may cause negative emotions and attitudes related to work. Burnout occurs when emotional exhaustion and depersonalization are overlaid, leading to lack of feelings of fulfillment at work. There are differences among authors regarding the triggering sequence of negative events and the meaning of manifestations; however, the three described components are fundamental to the burnout syndrome(7).

Since the syndrome evolves progressively in a cumulative fashion, and may occur in a short period of time or take years to appear(1-3), an examination of the answers in the MBI items demonstrated a concerning situation. The emotional exhaustion subscale revealed that, almost every day, almost two-fifths of nurses felt overloaded and exhausted by their work routine, and one-fourth of professionals were at the limit of their capabilities. Only a few of them did not mention work overload and exhaustion. Studies have demonstrated that work overload represents a source of chronic stress among nurses, constituting one of the main predictors of emotional exhaustion(8,10,20), a burnout dimension considered to be the initial stage and the central factor in the syndrome(6). Feelings of tiredness due to working with people all day, deception and frustration, even when sporadic, were present in a great proportion of the studied population.

In this present research, having to perform tasks too quickly and the perception of having too low a salary compared to the employed effort in performing tasks - similar to findings in other researches(3,6,7,21), was demonstrated to be statistically associated to high levels of emotional exhaustion. A gap between salary and efforts leads to the perception of lack of appreciation of their dedication. Under these circumstances exhaustion leads to, above all, a breach in reciprocity among professionals and the organization to which they are connected, resulting in feelings of being treated unfairly. Rewards (promotion, raise in salary, care for well-being) represent an important element of the perceived organizational support. Studies developed in distinct work contexts(2), including within Brazil(5-6), demonstrate the direct relationship between chronic exhaustion and the perception of insufficient organizational support.

The challenge of the tasks that need to be done and available time to perform them subjected workers to extreme tension, especially in light of the responsibility of performing as a professional, increasing fatigue, emotional stress and chronic exhaustion. However, exhaustion was not the only negative event resulting from the pressure of time, negative feelings and attitudes at work that characterize depersonalization; exhaustion was also more prevalent among nurses who frequently/always needed to act quickly in performing their tasks. The character of the relationship between the pressure of time and burnout impacts workers' health more and more (21).

A tendency to display high levels of emotional exhaustion was identified among women and among those with less time in the profession - these groups also demonstrated significantly higher levels of depersonalization, demonstrating consonant features with national(10) and international(8,11,20) studies. The high concentration of exhaustion and negative feelings and attitudes related to work among those who have less time in the profession is associated with being unable to accomplish tasks according to expectations and to the difficulty in envisioning possibilities to improve working conditions(10,22). Those with more time spent in the profession also feel emotional stress and tiredness; however, in order to maintain optimism, they continue to wait and hope for a solution, perhaps because they feel more complacent or are able to extract positive aspects out of negative experiences. A study(10) mentions that those who have been in the profession longer, and were not satisfied with work and had the opportunity for a change, may have followed different career paths.

A clear predominance of females in this research is congruent with the fact that choosing nursing as a profession is more frequent among women(8,13,15,20). Many arguments have been used to support the conclusion that women are more vulnerable to burnout than men. First, the role attributed to gender in the socialization process, where women tend to get more emotionally involved with the problems of people who they provide care for, may make women more vulnerable to burnout. Second, women have a higher probability of choosing professions involving more direct contact with people. Third, they are subjected to a double work standard (taking care of the home and their professional performance). Fourth, women use denial and repression as basic defense mechanisms: they deny or tend not to perceive their frustrations, negative feelings and exhaustion, always believing they can surpass their own limitations in each of the multiple roles they perform in life(10,20).

A study with a nursing team in Spain, concludes the existence of differentiated patterns for men (higher levels of depersonalization and professional fulfillment are not significant predictors for depersonalization) and women (emotional exhaustion does not predict absenteeism). However, the study points out that the strong predominance of women in this professional category may hide the gender influence regarding burnout. In Brazil, in the South region, a research with nursing workers found higher values in the personalization subscale for the male gender and similar levels of emotional exhaustion in men and women(10). Different authors considered that stress and burnout in women are presented by special characteristics that need to be understood and taken into consideration by prevention programs(10,20).

Regarding depersonalization, almost every day a small number of nurses perceived a lack of reciprocity with patients and became hardened, distancing themselves emotionally in dealing with their patients. This perception and attitude occurred a few times per year in approximately half of these professionals. It is important to note that there may be interference and a social desirability factor in the answers given regarding the dimension items, since they challenge the human service workers' professional image(8). In addition, results include a clearly female-predominant population who, considering hegemonic socialization models, are conditioned to care(8,10,20).

Lack of reciprocity, including gratitude and respect for caregivers, results in feelings of unfairness, compromising the patient-professional connection. Studies demonstrate a significant positive correlation between nurses' perception and lack of reciprocity towards patients and the two dimensions of burnout, emotional exhaustion and depersonalization(7-8). Non-productive emotional distancing, where professionals refer to escaping strategies and dealing indifferently with patients, is a way of coping with emotional exhaustion that evidences an urgent need for a commitment towards action on the part of the institution, regarding work health and quality of life. The search for individual solutions for collective problems facilitates burnout(16-17). The importance of nurses who provide services to the people is emphasized as a positive aspect.

High levels of personal fulfillment at work were found (84.1%), which is much higher than the 35.0%, 50.3% and 37.7% mentioned, respectively, by researchers in other studies(12-13,15). Most professionals who easily provide care for people and acknowledge the importance of the work they perform routinely are not affected by negative feelings and a sense of failure. There is a perception that their own work provides an undeniable value for the workers' self-esteem(10,21). Therefore, some difficulties are encountered but are dealt with, and these workers easily deal with emotional problems and feel energetic at work. Low professional fulfillment, aside from the place it occupies in the sequence of burnout-associated manifestations, is a key element of this syndrome, motivating a lower involvement at work and causing nurses to want to give up(7).

Approximately one-fourth of these professionals evidence an overlay of high emotional exhaustion and depersonalization, allowing to suggest that they were at the "almost-burnout" point, where their initial energy at work is transformed by chronic fatigue and increasing feelings of frustration(2,18). High fulfillment at work certainly constitutes a fundamental element for avoiding this transition state towards the syndrome in the evaluated population. Professionals who perceived themselves as being at the end of their resistance limitations can still be receptive to feelings of satisfaction(21). Studies performed in different countries evidence satisfaction at work despite high levels of stress(4). In a study performed in a Brazilian hospital organization, satisfaction as a protection factor against burnout(16) is identified.

A fundamental dimension to accomplishing the transition from almost-burnout to burnout, low personal fulfillment at work showed a higher tendency to be identified among professionals who performed several different functions and ceased to believe professional growth was possible. Overlaid tasks lead to the perception that the available resources are smaller than needed to accomplish predicted tasks. Many authors related the syndrome of burnout with tasks accumulation, being unable to grow professionally and obtaining acknowledgement at work, emphasizing the importance of the perception of insufficient organizational support regarding health at work(3,5-6,10). All of these aspects, isolated or enhanced by interaction, can lead to feelings of chronic imbalance, in which the work requires much more than the person can give, in order to provide less than what is needed.

CONCLUSION

The frequency of burnout was low in the studied population; however, results generate concerns, especially due to the hidden character of the syndrome, since some of the nurse's feelings and attitudes may be intermittently present and may increase over time. Work overload, emotional stress and resourcing to emotion-centered strategies, among other aspects, resulted in the identified high and medium levels of emotional exhaustion and depersonalization, demonstrating the need for commitment towards quality of life at work. Overlaying exhaustion and depersonalization resulted in an "almost-burnout" situation in which organizational support was perceived as insufficient, mainly by nurses who were professionally active for less than five years.

The ambiguity regarding the experience of work cannot be overemphasized since, even under unfavorable conditions, work can produce some degree of satisfaction. Such complexity of interactions that can be sources of both pleasure and suffering enhance the need for diversification of strategies to deal with emotional stress and satisfaction as a fundamental element to promote quality of life at work. Therefore, dealing with burnout may emphasize neither individual nor organizational processes that better support team work and the health of its members. It is probable that alternative ways of finding a balance between differentiations and integrations can be found this way, since it is considered to be a central problem for the organized group.

In addition, searching for personal solutions for work problems must draw our attention, since it discourages health and work performance. Professionals may feel more fulfilled and satisfied by adjusting their work expectations. However, on a long term basis, persisting in stressful work conditions enhances emotional exhaustion, depersonalization and feelings of low fulfillment at work. Certainly, the challenge of promoting health at work and preventing burnout is even larger than once thought, and a permanent dialogue among planning, executing and managing functions is required.

REFERENCE

  • 1. Gil-Monte P, Peiró JM. Perspectivas teóricas y modelos interpretativos para el estudio del síndrome de quemarse por el trabajo. An Psicol. 1999;15(20):261-8.
  • 2. Ruiz CO, Rios FL. El burnout o síndrome de estar quemado en los profesionales sanitarios: revisión y perspectivas. Int J Health Psychol. 2004;4(1):137-60.
  • 3. Trigo TR, Teng CT, Hallak JED. Síndrome de burnout ou estafa profissional e os transtornos psiquiátricos. Rev Psiquiatr Clín. 2007;34(5):223-33.
  • 4. Hall E. Nurse burnout in a high stress health care environment: prognosis better than expected? [Internet]. [cited 2010 June 7]. Available from: http://eprints.otago.ac.nz/278/1/Hall_working_paper2.pdf
  • 5. Oliveira PR, Tristão RM, Neiva ER. Burnout e suporte organizacional em profissionais de UTI Neonatal. Educ Profis Ciênc Tecnol. 2006;1(1):27-37.
  • 6. Tamayo MR, Tróccoli BT. Exaustão emocional: relações com a percepção de suporte organizacional e com as estratégias de coping no trabalho. Est Psicol. 2002;7(1):37-46.
  • 7. Tamayo M, Tróccoli BT. Burnout no trabalho. In: Mendes AM, Borges LO, Ferreira MC, organizadores. Trabalho em transição, saúde em risco. Brasília: Ed. UNB; 2002. p. 45-63.
  • 8. Gil-Monte PR. El síndrome de quemarse por el trabajo (síndrome de burnout) en profesionales de enfermería. Rev Eletr InterAção Psy [Internet]. 2003 [citado 2010 nov. 13];1(1):19-33. Disponível em: http://www.bvsde.paho.org/bvsacd/cd49/artigo3.pdf
  • 9. Murofuse NT, Abranches SS, Napoleão AA. Reflexões sobre estresse e burnout e a relação com a enfermagem. Rev Latino Am Enferm. 2005;13(2):255-61.
  • 10. Benevides-Pereira AMT. As atividades de enfermagem em hospital: um fator de vulnerabilidade ao burnout. In: Benevides-Pereira AMT, organizador. Burnout: quando o trabalho ameaça o bem-estar do trabalhador. São Paulo: Casa do Psicólogo; 2002. p. 133-55.
  • 11. Nordang K, Hall-Lord ML, Farup PG. Burnoutein health-care professionals during reorganizations and downsizing: a cohort study in nurses. BMC Nurs. 2010;9:8.
  • 12. Albaladejo R, Villanueva R, Ortega P, Astasio P, Calle ME, Dominguez V. Síndrome del burnout en el personal de enfermeria en un hospital de Madrid. Rev Española Salud Pública. 2004;78(4):506-16.
  • 13. Moreira DS, Magnago R, Sakae TM, Magajewski FRL. Prevalência da síndrome de burnout em trabalhadores de enfermagem de um hospital de grande porte da Região Sul do Brasil. Cad Saúde Pública. 2009;25(7):1559-68.
  • 14. Grau A, Suñer R, García MM. Desgaste profesional en el personal sanitario y su relación con los factores personales y ambientales. Gaceta San. 2005;19(6):463-70.
  • 15. Jodas DA, Haddad MCL. Síndrome de burnout em trabalhadores de enfermagem de um pronto socorro de hospital universitário. Acta Paul Enferm. 2009;22(2):192-7.
  • 16. Rosa C, Carlotto MS. Síndrome de burnout e satisfação no trabalho em profissionais de uma instituição hospitalar. Rev SBPH. 2005;8(2):1-15.
  • 17. Lemaire JB, Wallace JE. Not all coping strategies are created equal: a mixed methods study exploring physicians' self reported coping strategies. BMC Health Serv Res. 2010;10(2):208.
  • 18. Lautert L. O desgaste profissional do enfermeiro [tese doutorado]. Salamanca: Faculdade de Psicologia, Universidade Pontifícia de Salamanca; 1995.
  • 19. Grunfeld E, Whelan TJ, Zitzelsberger L, Willan AR, Montesanto B, Evans WK. Cancer care workers in Ontario: prevalence of burnout, job stress and job satisfaction. CMAJ. 2000; 163(1):166-9.
  • 20. Gil-Monte PR. Influencia del género sobre el proceso de desarrollo del síndrome de quemarse por el trabajo (burnout) en profesionales de enfermería. Psicol Estudo. 2002;7(1): 3-10.
  • 21. Soratto L, Pinto RM. Burnout e carga mental no trabalho. In: Codo W, organizador. Educação: carinho e trabalho. 2Ş ed. Petrópolis: Vozes; 2000. p. 282-92.
  • 22. Trindade LL, Lautert L. Síndrome de burnout entre os trabalhadores da Estratégia de Saúde da Família. Rev Esc Enferm USP. 2010;44(2):274-9.

Publication Dates

  • Publication in this collection
    07 May 2012
  • Date of issue
    Apr 2012

History

  • Received
    30 Sept 2010
  • Accepted
    18 Oct 2011
Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br