Original Article
Burnout, Resilience, and Mindfulness in Healthcare Workers in a Medically Underserved Region during the COVID-19 Pandemic
Abstract
Objectives: To evaluate employee burnout, work conditions, resilience, and mindfulness at an academic medical center in a US medically underserved region during the coronavirus disease 2019 pandemic.Methods: We surveyed employees from August 7, 2020 to January 17, 2021. Respondents completed the Maslach Burnout Inventory (MBI), the Areas of Worklife Survey, the Connor-Davidson Resilience Scale, and the Philadelphia Mindfulness Scale (PHLMS) and answered a question about intention to stay in the present job until retirement. We performed exploratory stepwise logistic regression to evaluate associations between variables and intention to stay. We evaluated associations between variables with a structural equation model (SEM).
Results: The 655 respondents mostly were White women providers, aged 50 years and younger, who worked in inpatient wards, emergency departments, or intensive care units. Respondents had high mean MBI emotional exhaustion (35 ± 12) and moderate MBI depersonalization (12 ± 6), despite high MBI personal accomplishment (43 ± 8), middle-range Areas of Worklife Survey results, and middle to high Connor-Davidson Resilience Scale scores (29 ± 5), PHLMS awareness scores (37 ± 6), and PHLMS acceptance scores (30 ± 8). There were 408 respondents (62%) with MBI latent profiles consistent with being burned out, but 447 respondents (68%) were willing to stay in their present job. Older age was associated with intention to stay (coefficient 1.1 ± 0.1; P < 0.001). The latent variable burnout structural equation model (burnout-SEM) constructed from the MBI subscales inversely predicted intention to stay (coefficient − 0.33; P < 0.001), and this relationship was mediated by age.
Conclusions: Burnout was prevalent despite substantial personal accomplishment, resilience, and mindfulness.
Posted in: Infectious Disease143
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1. Shanafelt TD, West CP, Sinsky C, et al. Changes in burnout and satisfaction with work-life integration in physicians and the general US working population between 2011 and 2020. Mayo Clin Proc 2022;97:491–506.
2. Han S, Shanafelt TD, Sinsky CA, et al. Estimating the attributable cost of physician burnout in the United States. Ann Intern Med 2019;170:784–790.
3. Maslach C, Jackson SE, Leiter MP. Maslach Burnout Inventory Manual, 4th ed. Menlo Park, CA: Mind Garden; 2018.
4. Ahola K, Hakanen J, Perhoniemi R, et al. Relationship between burnout and depressive symptoms: a study using the person-centred approach. Burnout Res 2014;1:29–37.
5. Willard-Grace R, Knox M, Huang B, et al. Burnout and health care workforce turnover. Ann Fam Med 2019;17:36–41.
6. Cole TR, Goodrich TJ, Gritz ER, eds. Faculty Health in Academic Medicine: Physicians, Scientists, and the Pressures of Success. Totowa NJ: Humana Press; 2009.
7. Al-Ghunaim TA, Johnson J, Biyani CS, et al. Surgeon burnout, impact on patient safety and professionalism: a systematic review and meta-analysis. Am J Surg 2022;224:228–238.
8. Salyers MP, Bonfils KA, Luther L, et al. The relationship between professional burnout and quality and safety in healthcare: a meta-analysis. J Gen Intern Med 2017;32:475–482.
9. Leiter MP, Maslach C. Areas of Worklife Survey Manual and Sampler Set, 5th ed. Menlo Park, CA: Mind Garden; 2011.
10. Turnipseed DL. An analysis of the influence of work environment variables and moderators on the burnout syndrome. J Appl Soc Psychol 1994;24: 782–800.
11. Linzer M, Poplau S, Babbott S, et al. Worklife and wellness in academic general internal medicine: results from a national survey. J Gen Intern Med 2016;31:1004–1010.
12. Renger D, Miché M, Casini A. Professional recognition at work: the protective role of esteem, respect, and care for burnout among employees. J Occup Environ Med 2020;62:202–209.
13. Davidson JR. Connor-Davidson Resilience Scale (CD-RISC)© Manual. http://www.connordavidson-resiliencescale.com/CD-RISC%20Manual%2008-19-18.pdf. Published August 19, 2018. Accessed March 12, 2022.
14. West CP, Dyrbye LN, Sinsky C, et al. Resilience and burnout among physicians and the general US working population. JAMA Netw Open 2020;3:e209385.
15. Cardaciotto L, Herbert JD, Forman EM, et al. The assessment of present-moment awareness and acceptance: the Philadelphia Mindfulness Scale. Assessment 2008;15:204–223.
16. Luken M, Sammons A. Systematic review of mindfulness practice for reducing job burnout. Am J Occup Ther 2016;70:7002250020p1-7002250020p10.
17. Mullins CH, Gleason F, Wood T, et al. Do internal or external characteristics more reliably predict burnout in resident physicians: a multi-institutional study. J Surg Educ 2020;77:e86–e93.
18. Trumello C, Bramanti SM, Ballarotto G, et al. Psychological adjustment of healthcare workers in Italy during the COVID-19 pandemic: differences in stress, anxiety, depression, burnout, secondary trauma, and compassion satisfaction between frontline and non-frontline professionals. Int J Environ Res Public Health 2020;17:8358.
19. Norman SB, Feingold JH, Kaye-Kauderer H, et al. Moral distress in frontline healthcare workers in the initial epicenter of the COVID-19 pandemic in the United States: relationship to PTSD symptoms, burnout, and psychosocial functioning. Depress Anxiety 2021;38:1007–1017.
20. Shanafelt TD, West CP, Dyrbye LN, et al. Changes in burnout and satisfaction with work-life integration in physicians during the first 2 years of the COVID-19 pandemic. Mayo Clin Proc 2022;97:2248–2258.
21. Garner S, Anand S, Campbell N, et al. Impact of the COVID-19 pandemic on clinical practice and work-life integration experienced by academic medical faculty. Can J Gen Int Med 2022;17:22–32.
22. Friedberg MW, Reid RO, Timbie JW, et al. Federally Qualified Health Center clinicians and staff increasingly dissatisfied with workplace conditions. Health Aff (Millwood) 2017;36:1469–1475.
23. Hayashi AS, Selia E, McDonnell K. Stress and provider retention in underserved communities. J Health Care Poor Underserved 2009;20:597–604.
24. Picquendar G, Guedon A, Moulinet F, et al. Influence of medical shortage on GP burnout: a cross-sectional study. Fam Pract 2019;36:291–296.
25. Meese KA, Colón-López A, Singh JA, et al. Healthcare is a team sport: stress, resilience, and correlates of well-being among health system employees in a crisis. J Healthc Manag 2021;66:304–322.
26. Leiter MP, Maslach C. Latent burnout profiles: a new approach to understanding the burnout experience. Burnout Res 2016;3:89–100.
27. Lowry PB, Gaskin J. Partial least squares (PLS) structural equation modeling (SEM) for building and testing behavioral causal theory: when to choose it and how to use it. IEEE Trans Prof Commun 2014;57:123–146.
28. Hu LT, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Struct Equ Modeling 1999;6:1–55.
29. Yuan KH, Chan W, Marcoulides GA, et al. Assessing structural equation models by equivalence testing with adjusted fit indexes. Struct Equ Modeling 2016;23:319–330.
30. Browne MW, Cudeck R. Alternative ways of assessing model fit. Sociol Meth Res 1992;21:230–258. .
31. Templeton GF. A two-step approach for transforming continuous variables to normal: implications and recommendations for IS research. Commun Assoc Inform Systems 2011;28:41–58.
32. Kisely S, Warren N, McMahon L, et al. Occurrence, prevention, and management of the psychological effects of emerging virus outbreaks on healthcare workers: rapid review and meta-analysis. BMJ 2020;369:m1642.
33. del Carmen MG, Herman J, Rao S, et al. Trends and factors associated with physician burnout at a multispecialty academic faculty practice organization. JAMA Netw Open 2019;2:e190554.
34. West CP, Dyrbye LN, Sloan JA, et al. Single item measures of emotional exhaustion and depersonalization are useful for assessing burnout in medical professionals. J Gen Intern Med 2009;24:1318–1321.
35. Shanafelt TD, Boone S, Tan L, et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med 2012;172:1377–1385.
36. Edwards ST, Marino M, Balasubramanian BA, et al. Burnout among physicians, advanced practice clinicians and staff in smaller primary care practices. J Gen Intern Med 2018;33:2138–2146.
37. Shanafelt TD, West CP, Sinsky C, et al. Changes in burnout and satisfaction with work-life integration in physicians and the general US working population between 2011 and 2017. Mayo Clin Proc 2019;94:1681–1694.
38. Sammut R, Griscti O, Norman IJ. Strategies to improve response rates to web surveys: a literature review. Int J Nurs Stud 2021;123:104058.
39. Denning M, Goh ET, Tan B, et al. Determinants of burnout and other aspects of psychological well-being in healthcare workers during the Covid-19 pandemic: a multinational cross-sectional study. PLoS One 2021;16:e0238666.
40. University of South Alabama. About Frederick P. Whiddon College of Medicine. https://www.southalabama.edu/colleges/com/com-bulletin/usa-com.html. Accessed August 31, 2023.
41. Vagni M, Giostra V, Maiorano T, et al. Personal accomplishment and hardiness in reducing emergency stress and burnout among COVID-19 emergency workers. Sustainability 2020;12:9071.
42. Vagni M, Maiorano T, Giostra V, et al. Emergency stress, hardiness, coping strategies and burnout in health care and emergency response workers during the COVID-19 pandemic. Front Psychol 2022;13:918788.
43. Garcia LC, Shanafelt TD, West CP, et al. Burnout, depression, career satisfaction, and work-life integration by physician race/ethnicity. JAMA Netw Open 2020;3:e2012762.
44. Robinson MN, Thomas Tobin CS. Is John Henryism a health risk or resource? Exploring the role of culturally relevant coping for physical and mental health among Black Americans. J Health Soc Behav 2021;62:136–151.
45. Kung A, Cheung T, Knox M, et al. Capacity to address social needs affects primary care clinician burnout. Ann Fam Med 2019;17:487–494.
46. Hogue A, Huntington MK. Family physician burnout rates in rural versus metropolitan areas: a pilot study. S D Med 2019;72:306–308.
47. Yarbrough S, Martin P, Alfred D, et al. Professional values, job satisfaction, career development, and intent to stay. Nurs Ethics 2017;24:675–685.
48. Mulisa D, Tolossa T, Oluma Ayana A, et al. Nurses are leaving the nursing profession: a finding from the willingness of the nurses to stay in the nursing profession among nurses working in selected public hospitals of Wollega Zones, Oromia, Ethiopia. SAGE Open Med 2022;10: 20503121221081755.
