Department of Pharmacy Administration, University of Mississippi, Oxford, Mississippi, USA.
Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.
Pediatr Blood Cancer. 2021 Nov;68(11):e29214. doi: 10.1002/pbc.29214. Epub 2021 Jul 6.
Workplace burnout can result in negative consequences for clinicians and patients. We assessed burnout prevalence and sources among pediatric hematology/oncology inpatient nurses, ambulatory nurses, physicians (MDs), and advanced practice providers (APPs) by evaluating effects of job demands and involvement in patient safety events (PSEs).
A cross-sectional survey (Maslach Burnout Inventory) measured emotional exhaustion, depersonalization, and reduced personal accomplishment. The National Aeronautics and Space Administration Task Load Index measured mental demand, physical demand, temporal demand, effort, and frustration. Relative weights analyses estimated the unique contributions of tasks and PSEs on burnout. Post hoc analyses evaluated open-response comments for burnout factors.
Burnout prevalence was 33%, 20%, 34%, and 33% in inpatient nurses, ambulatory nurses, and MD, and APPs, respectively (N = 481, response rate 69%). Reduced personal accomplishment was significantly higher in inpatient nurses than MDs and APPs. Job frustration was the most significant predictor of burnout across all four cohorts. Other significant predictors of burnout included temporal demand (nursing groups and MDs), effort (inpatient nurses and MDs), and PSE involvement (ambulatory nurses). Open-response comments identified time constraints, lack of administrator support, insufficient institutional support for self-care, and inadequate staffing and/or turnover as sources of frustration.
All four clinician groups reported substantial levels of burnout, and job demands predicted burnout. The body of knowledge on job stress and workplace burnout supports targeting organizational-level sources versus individual-level factors as the most effective prevention and reduction strategy. This study elaborates on this evidence by identifying structural drivers of burnout within a multidisciplinary context of pediatric hematology/oncology clinicians.
工作场所倦怠会对临床医生和患者产生负面影响。我们通过评估工作需求和参与患者安全事件（PSE）对儿科血液学/肿瘤学住院护士、门诊护士、医生（MD）和高级实践提供者（APP）的影响，来评估儿科血液学/肿瘤学住院护士、门诊护士、医生和高级实践提供者的倦怠发生率和来源。
横断面调查（Maslach 倦怠量表）衡量了情绪衰竭、去个性化和成就感降低。美国国家航空航天局任务负荷指数衡量了心理需求、身体需求、时间需求、努力和挫折。相对权重分析估计了任务和 PSE 对倦怠的独特贡献。事后分析评估了对倦怠因素的开放响应评论。
住院护士、门诊护士、MD 和 APP 的倦怠发生率分别为 33%、20%、34%和 33%（N=481，应答率 69%）。住院护士的成就感降低明显高于 MD 和 APP。工作挫折是所有四个队列中倦怠的最显著预测因素。倦怠的其他显著预测因素包括时间需求（护理组和 MD）、努力（住院护士和 MD）和 PSE 参与（门诊护士）。开放响应评论确定了时间限制、缺乏管理员支持、机构对自我保健的支持不足、人员配备不足和/或人员流动频繁是产生挫折感的原因。
所有四个临床医生群体都报告了相当高水平的倦怠，工作需求预测了倦怠。关于工作压力和工作场所倦怠的知识体系支持将组织层面的因素作为最有效的预防和减少策略，而不是个人层面的因素。本研究通过在儿科血液学/肿瘤学临床医生的多学科背景下确定倦怠的结构驱动因素，进一步阐述了这一证据。
