Annals of African Medicine

ORIGINAL ARTICLE
Year
: 2010  |  Volume : 9  |  Issue : 4  |  Page : 226--229

Burnout syndrome among multinational nurses working in Saudi Arabia


Haifa A Al-Turki1, Rasha A Al-Turki2, Hiba A Al-Dardas2, Manal R Al-Gazal2, Ghada H Al-Maghrabi2, Nawal H Al-Enizi2, Basema A Ghareeb2,  
1 Department of Obstetrics and Gynecology, College of Medicine, University of Dammam, AlKhobar, Saudi Arabia
2 Department of Nursing, King Fahd University Hospital, AlKhobar, Saudi Arabia

Correspondence Address:
Haifa A Al-Turki
PO Box 40286, King Fahd University Hospital, AlKhobar 31952
Saudi Arabia

Abstract

Background : Nursing Staff is reported to be under extreme state of stress, leading to burnout syndrome (BS). Most of the studies have been conducted among the nurses working in their home countries. This study was conducted to assess the prevalence of BS among a multinational nursing workforce in Saudi Arabia. Materials and Methods : King Fahd University Hospital, AlKhobar, Saudi Arabia, is a tertiary care hospital employing 510 nurses of multinational workforce. Two hundred and fifty Maslach Burnout Inventory (MBI) individual-based questionnaires were distributed after modification to include the age, sex, marital status, nationality, unit working and number of years on the job. The data were entered in the database and analyzed using Statistical Package for the Social Sciences (SPSS), version 14.0. A P value of <0.05 was considered statistically significant . Results : One hundred and ninety-eight nurses (77.2%) completed the questionnaire. Their average age was 34.46 ± 5.36 years. Forty-five percent (89) had high emotional exhaustion (EE) and 28.9% (57) had moderate suffering with EE. Staffs who were on the job for longer duration had a lesser frequency of EE (P ≤ 0.001). The frequency of depersonalization (DP) was 83 (42%) and was graded as high and 61 (30.8%) were moderately affected. Personal accomplishment (PA) was moderate to low in the majority of the nurses (71.5%). Married nurses were prone to EE (28.17 ± 12.1 versus 22.3 ± 9.6) than unmarried nurses (P = 0.003, CI 95% and OR 2.4). The nurses in the patients«SQ» wards and clinics were more emotionally exhausted with higher DP compared to nurses in the high stress and high activity areas (P < 0.001, OR −11.1; and P < 0.001, CI 95% and OR 9.65). Non-Saudi nurses were significantly more prone to EE (27.3 ± 12.1 versus 21.6 ± 2.9) than Saudi nurses (P = 0.004; 95% CI: <9.64). Conclusion : We found that majority of the nursing staff at our hospital were in a state of burnout with high frequency of EE and DP. Only a quarter of the surveyed staff felt that they had some level of PA. Age and working away from their home countries were the important predictors in the development of BS in nurses. We believe that working conditions have to be improved to develop strategies to cope and alleviate stressful situations.



How to cite this article:
Al-Turki HA, Al-Turki RA, Al-Dardas HA, Al-Gazal MR, Al-Maghrabi GH, Al-Enizi NH, Ghareeb BA. Burnout syndrome among multinational nurses working in Saudi Arabia.Ann Afr Med 2010;9:226-229


How to cite this URL:
Al-Turki HA, Al-Turki RA, Al-Dardas HA, Al-Gazal MR, Al-Maghrabi GH, Al-Enizi NH, Ghareeb BA. Burnout syndrome among multinational nurses working in Saudi Arabia. Ann Afr Med [serial online] 2010 [cited 2020 Sep 18 ];9:226-229
Available from: http://www.annalsafrmed.org/text.asp?2010/9/4/226/70960


Full Text

 Introduction



Burnout Syndrome (BS) was described for the first time by Freudenberger, an American phycho-analyst [1] in 1974, and later Maslach (1976) [2] gave the scientific concept, importance of early diagnosis and timely interference. There is no universally accepted definition for BS but many authorities believe that BS has a complex of symptoms of primarily exhaustion, in response to prolonged emotional and interpersonal stress at work, leading to depersonalization. [3] BS is common among certain professions which require high commitment, motivation and have high standards and require idealistic dedication to their jobs, like police personnel, judges, social workers and health care workers. [4]

Many researchers have indicated that BS is quite common among doctors and nurses. [5],[6] Orzechowska et al[7] found in their study that BS was more common among nurses in comparison to doctors. Cano et al[8] reported that 14.4% of their study group were moderately burnout. The prevalence of BS among nurses differs from unit to unit of their work. Braithwaite [9] reported that nurses in neonatal intensive care unit (ICU) experience high levels of psychologic and physical stress which leads to burnout, whereas Raggio and Malacarne [10] found that BS in ICU is common and is influenced by the position of the staff and the gender.

Why should hospitals worry about BS? It has been shown that emotional exhaustion (EE) can lead to staff conflicts, absenteeism, lowered morale, and decreased productivity, which finally ends up in the staff suffering from BS and the end result is deficient and compromising patients' care. [11],[12] Over 70% of the nursing workforce in Saudi Arabia is from foreign countries and this adds to the stress of their professional work. No studies have been undertaken in the country to assess the prevalence of BS among the nurses. We have undertaken this study to investigate the prevalence of burnout among the nurses and secondly to identify factors that may contribute to the development of BS.

 Materials and Methods



Before the study was instituted, approval from the Research and Ethical committee of College of Medicine, University of Dammam and King Fahd University Hospital, was obtained. Maslach Burnout Inventory (MBI) individual-based questionnaire was modified to include the age, sex, marital status, nationality, unit working and number of years on the work force and was distributed among all the nurses of King Fahd University Hospital, which is a tertiary care center of the Eastern Province of Saudi Arabia. There is a multinational work force of nursing staff in this hospital. All the nurses were explained the importance of the study, and the importance of giving truthful answers was emphasized. Three factors that the MBI assessed were EE, depersonalization (DP) and personal accomplishment (PA). The data were entered in the database and analyzed using using Statistical Package for the Social Sciences (SPSS, version 14.0, Chicago, II, USA). A P value of <0.05 was considered to be statistically significant, with a confidence interval of 95%. Descriptive statistics were expressed as mean ± SD, unless otherwise mentioned. All the variables were tested and the means compared using Student's t-test. Categorical data were analyzed using c2 or Fisher's exact test, as appropriate.

 Results



One hundred and ninety-eight nurses (79%) completed the questionnaire. The average age was 34.46 ± 5.36 years (range 24-56). The mean duration of work at the hospital was 71.6 ± 60 months (range 24-300). [Table 1] gives the prevalence of EE. Forty-five percent (89) had high EE and 28.9% (57) had moderate EE. Staffs who were on the job for longer duration had a lesser frequency of EE (P 0.001). [Table 2] gives the frequency of DP. Eighty-three (42%) of the staff had high depersonalization and 61 (30.8%) were moderately affected. PA was moderate to low in the majority of the nurses (71.5%) and survey showed that only 28.5% believed that their PA was high [Table 3]. EE and DP were observed to be significantly higher in nurses who were ≤35 years (P < 0.008; CI 95% and OR 1.27 and P < 0.03; CI 95% and OR 0.26, respectively).{Table 1}{Table 2}{Table 3}

Comparing the single and married groups, the married group was found to be more prone to EE (28.17 ± 12.1 versus 22.3 ± 9.6) (P = 0.003; CI 95% and OR 2.4). The staffs of high stress and high activity areas like Emergency Room (ER), Operating room (OR) and ICUs were compared with the nurses in the in-patient wards and out patient clinics. The nurses in the patients' wards and clinics were emotionally exhausted and showed an increase of DP when compared to nurses in the high stress and high activity areas (P < 0.001, OR −11.1; and P < 0.001, CI 95% and OR −9.65, respectively). There was no difference in the PA in both the groups (P < 0.5). Non-Saudi nurses were significantly more prone to EE and PE than Saudi nurses (27.3 ± 12.1 versus 21.6 ± 2.9) with a P = 0.004 and 95% CI: <9.64. There was difference between the two groups for PA (P = 0.2, 95% CI: 1.0479). DP was higher in Saudi nurses when compared to non-Saudi staff (P = 0.09, 95% CI: <0.553)[Table 4] mong non-Saudi nurses was significantly higher when compared to Saudi nurses (27.3 ± 12.1 versus 21.6 ± 2.9) with a P = 0.004 and 95% CI: <9.64, whereas the other parameters of DP and PA were not significant.{Table 4}

 Discussion



The results of this study have several important implications. Firstly, our results provide evidence that there is existence of the BS among nurses working in the teaching institution in Saudi Arabia. Secondly, the study reveals that the prevalence of BS is more common than that reported from other countries, indicating that the nurses are in a serious state of different parameters of burnout. The results also illustrate that several areas of well-being of the nurses are being neglected. Nursing profession has evolved over centuries as a science and service oriented profession, despite the ongoing adversity. Very little has been done in improving their self-esteem. The effect which leaves on the nursing staff, in general, causes stress including the critical nature of their work staffing shortages requiring fewer nurses to care for more patients with less help. [13] This leads to negative health conditions affecting personal well-being and subsequently decreases the quality and efficacy of patient care. [14]

Our study is probably the first which compared the expatriate nurses and ethnic Saudi Arabian nurses, and expatriate nurses were significantly in an increased state of EE and prevalence of low PA was similar in both the groups. Reports in the literature suggest that the prevalence of BS in nurses depends upon the area where they work. Nurses working in ICU and accident and emergency (A and E) room are reported to be more prone to burnout. [10],[15] It was found that working in units in which life-and-death issues are observed and taken care of every day, leading to a charged environment, becomes highly stressful and contributes to BS. [16],[17],[18] Our results show that the nurses in high stress areas like ICU, OR and the ER coped with stress better than the nursing staff in wards. Younger age was reported as a predictor of emotional stress and burnout, [19],[20] but Koivula et al[21] reported otherwise. Their study indicated that burnout increases with age, and staff with shorter work experience suffer with lower levels of burnout. In this study we found that EE and DP were more common in the younger nurses than in those of ≥36 years of age.

Our study has its limitations. First, the nursing workforce in the sample had at least five different nationalities and the tolerance of BS and exhibiting symptoms may be different. Second, a semi-structured personal interview might have produced different results from the MBI questionnaire used in our study. Some of the nurses who were surveyed may have just returned from their annual vacation, which could change the scoring of the domains as recovery might have set in.

In conclusion, our finding suggests the following:

EE and low PA leading to burnout in quite high, when compared with the international literature;Age was an important predictor in the development of BS;the increased prevalence could be due to majority of the nurses working away from their home countries.

The clinical significance of our finding cannot be overlooked and we emphasize that hospital and nursing administrators should recognize the importance of preventing the prevalence of burnout among their staff.

References

1Freudenberger HJ. The stress burnout syndrome. J Soc Issue 1974;30:159-65.
2Pines A, Maslach C. Characteristics of staff burnout in mental health settings. Hosp Community Psychiatry 1978;29:233-37.
3Maslach C, Jackson SE. The measurement of burn-out. J Occup Behav 1981;22:99-113.
4Della Valle E, De Pascale G, Cuccaro A, Di Mare M, Padovano L, Carbone U, et al. Burnout: Rising interest phenomenon in stressful workplace. Ann Ig 2006;18:171-7.
5Ramirez AJ, Graham J, Richards MA, Cull A, Gregory WM. Mental health of hospital consultants: The effects of stress and satisfaction at work. Lancet 1996;347:724-8.
6Lu H, While AE, Barriball KL. Job satisfaction among nurses: A literaturereview. Int J Nurs Stud 2005;42:211-27.
7Orzechowska A, Talarowska M, Drozda R, Mirowska D, Florkowski A, The burnout syndrome among doctors and nurses. Pol Merkur Lekarski 2008;25:507-9.
8Cano PMA, Garcia CC, Garcia RE, Lopez AM, Parera DN. Burn-out of nurses. Enferm Intensiva 1996;7:138-46.
9Braithwaite M. Nurse burnout and stress in the NICU. Adv Neonatal Care 2008;8:343-7.
10Raggio B, Malacarne P. Burnout in Intensive care unit. Minerva Anestesiol 2007;73:195-200.
11Corley MC. Moral distress of critical care nurses. Am J Crit Care 1995;4:280-5.
12Stechmiller JK, Yarandi HN. Predictors of burnout in critical care nurses. Heart Lung 1993;22:534-41.
13Burke, R. Workaholism in organizations: Psychological and physical well-being consequences. Stress and Health 2000;16,11-6.
14Gillespie M, Melby V. Burnout among nursing staff in accident and emergency and acute medicine: A comparative study. J Clin Nursing 2003;12:842-51.
15Corley MC. Moral distress of critical care nurses. Am J Crit Care 1995;4:280-5.
16Bartz C, Maloney JP. Burnout among intensive care nurses. Res Nurs Health 1986;9:147-53.
17Seeley HF. The practice of anaesthesia ΁ a stressor for the middle age? Anaesthesia 1996;51:571-4.
18Neil H, Fairer JG, Coleman MP, Thurston A, Vessey MP.Mortality among male anaesthetists in the United Kingdom. Br Med J (Clin Res Ed) 1987;295:360-2.
19Brewer EW, Shapard L. Employee burnout: A meta-analysis of the relationship between age or years of experience. Hum Resour Dev Rev 2004;3:102-23.
20Maslach C, Jackson SE. The measurement of experienced burnout. J Occup Behav 1981;2:99-113.
21Koivula M, Paunonen M, Laippala P. Burnout among nursing staff in two Finnish hospitals. J Nurs Manage 2000;8:149-58.