The Relationships Amongst Pediatric Nurses' Work Environments, Work Attitudes, and Experiences of Burnout

Abstract

Background: Pediatric nurses care for some of the most vulnerable patients in our healthcare system. Research on health care provider organizational behavior shows that the quality of care nurses provide is directly related to their well-being, influenced by Burnout and job stress, in the workplace. However, most of the research conducted on nursing populations neglects to separately study nurses who care for children. In a resource limited system where health care provider well-being is recognized as a priority, it is important for administrators to understand the environmental and attitudinal work factors most influential to pediatric nurse work outcomes in order to target optimization strategies. The aim of the study was to identify which modifiable work environment factors, e.g., [Incivility, Perceived Organizational Support, Quality of Work-life] make the greatest contribution to the work outcome of Burnout (i.e., Personal Accomplishment, Emotional Exhaustion, Depersonalization) in pediatric nurses.Methods: A cross-sectional survey design was used at a large quaternary care pediatric hospital in Toronto, Canada. We administered a survey to a convenience sample of all registered nurses with >3 months experience in the Pediatric, Cardiac, and Neonatal Intensive Care Units from January 2021–March 2021. Path analysis was used to test our proposed model which was specified a priori based on a review of the literature.Results: 143 nurses completed the survey. Path analysis of the tested model resulted in good fit. Quality of Work-life had the largest direct effect on Work Engagement (β = 0.582, S.E. = 0.111, p < 0.001). Work Engagement had the largest direct effect on Personal Accomplishment (β = 0.68, S.E. = 0.53, p < 0.001). Quality of Work-life had the largest indirect effect on Personal Accomplishment (β = 0.4, S.E. = 0.65, p < 0.001), Emotional Exhaustion (β = −0.33, S.E. = 0.87, p < 0.001), and Depersonalization (β =−0.17, S.E. = 0.41, p = 0.006), respectively. Work Engagement had the largest total effect on Personal Accomplishment (β = 0.68, S.E. = 0.64, p < 0.001) and the third largest total effect on Emotional Exhaustion (β = −0.57, S.E. = 0.83, p < 0.001). Quality of Work-life had the second largest total effect on Work Engagement (β = 0.58, S.E. = 0.11, p < 0.001) indicating that Quality of Work-life is mediated through Work Engagement for its effect on Burnout.Conclusions: Our results indicate work environment and work attitude factors that can provide organizational leadership with a targeted focus to reduce pediatric critical care nurse Burnout, and thus improve provider well-being, in a resource limited system.

Exploring Pediatric Nurses’ Perspectives on Their Work Environment, Work Attitudes, and Experience of Burnout: What Really Matters?

“…Consistent with the Theory of Reasoned Action and the pathway to burnout, factors of the work environment (quality of work-life) seemed to influence work attitudes (work engagement), which, subsequently influenced work outcomes (burnout). It became clear early in the analysis that the experience of burnout was common in pediatric critical care nurses as has been previously noted in the literature ( 11 , 17 ). The emphasis on burnout being elusive to self-identification is a strong reminder of the need to check in regularly with teammates and colleagues, both formally and informally, to facilitate early identification of burnout.…”

“…This study is the second phase of a two-phased mixed methods evaluation of pediatric nurses working in critical care using a convenience sample of nurses at a large quaternary care pediatric hospital in Toronto, Canada. The explanatory sequential mixed methods design began with a quantitative cross-sectional survey which was developed based on the Theory of Reasoned Action ( 17 ). Study findings were used to build the semi-structured interview guide for the current study.…”

“…The semi-structured interview guide was developed using the process of integration and building as described by Creswell and Creswell ( 19 ) based on the relationships uncovered in quantitative phase of the study ( 17 ). In accordance with the Theory of Reasoned Action, factors of the work environment influenced work attitudes, and work attitudes influenced work outcomes.…”

“…In accordance with the Theory of Reasoned Action, factors of the work environment influenced work attitudes, and work attitudes influenced work outcomes. Results of the quantitative phase indicated that quality of work-life and work engagement had the greatest impact on burnout ( 17 ). Therefore, interview guide questions were designed to more deeply explore these topics with the nurses.…”

“…We conducted a survey to examine factors of the work environment (e.g., quality of work-life, perceived organizational support, and workplace incivility) and work attitudes (e.g., work engagement) of pediatric critical care nurses and their relationship to burnout. Quality of work-life and work engagement were identified as the most important factors ( 17 ). However, in the interests of mitigating or preventing burnout, a thorough understanding of the experience of workplace burnout and related factors from the perspective of nurses is required.…”