Leadership wishing to reduce burnout and increase fulfilment among employees should increase levels of organisational support and consideration and expand supports to employees seeking treatment for depression and anxiety.
Individual factors such as personal mental health symptoms, including depression and anxiety, are also related to burnout among HCW (Denning et al., 2021). Depression and suicidality have been longstanding problems in the medical community, and discrimination in medical licensing and hospital privileges for physicians who seek mental health treatment have perpetuated the problem (Center et al., 2003). While multiple programs have been created to reduce the rates of depression and suicide among physicians and physicians in training, rollout to nurses has lagged behind (Davidson et al., 2008), potentially increasing disparities between these groups. Moreover, anxiety is one of the most common psychiatric conditions encountered in HCW, with young nurses being the most vulnerable (Tiete et al., 202. Further, a study on Chinese HCW demonstrated a positive association between anxiety symptoms with burnout and emotional exhaustion (Ding et al., 2014). Occupational stresses further contribute to anxiety in HCW, contributing to a positive feedback loop (Ding et al., 2014).
Distributions of outcomes. Distribution of outcome (Burnout and Fulfilment) scores at each timepoint (survey) of the study period. Only participants who completed at least any 4 surveys are included, though the results are qualitatively equivalent when all participants are included.
Estimates of interaction effect between nursing occupation and organisational structure on fulfilment. Each line represents level of fulfilment for nurses only and doctors only at one standard deviation above, below and at the mean of organisational structure as measured at baseline.
Standardised effect estimates and three standard deviation confidence intervals from the nested sequence of longitudinal regression models of burnout and fulfilment. Effects of dummy indicators for categorical predictors are unadjusted, effects of continuous predictors are multiplied (equivalent to having divided the predictors) by twice the standard deviations of the predictors, and distributions of random effects are represented by twice their standard deviations.
Another strong and reliable predictor of increased burnout and reduced fulfilment was depression symptoms. Anxiety also showed a clear relationship to increased burnout and decreased fulfilment in longitudinal analyses, but this relationship was weaker than that observed with depression. Even prior to the pandemic, healthcare workers, especially nurses, were at increased risk of developing mental health symptoms including depression and anxiety, and these findings are consistent with previous studies finding a strong relationship between psychological symptoms and work attitudes (Peterson et al., 2008). Consequently, healthcare systems would be wise to expand their offerings of mental health services to their employees. Such interventions can and should take varying forms so as to appeal and apply to the most individuals. The introduction of legislation like the Dr. Lorna Breen Health Care Provider Protection Act is also a promising start in providing funding and national support for efforts to improve mental health resources for healthcare workers. In the meantime, common workplace interventions include expansions of employee assistance programs to include more providers and allow for longer treatment, flexible scheduling to allow time for treatment, online trainings focusing on psychoeducation and online individual counselling programs.
There were also some weaknesses of this study to be considered in generalising the results and informing future study designs. Most notably, this sample was drawn from one geographic region and participants were mostly white American women. Additional studies in other healthcare systems and
