Overall, the prevalence of burnout observed among study participants in the present study was low (2.9%). The findings of this study underpins initial reports that burnout is rife among nursing professionals in sub-Saharan Africa [10], [44], [45]. The overall prevalence of burnout observed in the present study is consistent with the 2.1% reported among nursing professionals in the Kumasi Metropolis [15]. However, the overall prevalence of burnout observed in the present study is at variance with the prevalence of burnout (68.6%) that was reported among the nurses at a medical tertiary facility in Nigeria [46]. A possible reason for the disparity between the two studies could be attributed to the variations in the study design, sampling procedure, tools for assessing burnout, and the difference in the healthcare systems in Nigeria and Ghana. The Nigerian study [46] measured burnout using the Oldenburg Burnout Inventory while the present study used MBI to measure nurses' burnout which could affect the prevalence of burnout.
In the present study, a high burnout for both depersonalization (83.6%) was observed as compared to personal accomplishment (61.5%) and emotional exhaustion (54.5%) dimensions. The prevalence of emotional exhaustion observed in the present study affirms initial reports that Ghanaian nurses experience low emotional exhaustion [15], [35]. The high level of burnout observed in the present study for both depersonalization and personal accomplishment are similar to higher levels of burnout for depersonalization (71.6%) and personal accomplishment (90.8%) reported among nurses working in a tertiary hospital in Jeddah [47]. The higher prevalence of burnout for depersonalization is particularly a worry since the depersonalization dimension of burnout is when the employee no longer has an interest in the job and detaches him or herself from her core responsibilities at the workplace. The high depersonalization experienced by nurses in the present study can affect the contribution of nurses to quality healthcare delivery in the healthcare system. It is important to encourage nurses that may be experiencing any form of burnout to seek counselling and possible attention to reduce its incidence at the workplace.
The findings of the present study showed that the night shift was associated with the emotional exhaustion dimension while the full-day shift and rank of nursing/midwifery officer were associated with depersonalization. Casual/contract employment was significantly associated with personal accomplishment.
In this present study, it was found that night shifts and full-day shifts were significantly associated with emotional exhaustion and personal accomplishment, respectively. In this study, nurses who had most of their shifts to be full day had an expected decrease in high burnout for personal accomplishment compared to those who had the majority of their shifts to be morning. Also, compared to nurses who had the majority of their working shift to be morning shift, those who had most of their shift in the night had an expected increase in emotional exhaustion by six times. A possible explanation for this could be the longer working hours for the night shift compared to the morning shift. Nurses spend a lot of hours at the workplace for night shifts than morning shifts which may increase their stress levels thereby draining them emotionally. A previous study has stressed the need to reduce long working hours to reduce the incidence of burnout at the workplace [48]. In China, a similar study found a significant influence of long working hours on emotional exhaustion [49].
In this current study, it was revealed that nursing/midwifery officers had an expected increase in depersonalization levels by three compared with staff nurses/midwives. This may be explained by the high demand for nursing/midwifery officers to deliver quality services that meet the expectation of the patient as they mostly play supervisory roles compared to staff nurses/midwives who are junior officers at the workplace. This makes them overburden themselves with a lot of workloads which can predispose them to experience high burnout for depersonalization. A high workload has also been reported to increase one's risk of burnout in China [50]. A study in Nigeria also found that senior nurses were at increased risk of high burnout for depersonalization [12].
The study observed that casual/contract nurses had an expected increase in high burnout for personal accomplishment compared to permanent workers. A possible reason could be that temporary casual/contract nursing workers could be so driven by their desire to land permanent jobs that they accept and complete assignments if they are even tired without taking breaks which can predispose them to high burnout for personal accomplishment.
The welfare of every healthcare professional is essential for the delivery of high-quality medical care, based on that, this study assessed the QoL of nursing professionals. Overall, the QoL observed among study participants in the present study was high. Participants reported high QoL in all four domains. However, among the four domains of QoL, participants reported the highest QoL in the social health domain and the least in the physical health domain. The high QoL observed among study participants is important for quality healthcare delivery. This is because nurses play a critical role in the provision of quality healthcare delivery in the healthcare continuum.
The high QoL of the social health domain observed in the present study reflects participants’ high level of contentment with social support and peer interaction in their daily lives. This is in agreement with a study in Malaysia which also observed the highest QoL scores in the social health domain among nurses [51]. In India, a study also reported high QoL scores in the social health domain [52]. More than half of the nurses in this study were married, and having a supportive partner could be one of the variables that contribute to a good QoL score in terms of social relationships. Again, over half of the study participants indicated they received management support at the workplace which is also a good recipe for good QoL score of the social health domain.
The least QoL scores observed in the physical health domain in the present study could be explained by the notion that nurses concurrently perform the responsibilities of woman, mother, wife, and daughter. These can impair physical QoL and cause fatigue and sleep deprivation. In Poland, a similar study reported that of the four domains of the QoL, nurses reported the worst in the physical health domain [53]. In China, a similar study also observed lower scores of QoL in the physical domain [54]. However, the physical domain is the worst QoL observed in the present study and is at variance with a study in Australia where nurses performed higher scores in the physical health domain [55].
The results from the present study underpins initial reports that the occurrence of burnout is negatively associated with the QoL of nursing professionals [56], [57], [58]. It was found out in this present study that participants’ QoL was significantly predicted by high and moderate burnout for personal accomplishment and depersonalization dimensions of burnout respectively.
It was found out in this present study that nursing professionals that experienced high burnout for personal accomplishment had an expected decrease in the overall QoL scores compared to those that experienced low burnout. This implies that nursing professionals who experience high levels of burnout for personal accomplishment are greater likelihood of a reduction in their QoL. Nursing professionals assessing themselves as having high burnout for personal accomplishment means that he or she sees themselves as negatively and cannot progress in their professional career. At this stage, the nursing professional may start to doubt his or her capability to progress professionally and this can negatively affect his or her well-being. Findings from this study is in agreement with earlier studies which reported a significantly negative correlation between personal accomplishment and QoL [59], [60].
Another significant finding of the present study was that participants that experienced moderate burnout levels for depersonalization had an expected decrease in the QoL scores by four compared to those who had modest degrees of burnout for the depersonalization dimension. This is in line with previous studies that have reported a negative correlation between burnout and QoL [19], [61]. A nursing professional experiencing high levels of depersonalization may detach themselves from colleagues and patients which can affect his or her psychological health domain of QoL [60].
Strengths and limitations of study
The study had some strengths and limitations positing that results should be cautiously interpreted. The study’s strength resides in its novelty as the first study to investigate burnout and quality of life among nursing professionals in the study settings. Additionally, the use of appropriate methodology and rigorous analysis is a strength of the study. Despite the strength of the study, it has weaknesses that cannot be overemphasized. The study used a cross-sectional design which provides a snapshot of a particular point in time limiting the ability to establish causality. Additionally, the study is subject to recall bias and social desirability flaws following the design employed This notwithstanding, the rigorous procedures adopted in our study were able to suppress the effects of the weaknesses, thus making the findings viable for decision making.