Our study identified the high prevalence of burnout rate (overall burnout rate: 35.4%) in critical healthcare practitioners during the post-pandemic era in Taiwan and discovered they were experiencing high levels of EE and DP, coupled with a low level of PA. Lacking experience of critical care, excessive working hours and night shifts were possible key factors damaging the wellbeing of the critical healthcare professionals. Besides, the top three work stressors identified were excessive workload, the burden of administrative tasks, and a shortage of vacation time. Through systematic reviews of Asian literature regarding burnout, we had discovered not only demographic variations in the prevalence of burnout but differences in the associated factors before and after the COVID-19 pandemic.
Associated factors of burnout during the post-pandemic era
Despite the causal relationship between burnout and risk factors may be limited by the cross-sectional design of studies, we can still take a glance at the vulnerable populations. Previous studies discovered that being nurses, job overload, perception of underpaid, experiencing stigma from caring for COVID-19 patients, having personal health condition and more night shift were possible risks factors (see Table 3). In our study, several variables were found associated with burnout, including being younger, unmarried, having less working experience, longer working hours and more night shifts.
Undoubtedly, being a critical care professional entails a high risk of burnout compared to other specialties due to the nature of the job12, 46–48. However, there remains conflicts concerning level of burnout between different occupation. Previous meta-analysis by MM Macaron et al and multinational survey by See KC et al revealed no significant difference in pooled estimate of burnout prevalence between physicians and nurses11, 12. On the contrary, critical care nurses were recognized as high-risk group by Gualano MR et al32 and the multi-center study by Chor WP et al also discovered slightly higher burnout rate among nurses compared with physicians working in ED (53.3% versus 42.5%)32.These variation between studies may reflect the difference in organization-level healthcare systems. In Taiwan, there is the lowest physician or nurse -population ratio, with 2 physicians and 7.6 nurses per 1,000 population, according to the survey by Organization for Economic Cooperation and Development (OECD). However, the number of adult critical care beds leads among Asian countries, with 28.5 beds per 100,000 population, compared to the average of 3.6 beds per 100,000 population49. In our study, we found one-third of critical care professionals reported stress related to shift work, and over 70% of nurses experienced a workload burden (Fig. 2). Despite no significant difference in each subscale of burnout between physicians and nurses, nurses had higher prevalence of overall burnout compared to physicians (37.5% versus 26%), which may be associated with the critical care nurses were often working understaffed, having additional administrative tasks, and working overtime33, 50.
High EE and DP were observed in younger, less experienced individuals, consistent with previous studies50–53. While burnout is often considered to mainly affect those in their later careers, this may be related to the shortage of critical professionals and the common situation where nurses are forced to handle excessive, unfamiliar clinical tasks before they are fully prepared. Our data reflected that workload burden and staff shortages were reported as the top work stressors (Fig. 2). According to a survey by the Taiwan Ministry of Health and Welfare, one nurse in Taiwan cares for an average of 9 to 15 patients. Notably, younger individuals comprise most critical healthcare professionals in Taiwan. Therefore, it’s not surprising that the turnover rate for nurses is as high as 14.5% annually, with most nurses leaving within an average of 6.5 years, according to the Taiwan Ministry of Health and Welfare's 2023 survey.
Irregular night shifts and longer working hours were associated with higher scores in EE in our study. Night shift stress has been previously linked to burnout, mental health problems, and sleep disturbances54, 55. Furthermore, compared to those with fixed night shifts, participants with irregular night shifts had a higher risk of burnout 56. Irregular shift schedules can compromise physical and psychological health as well as occupational functionality. Additionally, long working hours, especially working more than 55 hours per week, were associated with greater sleep disturbances and occupational stress compared to working 40 hours a week57. Implementing reasonable working hours and regular shift schedules may be effective interventions for preventing burnout and enhancing job performance.
Maintaining a work-life balance is crucial for well-being, and marriage appears to be one of the solutions58, 59. According to the theory of work-family enrichment, married individuals tend to experience better job satisfaction by actively engaging in their parental roles60. Recent studies conducted during the COVID-19 pandemic have highlighted the significant moderating role of family support in mitigating burnout across various dimensions and enhancing subjective well-being61, 62. Despite the potential stresses of parenthood, the protective effects of marriage can be attributed to lifestyle changes, involvement in parental responsibilities, and simply spending time with family63. Consistent with prior research, we found that married individuals exhibited lower EE and PA with higher DP compared to their unmarried counterparts36. Individuals with more children also exhibited lower EE and PA with higher DP, a phenomenon not observed in individuals with pets in our study.
The relationship between burnout interventions and locally identified workplace stressors and risk factors.
Given the demographic variation in burnout, gathering local data, identifying vulnerable populations, and promoting interventions can help reduce the risk of burnout.
At the individual level, improving interprofessional communication, participating in face-to-face group programs, fostering a positive mindset, and maintaining a work-family balance have proven beneficial64, 65. Organizational-level interventions include reducing unnecessary administrative tasks and workload, creating a supportive work atmosphere, and regulating the number of workdays and night shifts. Prioritizing the well-being of healthcare staff through these interventions establishes a solid foundation for reducing burnout. Consequently, it leads to improvements in the quality of care, reductions in medical expenditures, and lower turnover rates.