Association between Job burnout and Productivity among Iranian operating room Nurses: A cross-sectional study in northwest Iran

doi:10.21203/rs.3.rs-4839472/v1

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Association between Job burnout and Productivity among Iranian operating room Nurses: A cross-sectional study in northwest Iran

https://doi.org/10.21203/rs.3.rs-4839472/v1

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Background

Job burnout is a widespread issue among medical staff and operating room nurses due to the complex and stressful conditions they face in their work environment. This phenomenon can have several negative effects, such as reducing job satisfaction, increasing absenteeism, and lowering the quality of patient care. Therefore, this study aims to investigate the association between job burnout and productivity among Iranian operating room nurses.

Methods

This cross-sectional study was conducted on 294 operating room nurses in Iran. The study made use of a demographic information questionnaire, Maslach Burnout Inventory (MBI), and Hersey and Goldsmith Productivity Questionnaire for data collection. The collected data were analyzed using descriptive and analytical tests with SPSS V.27.

Results

The study's findings indicate that operating room nurses experience a moderate level of job burnout (62.18 ± 14.17) and productivity (55.61 ± 12.37). Furthermore, the study discovered a significant negative correlation between burnout and productivity in these nurses (P < 0.001, r=-0.278).

Conclusion

The study shows a negative association between job burnout and productivity, suggesting actions like workload reduction, enhanced social support, better work-life balance, process improvements, and increased appreciation could mitigate burnout and boost productivity, thereby improving patient care quality.

Health sciences/Health occupations

Health sciences/Health care

Health sciences/Health care/Health services

Health sciences/Health care/Public health

occupational burnout

productivity

perioperative

operating room

nurses

The operating room is crucial for enhancing hospital quality and efficiency, as it represents 40% of hospital expenditures while generating 60–70% of the hospital's revenue (1). Hospital administrators should strive to enhance efficiency in the operating room. Operating room efficiency hinges on optimizing resource utilization and service quality. Factors like inadequate staffing, poor communication, and outdated equipment hinder productivity, while motivated staff, effective collaboration, and timely patient prep enhance it (2). Higher productivity leads to improved resource utilization, increased power and potential, and better living standards, all of which contribute to greater organizational success (3).

According to the definition provided by the European Productivity Agency (EPA), productivity is a person's ability to do his work so that he can do it better every day and get better results (4). Employees working in safe conditions and at a high psychological level can enhance their productivity and performance (5).

Operating room nurses are exposed to special conditions and risks, such as biological, chemical, physical, ergonomic, psychological, and cultural issues, which can lead to burnout resulting from different cases (6). Burnout is a response to stress caused by work, leading to reduced effectiveness, a negative attitude, and emotional exhaustion at work (7). Many factors, such as an unhealthy and stressful work environment, insufficient personnel and a high workload, job dissatisfaction, an insufficient supply of equipment, and ineffective management approaches, can aggravate job burnout (8–10). As a result, employees often suffer from physical, communication, mental, and psychological problems, in which case the organization may face excessive employee absences, reduced job commitments, and ultimately reduced productivity (11, 12).

Job burnout is a significant problem that affects different organizations, but it becomes more important in healthcare organizations (13). According to estimates, job burnout costs the United States of America (USA) between 50 and 70 million dollars annually (14). In Iran, the rates of job burnout range from 60 to 87% (15). Among hospital healthcare professionals, nurses have the highest rate of burnout, In fact, the USA has estimated that nurses experience burnout at a rate four times higher than other professions (16). This condition is particularly important to consider in the operating room, and researchers have found that its prevalence varies across different therapeutic specialties (17). Operating room nurses face a higher risk of exposure to biological, chemical, and physical risks such as exposure to disinfectants, X-rays, sharp instruments, anesthetic gases, and physical damage from prolonged standing (18, 19).

Burnout in the operating room can have adverse consequences, leading to increased work-related stress and a decline in patient care quality. This can ultimately compromise patient safety. Therefore, it is crucial to investigate and address burnout among surgical team members, as it helps to enhance patient care quality and safety (20).

Medical and healthcare centers play a crucial role in our society by providing treatment, prevention, and care services. Employee productivity and well-being are critical for maintaining service quality and patient satisfaction. By addressing healthcare workers' concerns and needs, we can improve the healthcare system. Therefore, this study aims to investigate the relationship between job burnout and productivity among Iranian operating room nurses.

Study design and Participants:

The current study is a correlational description, and its purpose is to determine the relationship between job burnout and productivity among Iranian operating room nurses in 2022. Between March and October 2022, we conducted the study in the operating rooms of hospitals in East Azarbaijan, the largest province in northwest Iran. Participants were operating room nurses working in the operating rooms of medical education hospitals in East Azarbaijan, Iran.

Utilizing Cochran’s formula, the number of nurses to be included in this study was calculated. The total number of nurses employed in operating rooms was approximately 1150. With p and q both equal to 0.5 and d = 0.05, a sample size of 288 individuals was determined. To account for potential dropouts, we did, however, raise the sample size to 300. This research used stratified random sampling.

The work was approved by the Maragheh University of Medical Sciences research council and the regional research ethics commission. The researcher then proceeded to the nursing offices of the participating hospitals to identify research participants. Then, from each hospital’s nursing administration, a list of qualified nurses employed in the operating room was compiled. In order to enhance the sample’s representativeness, stratified random sampling was implemented. To do this, the scholar first figured out how many samples were needed from each hospital by dividing the total number of needed samples by the number of nurses working in operating rooms of each hospital. The samples were subsequently drawn at random from each hospital using a table of numbers.

The inclusion criteria for the study were as follows: having an associate's, bachelor's, or master's degree and working full-time in an operating room at an educational or medical center in East Azerbaijan province. Participants were required to have at least six months of work experience, be a member of the surgical team, and express a willingness to participate in the research. The exclusion criteria consisted of participants who did not fully complete the questionnaire.

The researcher visited hospitals on weekdays to access operating room nurses. The researcher individually stated the study objectives and obtained written informed consent before giving a questionnaire to qualified individuals, and encouraged them to join. If the nurse declined, another from the same department was randomly picked. The personnel completed the questionnaires themselves, taking adequate time to ensure high response rates while also being mindful of their workload. To ensure ethical practice, participants were guaranteed confidentiality. Each participant was assigned a special code instead of using their names.

Out of the 304 nurses that were eligible, 6 nurses declined to participate. 298 individuals submitted completed surveys. Out of these, 4 surveys were removed due to incomplete responses, leaving a total of 294 questionnaires for analysis.

Measurements:

Data collection tools included demographic information, the Maslach Burnout Inventory (MBI), and the Hersey and Goldsmith productivity standard questionnaire.

Demographic Questionnaire

The demographic information questionnaire consisted of six questions, including age, gender, marital status, work experience, level of education, and work schedule.

Maslach Burnout Inventory‎

The Maslach Burnout Inventory (MBI) is a common questionnaire utilized to assess burnout. Maslach developed it and it consists of 22 items (21). The MBI assesses three dimensions of burnout: emotional exhaustion, depersonalization, and personal accomplishment. Nine items (1–3, 8, 13–16, and 20) measure emotional exhaustion, five items (5, 6, 10, 11, and 23) measure depersonalization, and eight items (4, 7, 9, 12, 17–19, and 21) measure personal accomplishment.

The MBI rates each item from 0 (never) to 6 (every day), with scores ranging from 0 to 54 for emotional exhaustion, 0 to 30 for depersonalization, and 0 to 48 for lack of personal accomplishment. High scores in emotional exhaustion, depersonalization, and reduced personal accomplishment indicate high levels of burnout. The MBI scoring procedure is as follows: Emotional exhaustion scores are categorized as high (greater than 26), medium (between 17 and 26), or low (less than 17). Depersonalization scores are categorized as high (greater than 12), medium (between 7 and 12), or low (less than 7). Reduced personal accomplishment scores are categorized as high (greater than 39), medium (between 32 and 39), or low (less than 32). The validity and reliability of the MBI questionnaire have been established in various studies (22, 23).

Hersey and Goldsmith productivity questionnaire

This questionnaire comprises 26 items divided into seven subscales: ability (3 items), occupational identification (4 items), organization support (4 items), motivation (4 items), performance feedback (4 items), credit (4 items), and environment compatibility (3 items). A 5-point Likert scale, ranging from 1 (never) to 5 (true most of the time), rates each item. The productivity level of the study population was judged based on the minimum and maximum attainable scores of the index (29–130). Average production scores falling close to 29, 79.5, or 130 are classified as low, moderate, or high, accordingly. In a study conducted by Nasirpour et al. (24), the questionnaire's validity and reliability were confirmed. The Cronbach alpha coefficient was 0.81.

The data were gathered in consecutive fashion over a span of six months. The individuals who satisfied the inclusion criteria were provided with instructions by the researcher on how to respond to the questionnaires. They were requested to complete the forms individually, in a private environment. The researcher distributed the questionnaires, which were then collected in a sealed receptacle within the department.

Ethical considerations:

All participants provided their written assent by signing an informed consent form. To protect nurses' confidentiality, all collected data was anonymized. this study was approved by the Ethics Committee of the Maragheh University of Medical Sciences (Ethical Code: IR.MARAGHEHPHC.REC.1401.005). The study was carried out in accordance with the revised Declaration of Helsinki.

Data analysis:

All data manipulation and statistical analyses were performed with SPSS Software version 27. Results for quantitative factors were presented as mean ± standard deviation, whereas qualitative variables were provided as number and percentage. Normality of continuous data was tested by the Kolmogorov-Smirnov test. The association between variables was assessed using Pearson's correlation coefficient, independent t-test, and ANOVA or its non-parametric equivalent. For multivariate analysis, Spearman and Kendall correlation tests and quartile regression were used. A significance level of less than 0.05 was used to determine statistical significance.

According to Table 1, the average age of the participants was 30.34 ± 7.34 years. Out of 294 operating room nurses, 65 (22.1%) were male, and 229 (77.9%) were female. The majority of the participants were married (52.4%). Moreover, 256 (87.1%) of them had a bachelor's degree. The study found significant correlations between age, marital status, work shift, work experience, and productivity. Additionally, the study found a link between marital status and job burnout.

220 operating room nurses experienced high to moderate job burnout, while 244 had moderate to high productivity, according to the results obtained (Table 2).

The Kolmogorov-Smirnov and Shapiro-Wilk test results revealed that the investigated variables do not conform to a normal distribution. Hence, the non-parametric correlation coefficients of Spearman and Kendall Tau were used to examine the relationship between the two variables. The analysis revealed a significant negative correlation between the two variables (P < 0.001, r = -0.278). (Table 3)‎

To better understand the connection between burnout and productivity among operating room nurses, we created a scatter plot of two variables and a non-parametric Loess correlation curve. The indicators and the graph demonstrate that the two variables have an inverse relationship. This implies that reducing burnout among operating room nurses can increase their productivity (Fig. 1).‎

The mean score for overall job burnout was 62.18 ± 14.17, with the lowest score observed in the depersonalization component at an average of 8.73 ± 5.38, and the highest score observed in the emotional exhaustion dimension at an average of 27.14 ± 13.10. The mean productivity score was 55.60 ± 12.37, with the technological dimension receiving the highest score and the psychological dimension receiving the lowest score (Table 4).

The present study aimed to determine the relationship between job burnout and productivity among Iranian operating room nurses. The average level of job burnout in the current study was 62.18 ± 14.17. The majority of the operating room nurses included in the study experienced a moderate level of job burnout. These findings are consistent with the results of Filipska-Blejder et al (25) and Sillero and Zabalegui's study (26).While the majority of burnout research has mostly examined nurses in general, a limited number of studies have specifically explored burnout levels among operating room nurses (27). However, Sillero and Zabalegui's study indicates that operating room nurses experience a significant degree of burnout, ranging from moderate to high levels (26). According to Sillero and Zabalegui, the researchers found that nurses consider the operating room to be a challenging work environment and that organizational variables significantly contribute to burnout. In another study by Almodibeg and Smith (28), it was shown that while the occurrence of burnout was moderate among operating room nurses, these individuals were highly susceptible to it. The primary causes of burnout were identified as a heavy workload, inadequate income, employment hazards, and a lack of support from the organization. Cultural and hospital policy variations across countries may account for the difference in study results, thereby necessitating further research.

In the current study, emotional exhaustion was the highest subscale of job burnout. As a result of work-related stress, these nurses may experience a lack of energy and enthusiasm, which can negatively affect their ability to provide quality care to patients. Over time, this may lead to a decline in interest, excitement, and positive emotions towards their work, further exacerbating the issue of burnout (7). Studies have indicated that emotional exhaustion is the primary symptom of occupational burnout (15). Based on the findings of the current study, it has been determined that depersonalization is the lowest subscale of job burnout. When healthcare providers experience a high level of this dimension, they may exhibit improper behavior towards the patient and perceive them as the source of their stress. This can lead to both aggressive (using words and actions) and passive (intentional disruptions and delays) violence. In such scenarios, nurses view their clients as things and demonstrate apathy towards them (7). This finding is consistent with the research conducted by Qedair et al.(29) and kong et al. (30), but the results of Samadi et al. (31) investigation did not align with the findings presented earlier. Another study (32) shown that nurses experienced modest levels of emotional exhaustion but high levels of depersonalization and personal inefficacy. It seems that the difficult and stressful nature of the job of operating room nurses significantly increases different levels of burnout, and the influence of other risk factors that contribute to burnout can explain the changes in research findings.

The study found that the operating room nurses had a mean productivity of 55.61 ± 12.37, with most exhibiting moderate productivity. The results of the present study were consistent with the study of Bozorgzad et al. (33) and Khammarnia et al. (34) but In contrast to the present study, the research by Farsi et al. (35) on hospital nurses - excluding those in the operating room - showed a higher average total productivity score. This difference appears to be due to variations in the studied community and the distinct roles of operating room nurses compared to those in other departments. Improving hospital productivity involves efficient resource utilization, quality enhancement, patient satisfaction, and staff engagement, all of which contribute to organizational growth (36).

The highest subscale for productivity was environment compatibility, whereas the lowest subscale was motivation. In a confined operating room environment where individuals engage in highly demanding tasks for extended periods of time, it is critical to have good compatibility with colleagues, job requirements, and the environment in order to achieve excellent outcomes for the organization. However, neglecting the motivation factor can lead to a decrease in morale over time, resulting in a decline in productivity. This finding is consistent with Boromand et al. (37) They suggested that organizational apathy can decrease productivity, and it is essential to use practical, motivational elements to help staff visualize a more promising professional future. This result contradict the findings of the studies conducted by Ziapour et al. (38) and Khammarnia et al. (34) This difference in results may be due to variations in the sample sizes used in the research. Therefore, further investigation and exploration are needed across various statistical communities.

The results indicate a significant negative relationship between job burnout and productivity, indicating that individuals with higher levels of productivity experience lower levels of job burnout. The result of the present study is consistent with the findings of Mohammadnahal et al. (39), Nwosu et al. (40), Ohaeri et al. (41), and Li et al (42). These findings suggest that burnout can significantly negatively impact nurses' productivity.

In line with the current study, Mirkamali et al. (15) highlighted that factors such as burnout can significantly impact employee productivity. Therefore, it's essential to identify and mitigate these factors to improve employees' productivity levels, particularly among operating room nurses. Achieving this goal requires a comprehensive and practical approach that addresses the factors that impact productivity systematically and locally.

In line with the present study, Nayeri et al (43) concluded that emotional burnout and depersonalization have a negative correlation with productivity and personal inadequacy has a positive correlation with productivity. This means that increasing the feeling of personal sufficiency and reducing emotional exhaustion and reducing personality distortion can lead to an increase in personnel productivity. In the study of Farsi et al. (44), it was stated that in order for people to behave in accordance with the norms, a little tension is necessary, and mild stimulation can keep people alert and lead them to perform assigned tasks. But if the tension exists for a long time, it can bring physical and mental destructive effects and reduce productivity.

This study has the potential to mitigate burnout among operating room nurses by identifying the elements that lead to its development and applying suitable educational interventions to enhance their productivity. Ultimately, these elements have the potential to result in an enhanced level of patient care. Standardizing and equipping healthcare facilities adequately, as well as enhancing staff motivation, can play a vital role in enhancing the productivity of employees in the operating room. According to the results of this study, it is recommended that relevant authorities adopt strategies such as offering training in practical communication skills, time management skills, and task allocation. also, nurses must develop strategies to manage stress and prevent burnout, which has important implications for nurses, hospital managers, and policymakers.

Limitations:

Although this study provides substantial evidence on the relationship between burnout and productivity among operating room nurses, it has several limitations. Firstly, the study was cross-sectional, meaning it only measured the relationship between burnout and productivity at a single point in time. Therefore, this study cannot prove causality. Secondly, the study sample was relatively small, which can impact the generalizability of the findings. Lastly, the data were self-reported, which may be prone to bias. Despite these limitations, the findings of this study can be used to develop interventions to improve the quality of patient care.

Based on the findings, there was an average level of job burnout and productivity. In addition, a significant negative correlation was observed between the two variables. Therefore, it is highly recommended that the relevant authorities take the necessary steps to address this issue. Some of the measures that can be implemented include reducing workload, increasing social support, improving work-life balance, enhancing processes and workflow, and providing feedback and appreciation to nurses. These actions aim to reduce burnout and enhance productivity, ultimately leading to an improvement in the quality-of-care services provided to patients.

Acknowledgments:

The researchers sincerely appreciate everyone who voluntarily participated in the research.

Author Contributions:

V.R and N.A contributed to the study design, data collection, data analysis, interpretations of the results and manuscript write-up.A.A and M.GH and M.A contributed to data analysis, interpretations of the results and manuscript write-up and review. All authors read and approved the final manuscript.

Funding source:

The Maragheh University of Medical Sciences provided funding for this study (Grant numbers: IR.MARAGHEHPHC.REC.1401.005).

Data availability:

The datasets used and analysed during the current study are available from the corresponding author on reasonable request.

Consent for publication

Not applicable.

Conflict of Interest:

The study was carried out without any financial or commercial ties that may be seen as having a conflict of interest, the authors disclose.

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Table 1

Socio-demographic characteristics of study subjects and their relationship with job burnout and productivity (n = 294)
Variables		Mean ± SD Percentage (Frequency)	job burnout Mean ± SD	P-value	productivity Mean ± SD	P-value
Age		30. 34 ± 7.34		0.137 0.087		0.025 -0.131
Work Experience		7.06 ± 7.20		0.436 0.046		0.032 -0.125
Gender	Male	22.1% (65)	62.12 ± 14.66	0.813	58.6 ± 12.05	< 0.001
Gender	Female ‎	‎77.9%‎ (229)	‎62.19 ± 14.06‎	0.813	‎54.75 ± 12.36‎	< 0.001
Marital status	Single	47.6% (140)	60.69 ± 13.96	0.040	58.27 ± 12.62	< 0.001
Marital status	Married ‎	‎52.4%‎ (154)	‎63.53 ± 14.27‎	0.040	‎53.18 ± 11.67‎	< 0.001
Educational Level	Associate	8.1% (24)	63.83 ± 14.31	0.674	55.75 ± 10.28	0.911
	B‏.‏‎ Sc‏.‏	‎87.1%‎ (256)	‎62.17 ± 14.29‎		‎55.37 ± 12.35‎
	M‏.‏‎ Sc‏.‏	‎4.8%‎ (14)	‎59.50 ± 11.89‎		‎59.64 ± 15.81‎
work shift	Rotational	55.4% (163)	62.90 ± 13.52	0.896	54.22 ± 11.64	0.038
work shift	Fixed shift	‎44.6%‎ (131)	‎61.28 ± 14.95‎	0.896	‎57.33 ± 13.07‎	0.038

Table 2

frequency and percentages of job burnout and productivity among operating room nurses
Job burnout	low	74 (25.17%)
	Medium	213 (72.44%)
	High	7 (2.38%)
Productivity	Low	50 (17%)
	Medium	240 (81.63%)
	High	4 (1.36%)

Table 3

correlation between job burnout and it’s dimension with productivity
	Ability	Occupational identification	Organization support ‎	Motivation	Performance feedback ‎	Credit	environment compatibility ‎	Total productivity
Emotional exhaustion	< 0.001 -0.344	< 0.001 -0.297	< 0.001 -0.337	< 0.001 -0.326	< 0.001 -0.308	< 0.001 -0.432	0.012 -0.147	< 0.001 -0.444
Depersonalization	0.205 -0.074	0.683 -0.024	0.108 -0.094	0.770 -0.017	0.275 -0.064	0.155 -0.083	0.075 -0.104	0.293 -0.062
personal accomplishment‎	< 0.001 0.228	< 0.001 0.227	0.007 0.158	0.057 0.111	0.243 0.068	0.032 0.125	< 0.001 0.198	< 0.001 0.209
Total job burnout	0.003 -0.172	0.033 -0.125	< 0.001 -0.234	< 0.001 -0.209	< 0.001 -0.243	< 0.001 -0.331	0.201 -0.075	< 0.001 -0.278

Table 4

mean average of job burnout and productivity and their dimensions among Iranian operating room nurses
variable	Mean	SD
emotional exhaustion‎	27.14	13.10
Depersonalization	8.73	5.38
personal accomplishment‎	26.27	7.58
Total job burnout	62.18	14.17
Ability	8.27	2.91
occupational identification	8.95	2.80
organization support ‎	7.02	2.40
Motivation	6.22	2.41
performance feedback ‎	8.68	2.32
Credit	5.12	2.17
environment compatibility ‎	11.31	2.04
Total productivity	55.60	12.37

No competing interests reported.

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Association between Job burnout and Productivity among Iranian operating room Nurses: A cross-sectional study in northwest Iran

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Introduction

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Demographic Questionnaire

Maslach Burnout Inventory‎

Hersey and Goldsmith productivity questionnaire

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