Identifying Burnout and Turnover Risks in Canadian Healthcare Workers During the COVID-19 Pandemic

doi:10.21203/rs.3.rs-4850310/v1

Download PDF

Research Article

Identifying Burnout and Turnover Risks in Canadian Healthcare Workers During the COVID-19 Pandemic

https://doi.org/10.21203/rs.3.rs-4850310/v1

This work is licensed under a CC BY 4.0 License

You are reading this latest preprint version

Background/Objectives: The COVID-19 pandemic has tested health systems worldwide, exposing significant weaknesses and vulnerabilities, particularly its toll on healthcare workers (HCWs). This study aimed to identify risk factors leading Canadian HCWs to consider leaving their positions due to stress or burnout during the pandemic.

Methods: Data from the 2022 Survey on Healthcare Workers’ Experiences During the Pandemic (SHCWEP) were analyzed using the Shanafelt and Noseworthy (2017) framework for understanding clinician burnout. We hypothesized that factors such as workload, work-life balance, resource availability, social and community support at work, and job environment—including organizational culture, values, and flexibility—could influence HCWs' intentions to leave due to stress or burnout. Multivariable logistic regression models were employed to identify significant risk factors for each HCW group.

Results: The SHCWEP survey had a 54.9% response rate, with 12,139 HCWs participating. Of these, 3,034 HCWs (25%) expressed an intention to leave their current job, and within this group, 1,350 cited stress or burnout as their reason, representing 11% of the total participants and 44% of those intending to leave. Factors associated with HCWs considering leaving due to stress and burnout included younger to middle-age, heightened work stress, longer working hours, increased workload, financial difficulties, conflicts with colleagues or management, non-adherence to PPE/IPC protocols, and lack of professional emotional support.

Conclusion: The findings align with the recommendations of the Framework for a Systems Approach to Clinician Burnout and Professional Well-Being. Many factors contributing to HCWs' intentions to leave due to stress or burnout could be mitigated by policymakers and health organizations.

Burnout

COVID-19

Healthcare

Intention to leave work

Health systems

Canada

healthcare services

healthcare workers

The COVID-19 pandemic has profoundly impacted healthcare systems worldwide, presenting unprecedented challenges that have strained resources, tested resilience, and highlighted vulnerabilities in healthcare delivery (WHO, 2020). Among the most critical issues exacerbated by this global crisis is the heightened burden experienced by healthcare workers (HCWs). Reports from the World Health Organization (WHO) and various studies underscore the alarming levels of stress, burnout, and workforce attrition among HCWs during the pandemic (Burn-out an “Occupational Phenomenon,” n.d.; Singh et al., 2024).

Burnout, characterized by emotional exhaustion, depersonalization, and reduced personal accomplishment, has long been recognized as a significant issue among healthcare professionals (Leiter et al., 2015; Schaufeli et al., 2009). The pandemic magnified these challenges, as HCWs faced prolonged exposure to high-stress environments, increased workloads, and often inadequate resources (Tabur et al., 2022). Studies indicate a significant rise in burnout during the pandemic, contributing to increased turnover intentions among HCWs (Rotenstein et al., 2023). Factors such as excessive workload, poor work-life balance, and emotional exhaustion have been identified as primary drivers (Aras & Gümüşsoy, 2024; Blanco-Donoso et al., 2021; Montgomery & Patrician, 2022). For instance, a recent cross-sectional study in Canada highlighted a strong association between burnout and early retirement or intentions to leave among healthcare professionals, stressing the urgent need to address burnout, including its subscales like exhaustion and disengagement, to retain healthcare workers in the workforce (Singh et al., 2024).

Job vacancies in healthcare settings surged during the pandemic, exacerbating the strain on healthcare professionals and health systems. This increase in workload for HCWs was evident as seventeen out of twenty healthcare workers reported increased work-related stress during this period (Government of Canada, 2021). By 2021, more than one-fifth of the health sector workforce (236,000) reported working overtime, with average weekly totals of 8.2 hours of paid overtime and 5.8 hours of unpaid overtime—the highest in nearly a decade (Government of Canada, 2022). These challenges have significantly contributed to healthcare workers expressing intentions to leave their positions due to stress or burnout. Understanding the factors driving these intentions is crucial for addressing workforce retention and fostering a sustainable healthcare system post-pandemic.

This study aims to address this gap by investigating the specific risk factors contributing to Canadian HCWs' intentions to leave their current positions due to stress or burnout during the COVID-19 pandemic. By analyzing data from the 2022 Survey on Healthcare Workers’ Experiences During the Pandemic (SHCWEP) and applying a framework adapted from Shanafelt and Noseworthy (2017) for understanding clinician burnout, this research seeks to provide empirical insights into the multifaceted nature of healthcare worker burnout in Canada. The findings of this study may help guide interventions aimed at mitigating burnout, enhancing job satisfaction, and ultimately fostering a resilient healthcare workforce capable of meeting future challenges effectively.

Data

Data for this study were extracted from the 2022 Survey on Healthcare Workers’ Experiences During the Pandemic (SHCWEP), conducted between September 2, 2021, and November 12, 2021, across 10 provinces in Canada. The survey aimed to capture healthcare workers' experiences since the onset of the COVID-19 pandemic.

The SHCWEP collected comprehensive data including demographics, job types, workplace settings, use of personal protective equipment (PPE), infection prevention and control (IPC) practices, and the impacts of COVID-19 on personal health and work life (Government of Canada, 2021). This study focuses on healthcare workers' intention to leave their positions due to burnout, using variables selected based on the framework developed by Shanafelt and Noseworthy (2017) and existing literature.

Reprinted from Shanafelt TD and Noseworthy JH. Executive Leadership and Physicians Well-being: Nine Organizational Strategies to Promote Engagement and Reduce Burnout. Mayo Clin Proc. 2017 January; 92(1): 129 146 with permission from Elsevier.

Conceptual Framework

The Shanafelt and Noseworthy framework, as shown in Fig. 1, identifies key drivers of burnout and engagement across seven critical areas affecting physician well-being: workload and job demands, control and flexibility, work-life integration, social support and community at work, organizational culture and values, efficiency and resources, and meaning in work. These factors are known to influence burnout among healthcare professionals, with excessive workload, lack of control, and poor work-life balance being significant contributors (Shanafelt & Noseworthy, 2017).

We operationalized the model as shown in Table 1. Although the model was initially intended to explain physician burnout, we extended it to two additional groups: nurses and health aides. We conducted three separate regressions, one for each of the three medical professions (physicians, nurses, and health aides).

Table 1
Variables included in the analysis
Control variables	Workload and job demands	Efficiency and resources	Organizational culture and values	Social and community support	Work life integration	Control and flexibility
(AGEDVGRP): Age	(ICJ_05E): Experienced an increased in their workload	(PPE_30B): Access to N95 Masks	(PPE_40C): Whether colleagues were following IPC/PPE policies	(PPE_40F): Whether a professional emotional support was available	(IM_10A) Difficulty caregiving at home	(ICJ_05K): Having to take unpaid leave
(GDRDVGRP): Sex	(ICJ_05D): Whether additional atypical work tasks were given	(PPE_40B): Whether ICP/PPE training was received	(PPE_40D): Whether ICP measures were enforced by management		(IM_10B): Difficulty meeting financial obligations or essential needs	(ICJ_05M): Had to change method of delivery of health care
(LMAGNOC): Occupation	(ICJ_05G): Experienced a reduction in hours		(ICJ_05B): Whether there was more conflict between employees and management		(ICJ_05I): Experienced a loss of income since the pandemic started
(OCCDVGYW): Years at current job			(ICJ_05C): Experienced an increase in work stress		(ICJ_05J): Experienced an increase in income since the pandemic started
(PGDVFLA): Visible minority status
(HHCDVGRP): Number of household Members
(ENVDVCON): Contact with COVID-19 patients
(ENVDVGRW): Province of work

Statistical Analysis

Survey participants were asked, "How long are you planning to stay in your current job?" If a participant indicated a timeframe of two years or less, they were asked follow-up questions regarding their reasons for considering leaving. A total of 3,034 participants expressed intentions to leave within two years, forming the cohort for our analysis. The dichotomous outcome of interest was whether they planned to leave due to stress or burnout versus any other reason. This inclusion criterion aimed to isolate the effects of variables specifically related to burnout or stress rather than other reasons for leaving (Government of Canada, 2021).

Each independent variable of interest had varying degrees of missing data, ranging from 0.1–11.1%. To address this, we employed multiple imputation by chained equations (MICE) (Azur et al., 2011). The data cohort of 3,034 healthcare workers (HCWs) intending to leave their jobs was imputed 30 times over 20 iterations, producing 30 imputed datasets. Subsequently, sub-datasets for each HCW cohort (physicians, n = 500; nurses, n = 1,138; health aides, n = 625) were created from each of the 30 imputed datasets. Binary logistic regression models with backward selection were then fitted to all 30 datasets for each HCW cohort. Independent variables selected in 50% or more of the models after backward selection were included in the final model. This final model was run on all 30 datasets, and the results for each HCW cohort were obtained by averaging the model coefficients and standard errors across the imputed datasets. All data analyses were conducted using R version 4.3.0, with the packages “mice” and “survey” for the MICE and svyglm functions, respectively(Thomas Lumley, Peter Gao, Ben Schneider, 2003). Forest plots for each HCW cohort were created using Tableau 2023.3.

Of the total survey sample, 12,139 healthcare workers across Canada participated. Among them, 3,034 (24.9%) indicated they intended to leave their current job within two years, with 1,350 (44% of those intending to leave) citing stress or burnout as the reason. Table 2 presents the descriptive statistics for survey respondents intending to leave their current job. Figures 2.1 through 2.4 visually represent the sample characteristics, covering various aspects such as occupation, sex, age, province of residence, and intention to leave current job.

Table 2
Descriptive Statistics of all healthcare workers intending to leave their current job, n = 3,034
Characteristic	Leaving current job	Leaving current job due to stress/burnout
Age 18 to 34 years 35 to 44 years 45 to 54 years 55 and older	738 484 353 1453	455 (61%) 318 (65%) 219 (62%) 355 (24%)
Sex Female Male	2,370 651	1,103 (46%) 240 (36%)
Occupation Physicians Nurses Care aids Other	500 1,138 625 771	160 (32%) 609 (53%) 240 (38%) 341 (44%)
Province British Columbia Alberta Saskatchewan Manitoba Ontario Quebec Atlantic Provinces (NB, NL, NS, PE)	429 363 303 361 361 307 910	197 (45%) 182 (50%) 156 (51%) 165 (45%) 173 (47%) 103 (33%) 374 (41%)

Figure 2: Sample description

Figure 2.1: SHCWEP Participants by Occupation and Age Group (n = 12,139)

Figure 2.2: SHCWEP Participants by Occupation and Sex (n = 12,139)

Figure 2.3: SHCWEP Participants by Occupation and Province (n = 12,139)

Figure 2.4: SHCWEP Participants Intending to Leave Their Job by Occupation and Their Reason, (n = 12,139)

Table 3 and Fig. 3 show the results of the model examining factors associated with physicians' intentions to leave work due to burnout. Physicians who experienced financial difficulty since the onset of the COVID-19 pandemic had significantly higher odds of leaving their job due to stress/burnout (aOR 3.95; 95% CI 1.28–12.2). Additionally, those who faced an increased workload had significantly higher odds of leaving due to stress/burnout (aOR 5.16; 95% CI 2.46–10.9). Physicians who agreed slightly (aOR 2.84; 95% CI 1.19–6.78) or disagreed (aOR 3.69; 95% CI 1.11–12.30) that their IPC training was sufficient also had significantly higher odds of leaving due to stress/burnout compared to those who strongly agreed.

Physicians practicing in British Columbia (aOR 0.32; 95% CI 0.12–0.84) and Manitoba (aOR 0.34; 95% CI 0.13–0.89) had significantly lower odds of leaving due to stress/burnout compared to those in Ontario. Those working in long-term care settings had significantly lower odds of leaving due to stress/burnout than those in acute care (aOR 0.047; 95% CI 0.003–0.601).

Table 3
Likelihood of a Canadian physician intending to leave their current job due to stress/burnout versus leaving due to any other reason.
		95% Confidence Interval
Characteristic	Odds Ratio	Lower	Upper
Age (Ref: 18–34)
35–44 45–54 55+	2.92 0.41 0.16	0.99 0.03 0.004	8.60 5.97 5.22
Gender (Ref: Male)
Female	1.67	0.78	3.55
Household Number (Ref: 1)
2 3 4+	1.2 0.63 2.03	0.44 0.16 0.54	3.27 2.46 7.67
Province (Ref: Ontario)
Alberta British Columbia Saskatchewan Manitoba Quebec Atlantic Provinces (NB, NL, NS, PE)	0.83 0.32* 0.44 0.34* 0.35 0.76	0.29 0.12 0.12 0.13 0.12 0.30	2.31 0.84 1.57 0.89 1.04 1.94
Job Setting (Ref: Acute Care)
Long-term Outpatient/ambulatory Other	0.047* 1.18 1.27	0.003 0.563 0.295	0.601 2.47 5.49
Years in current occupation (Ref: < 10 years)
10 to 19 years 20 years or more	4.58 15.9	0.55 0.53	37.9 478.0
Difficulty Balancing Responsibilities (Ref: No)
Yes	1.69	0.82	3.51
Employee-Management Conflict (Ref: No)
Yes	1.75	0.87	3.53
Financial Difficulty (Ref: No)
Yes	3.95*	1.28	12.2
Income Loss (Ref: No)
Yes	1.96	0.85	4.52
Increased Workload (Ref: Yes)
No	5.16***	2.46	10.9
IPC Training was Sufficient (Ref: Strongly Agree)
Agree Neither Disagree Strongly Disagree	2.84* 2.05 3.69* 5.66	1.19 0.496 1.11 0.63	6.78 8.49 12.30 50.30
New Work Tasks (Ref: No)
Yes	0.65	0.31	1.35
Professional Therapy Available (Ref: Strongly Agree)
Agree Neither Disagree Strongly Disagree	0.341 0.455 0.806 0.940	0.099 0.128 0.191 0.168	1.18 1.62 3.40 5.27
Unpaid Leave (Ref: No)
Yes	2.24	0.58	8.59
Contact with COVID-19 Patients (Ref: No)
Yes	2.03	9.66	4.26
Increased Income (Ref: No)
Yes	2.51	0.771	8.18
p < 0.05; p < 0.01; *p < 0.001. Results are based on multivariable logistic regression accounting for complex survey weights.*

For nurses, as shown in Table 4 and Fig. 4, experiencing conflict with management (aOR 1.67; 95% CI 1.07–2.61), an increased workload (aOR 2.46; 95% CI 1.30–4.64), and increased stress at work (aOR 3.79; 95% CI 1.67–8.59) were all significantly associated with a higher likelihood of leaving due to stress/burnout. Nurses who disagreed with whether IPC measures were enforced/maintained had significantly higher odds of leaving due to stress/burnout (aOR 3.67; 95% CI 1.17–11.50). Conversely, nurses who neither agreed nor disagreed about having sufficient IPC training had significantly lower odds of intending to leave due to stress/burnout compared to those who strongly agreed (aOR 0.24; 95% CI 0.09–0.61). Those who disagreed (aOR 3.80; 95% CI 1.42–10.10) or strongly disagreed (aOR 5.38; 95% CI 1.82–15.80) with having professional therapy available had a higher odds of leaving due to stress/burnout.

Age and province of work were also significant factors. Nurses aged 35–44 (aOR 0.38; 95% CI 0.17–0.87) and 55+ (aOR 0.14; 95% CI 0.05–0.39) had significantly lower odds of leaving due to stress/burnout compared to those aged 18–35. Nurses practicing in Quebec had significantly lower odds than those in Ontario (aOR 0.32; 95% CI 0.15–0.68). Those who had been working at their current job for 10–19 years had significantly higher odds of leaving due to stress/burnout compared to those who had worked less than 10 years (aOR 2.79; 95% CI 1.21–6.41).

Table 4
Likelihood of a Canadian nurse intending to leave their current job due to stress/burnout versus leaving due to any other reason.
		95% Confidence Interval
Characteristic	Odds Ratio	Lower	Upper
Age (Ref: 18–34)
35–44 45–54 55+	0.387* 0.527 0.144***	0.172 0.203 0.052	0.871 1.37 0.397
Household Number (Ref: 1)
2 3 4+	1.52 1.44 0.73	0.761 0.613 0.329	3.02 3.37 1.65
Province (Ref: Ontario)
Alberta British Columbia Saskatchewan Manitoba Quebec Atlantic Provinces (NB, NL, NS, PE)	0.896 1.12 0.929 1.17 0.323** 0.765	0.439 0.563 0.399 0.538 0.153 0.420	1.83 2.24 2.17 2.55 0.685 1.39
Job Setting (Ref: Community/Homecare)
Acute Long-term Outpatient/ambulatory Other	1.070 0.716 0.414 0.520	0.364 0.224 0.122 0.129	3.150 2.290 1.400 2.090
Years in current occupation (Ref: < 10 years)
10 to 19 years 20 years or more	2.790* 1.130	1.210 0.444	6.410 2.870
Colleagues Followed IPC Policies (Ref: Strongly Agree)
Agree Neither Disagree Strongly Disagree	1.57 2.54 0.93 0.615	0.692 0.904 0.374 0.139	3.560 7.130 2.640 2.730
Employee-Management Conflict (Ref: No)
Yes	1.670*	1.070	2.610
Financial Difficulty (Ref: No)
Yes	1.840	0.713	4.760
Increased Workload (Ref: Yes)
No	2.46**	1.300	4.640
Increased Work Stress (Ref: No)
Yes	3.790**	1.670	8.590
IPC Measures were Enforced/Maintained (Ref: Strongly Agree)
Agree Neither Disagree Strongly Disagree	1.260 1.170 3.670* 7.970	0.601 0.417 1.170 0.900	2.630 3.260 11.50 70.50
IPC Training was Sufficient (Ref: Strongly Agree)
Agree Neither Disagree Strongly Disagree	0.982 0.247** 0.910 2.230	0.536 0.098 0.371 0.235	1.800 0.610 2.240 21.20
Professional Therapy Available (Ref: Strongly Agree)
Agree Neither Disagree Strongly Disagree	1.45 1.59 3.80 5.38	0.594 0.642 1.423 1.827	3.530 3.930 10.10 15.80
Reduced Hours (Ref: Yes)
No	2.370	0.778	7.240
Unpaid Leave (Ref: No)
Yes	1.710	0.785	3.710
p < 0.05; p < 0.01; *p < 0.001. Results are based on multivariable logistic regression accounting for complex survey weights.*

Table 5 and Fig. 5 present the results for health care aides. Those who reported that N95/KN95 masks were only sometimes available had increased odds of leaving due to stress/burnout compared to those who said these masks were always available (aOR 4.74; 95% CI 1.72–13.10). Experiencing an increase in income significantly decreased the odds of leaving due to stress/burnout (aOR 0.43; 95% CI 0.19–0.93). Health care aides who disagreed with whether IPC measures were enforced/maintained at their workplace had significantly higher odds of intending to leave work compared to those who strongly agreed (aOR 9.30; 95% CI 1.61–53.8).

Age was also a significant factor, with those aged 55 + having significantly lower odds than those aged 18–34 for intending to leave their job due to stress/burnout (aOR 0.25; 95% CI 0.09–0.67). Working in long-term care compared to community/home care was associated with a significantly increased odds of leaving due to stress/burnout (aOR 4.61; 95% CI 2.19–9.69). Those who had worked at their current job for 10–19 years compared to less than 10 years had significantly higher odds of leaving due to stress/burnout (aOR 2.25; 95% CI 1.01–5.05).

Table 5
Likelihood of a Canadian health care aid intending to leave their current job due to stress/burnout versus leaving due to any other reason.
		95% Confidence Interval
Characteristic	Odds Ratio	Lower	Upper
Age (Ref: 18–34)
35–44 45–54 55+	0.914 1.640 0.255***	0.354 0.513 0.095	2.360 5.260 0.677
Gender (Ref: Male)
Female	0.654	0.255	1.680
Job Setting (Ref: Community/Homecare)
Acute Long-term Outpatient/ambulatory Other	2.42 4.61*** 1.90 1.36	0.97 2.19 0.29 0.34	6.04 9.69 12.4 5.39
Years in current occupation (Ref: < 10 years)
10 to 19 years 20 years or more	2.25* 1.23	1.01 0.45	5.05 3.35
Access to N95/KN95 Masks (Ref: Always Available)
Usually Available Sometimes Available Never Available Not Needed	1.51 4.74*** 1.43 1.00	0.59 1.72 0.48 0.47	3.82 13.10 4.59 2.11
Colleagues Followed IPC Policies (Ref: Strongly Agree)
Agree Neither Disagree Strongly Disagree	0.768 2.17 0.81 1.03	0.28 0.57 0.17 0.07	2.11 8.17 3.76 13.7
Contact with COVID-19 Patients (Ref: No)
Yes	1.78	0.93	3.40
Financial Difficulty (Ref: No)
Yes	1.68	0.82	3.40
Increased Income (Ref: No)
Yes	0.43*	0.19	0.93
IPC Measures were Enforced/Maintained (Ref: Strongly Agree)
Agree Neither Disagree Strongly Disagree	1.02 2.52 9.30* 0.72	0.39 0.65 1.61 0.03	2.67 9.68 53.8 16.5
New Work Tasks (Ref: No)
Yes	1.69	0.91	3.14
Unpaid Leave (Ref: No)
Yes	1.93	0.85	4.38
p < 0.05; p < 0.01; *p < 0.001. Results are based on multivariable logistic regression accounting for complex survey weights.*

The COVID-19 pandemic has placed an unprecedented burden on Canadian healthcare workers, with a notable impact on their well-being. Our study, contextualized within the 2022 Survey on Healthcare Workers’ Experiences During the Pandemic, reveals that a significant proportion of healthcare workers contemplated leaving their jobs, primarily citing stress or burnout as reasons, aligning with global trends (Anzaldua & Halpern, 2021; Caponnetto et al., 2022; Said & El-Shafei, 2021). This research uniquely focuses on identifying how various risk factors affect different healthcare worker groups in Canada, particularly examining the intention to leave due to burnout rather than burnout itself.

Workload and Work-Life Balance

Consistent with the Shanafelt and Noseworthy framework, excessive workload emerges as a primary contributor to burnout among physicians and nurses, reinforcing existing literature (Work Overload Triples the Risk of Burnout in Health Care, 2023). The integration of work and personal life also significantly influences burnout intentions. Financial strain during the pandemic heightened intentions to leave among physicians, while increased income buffered such intentions among healthcare aides, underscoring the critical role of work-life balance (Hämmig, 2018).

Resources and Work Environment

Inadequate resources and operational inefficiencies added to the stress levels of healthcare workers during the pandemic, especially regarding PPE availability and IPC practices. Physicians who felt they did not receive sufficient IPC training were more likely to consider leaving, while inconsistent access to N95/KN95 masks increased stress among healthcare aides. These findings highlight the importance of ensuring adequate resources and strong infection control measures to help reduce burnout risks.

Social Support and Community

Strong social support and organizational cohesion can help reduce burnout risks. Healthcare workers who felt that IPC measures were not consistently enforced were more likely to consider leaving, suggesting the importance of supportive work environments (Montgomery & Patrician, 2022). Additionally, access to professional therapy appeared to be important, as nurses without such access were more likely to express intentions to leave due to burnout. This highlights the value of comprehensive mental health support systems within healthcare settings.

Organizational Culture and Values

Conflict

between employees and management, which may reflect challenges in organizational culture, was associated with higher burnout intentions among nurses in our study. Additionally, moral distress from value conflicts within the workplace appeared to increase burnout risks (LeClaire et al., 2022). Efforts to improve organizational culture and align values with workforce needs could be beneficial for retaining healthcare professionals.

Setting Differences

The work setting had a notable influence on burnout intentions. Physicians in long-term care settings were less likely to consider leaving compared to those in acute care, while healthcare aides showed the opposite trend. This highlights how different work environments can impact burnout in various healthcare roles (Smith et al., 2023).

Provincial and Demographic Differences

While not explicitly outlined in existing frameworks, provincial disparities were evident in burnout intentions. Physicians in British Columbia and Manitoba showed lower odds of intending to leave compared to Ontario, echoing regional variations in healthcare system support. Age and experience also played significant roles, with younger healthcare workers and those with intermediate tenure facing heightened burnout risks, indicating diverse needs across demographic groups.

Policy Implications

Our findings suggest several policy interventions and organizational strategies that could help mitigate burnout and improve retention among healthcare workers. These suggestions are context-dependent and may vary in importance based on specific healthcare settings and regional needs.

Firstly, implementing strategies to manage workload effectively, such as offering flexible scheduling options and workload adjustments, could alleviate burnout risks among healthcare professionals. Promoting a supportive work environment that emphasizes work-life balance and strengthens social support mechanisms may also enhance overall well-being.

Additionally, ensuring sufficient resource allocation and maintaining rigorous adherence to infection prevention and control (IPC) protocols during public health crises are recommended to safeguard healthcare worker health and safety. These measures are critical in providing a secure and supportive environment for healthcare professionals.

Furthermore, enhancing access to professional emotional support services within healthcare settings, including counseling and therapy tailored to the unique stressors faced by healthcare workers, could foster resilience and promote mental well-being.

These policy recommendations aim to create environments that sustain healthcare workforce morale and effectiveness, potentially leading to improved patient care outcomes. They should be adapted and prioritized based on local healthcare contexts and ongoing assessments of healthcare worker needs.

Limitations

This study has several limitations. Firstly, the timing of the survey administration introduces potential recall bias, as participants were asked to reflect on their experiences over a 1.5-year period. Additionally, the survey itself acknowledges that it may not be a completely representative sample of the entire Canadian healthcare worker population. However, with over 12,000 respondents, including more than 3,000 in our specific analysis, the diverse demographics of the participants likely reflect overall trends.

Relying on secondary data limited our ability to operationalize and test certain constructs due to the absence of corresponding survey questions. For instance, there was limited attention to "control and flexibility" in the work environment, preventing us from assessing the connection between a lack of control over work, inflexibility in job roles, and the intention to leave work due to burnout.

Lastly, the absence of qualitative data makes it challenging to fully understand the context behind the survey responses. This limitation restricts our ability to delve deeper into the personal experiences and nuances that may influence healthcare workers' intentions to leave their jobs due to stress and burnout.

Healthcare workers (HCWs) in Canada are significantly impacted by burnout, worsened by the COVID-19 pandemic. The 2022 Survey on Healthcare Workers’ Experiences During the Pandemic provided valuable insights into factors influencing intentions to leave work due to burnout. Our study highlights that workload, work-life balance, social support, and organizational culture are key contributors, with notable provincial differences and heightened vulnerability among younger nurses and healthcare aides.

Aligned with a systemic approach to clinician well-being, our findings emphasize the need for tailored organizational changes and policy interventions to improve work environments, reduce administrative burdens, and enhance mental health support. Mitigating burnout requires multifaceted strategies tailored to specific groups.

In conclusion, addressing HCW burnout necessitates ongoing adaptation and targeted policies to foster supportive work cultures and sustain a resilient workforce, ultimately improving patient care outcomes.

Ethics approval and consent to participate

Not applicable. This research used secondary data obtained from Statistics Canada.

Consent for publication

Not applicable. This research used secondary data obtained from Statistics Canada.

Competing interests

The authors declare that they have no competing interests related to this study.

Funding

The authors received no funding for this study.

Author Contribution

T.O. conducted the analyses in this study and served as the lead author of the manuscript. M.F. supervised the research study from design to implementation and played a major role in writing the manuscript. E.C. led the literature review. M.S. participated in the interpretation of the results. T.B. contributed to writing the discussion. C.F. supervised the data analysis and contributed to its execution. All authors participated in writing the manuscript. All authors have reviewed and approved the final version of the manuscript.

Acknowledgement

To provided later to maintain anonymity

Data Availability

Data is publicly available from Statistics Canada

Anzaldua A, Halpern J. Can Clinical Empathy Survive? Distress, Burnout, and Malignant Duty in the Age of Covid-19. Hastings Center Rep. 2021;51(1):22–7. https://doi.org/10.1002/hast.1216.
Aras FM, Gümüşsoy S. (2024). Emotional burnout, job satisfaction, and intention to leave among pre-hospital emergency healthcare workers during the COVID-19 pandemic. Work (Reading, Mass.). https://doi.org/10.3233/WOR-230589
Blanco-Donoso LM, Moreno-Jiménez J, Hernández-Hurtado M, Cifri-Gavela JL, Jacobs S, Garrosa E. (2021). Daily Work-Family Conflict and Burnout to Explain the Leaving Intentions and Vitality Levels of Healthcare Workers: Interactive Effects Using an Experience-Sampling Method. International Journal of Environmental Research and Public Health, 18(4), 1932. https://doi.org/10.3390/ijerph18041932
Burn-out an occupational phenomenon: International Classification of Diseases. (n.d.). Retrieved May 31, 2024, from https://www.who.int/news/item/28-05-2019-burn-out-an-occupational-phenomenon-international-classification-of-diseases
Caponnetto P, Platania S, Maglia M, Morando M, Gruttadauria SV, Auditore R, Ledda C, Rapisarda V, Santisi G. Health Occupation and Job Satisfaction: The Impact of Psychological Capital in the Management of Clinical Psychological Stressors of Healthcare Workers in the COVID-19 Era. Int J Environ Res Public Health. 2022;19(10):6134. https://doi.org/10.3390/ijerph19106134.
Government of Canada, S. C. (2022, June 03). Survey on Health Care Workers’ Experiences During the Pandemic (SHCWEP). https://www23.statcan.gc.ca/imdb/p2SV.pl?Function=getSurvey&SDDS=5362
Government of Canada, S. C. (2022, August 5). The Daily—Labour Force Survey, July 2022. https://www150.statcan.gc.ca/n1/daily-quotidien/220805/dq220805a-eng.htm
Hämmig O. Explaining burnout and the intention to leave the profession among health professionals – a cross-sectional study in a hospital setting in Switzerland. BMC Health Serv Res. 2018;18(1):785. https://doi.org/10.1186/s12913-018-3556-1.
LeClaire M, Poplau S, Linzer M, Brown R, Sinsky C. Compromised Integrity, Burnout, and Intent to Leave the Job in Critical Care Nurses and Physicians. Crit Care Explorations. 2022;4(2):e0629. https://doi.org/10.1097/CCE.0000000000000629.
Leiter MP, Maslach C, Frame K. Burnout. The Encyclopedia of Clinical Psychology. John Wiley & Sons, Ltd; 2015. pp. 1–7. https://doi.org/10.1002/9781118625392.wbecp142.
Montgomery AP, Patrician PA. Work environment, resilience, burnout, intent to leave during COVID pandemic among nurse leaders: A cross-sectional study. J Nurs Adm Manag. 2022;30(8):4015–23. https://doi.org/10.1111/jonm.13831.
National Academies of Sciences, 20ing, and Medicine, National Academy of Medicine; Committee on Systems Approaches to Improve Patient Care by Supporting Clinician Well-Being. ; (2019). Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being. National Academies Press (US). http://www.ncbi.nlm.nih.gov/books/NBK552618/
Rotenstein LS, Brown R, Sinsky C, Linzer M. The Association of Work Overload with Burnout and Intent to Leave the Job Across the Healthcare Workforce During COVID-19. J Gen Intern Med. 2023;38(8):1920–7. https://doi.org/10.1007/s11606-023-08153-z.
Said RM, El-Shafei DA. Occupational stress, job satisfaction, and intent to leave: Nurses working on front lines during COVID-19 pandemic in Zagazig City, Egypt. Environ Sci Pollut Res Int. 2021;28(7):8791–801. https://doi.org/10.1007/s11356-020-11235-8.
Schaufeli WB, Bakker AB, Van Rhenen W. How changes in job demands and resources predict burnout, work engagement, and sickness absenteeism. J Organizational Behav. 2009;30(7):893–917. https://doi.org/10.1002/job.595.
Shanafelt TD, Noseworthy JH. (2017). Executive Leadership and Physician Well-being. Mayo Clinic Proceedings, 92(1), 129–146. https://doi.org/10.1016/j.mayocp.2016.10.004
Singh J, Poon DE-O, Alvarez E, Anderson L, Verschoor CP, Sutton A, Zendo Z, Piggott T, Apatu E, Churipuy D, Culbert I, Hopkins JP. Burnout among public health workers in Canada: A cross-sectional study. BMC Public Health. 2024;24:48. https://doi.org/10.1186/s12889-023-17572-w.
Smith J, Tiwana MH, Samji H, Morgan R, Purewal S, Delgado-Ron JA. An Intersectional Analysis of Moral Distress and Intention to Leave Employment Among Long-Term Care Providers in British Columbia. J Aging Health. 2023;8982643231212981. https://doi.org/10.1177/08982643231212981.
Tabur A, Choudhury A, Emhan A, Mengenci C, Asan O. Clinicians’ Social Support, Job Stress, and Intent to Leave Healthcare during COVID-19. Healthcare. 2022;10(2):229. https://doi.org/10.3390/healthcare10020229.
Work overload triples the risk of burnout in health care. (2023, April 18). American Medical Association. https://www.ama-assn.org/practice-management/physician-health/work-overload-triples-risk-burnout-health-care

No competing interests reported.

Download PDF

Editorial decision: Revision requested
23 Aug, 2024
Editor assigned by journal
21 Aug, 2024
Submission checks completed at journal
21 Aug, 2024
First submitted to journal
02 Aug, 2024

You are reading this latest preprint version

Identifying Burnout and Turnover Risks in Canadian Healthcare Workers During the COVID-19 Pandemic

Status:

Version 1

Abstract

Figures

Introduction

Methods

Data

Conceptual Framework

Statistical Analysis

Results

Discussion

Workload and Work-Life Balance

Resources and Work Environment

Social Support and Community

Organizational Culture and Values

Setting Differences

Provincial and Demographic Differences

Policy Implications

Limitations

Conclusion

Declarations

Ethics approval and consent to participate

Funding

Author Contribution

Acknowledgement

Data Availability

References

Additional Declarations

Status:

Version 1