PSIWORLD Mara Briaª*, Florina Spânuª, Adriana B banª, Cezarin Todea b

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1 Available online at ScienceDirect Procedia - Social and Behavioral Scien ce s 127 ( 2014 ) PSIWORLD 2013 Burnout and occupational factors among Romanian healthcare professionals working in obstetrics and gynecology clinics Mara Briaª*, Florina Spânuª, Adriana B banª, Cezarin Todea b ªBabe -Bolyai University, 37 Republicii Street, , Cluj-Napoca, Romania b University of Medicine and Pharmacy Iuliu Ha ieganu, no. 59, 21 st December Boulevard , Cluj-Napoca, Romania Abstract The present research aims to identify the relations between burnout, job demands and negative work-home interference. One hundred and sixty seven physicians, residents and nurses working in obstetrics and gynecology clinics filled out the Maslach Burnout Inventory-General Survey, the Questionnaire on the Experience and Evaluation of Work and the Survey Work-Family Interaction Nijmegen. Results of multiple regression analyses indicate that while job demands predict burnout, the negative work-home interference partially mediates the relation between job demands and burnout. The present results have implications for designing interventions focused on reducing burnout among healthcare professionals The Authors. Published by Elsevier Ltd. Open access under CC BY-NC-ND license. Selection and peer-review under responsibility of of PSIWORLD Romanian Society 2013 and of Applied their Guest Experimental Editors: Dr Psychology. Mihaela Chraif, Dr Cristian Vasile and Dr Mihai Anitei Keywords: burnout; job demands; obstetrics and gynecology clinics. 1. Introduction Healthcare professionals burnout is a response to long term exposure to occupational stress which negatively impacts both employees wellbeing and organizations performance (Maslach & Leiter, 2008). Studies conducted on healthcare professionals identified burnout to be a predictor for depression (Ahola & Hakanen, 2007), future incidence of coronary heart diseases (Toker, Melamed, Berliner, Zeltser, & Shapira, 2012), or alcohol abuse * Corresponding author. Mara Bria. Tel.: , ext address: marabria@psychology.ro The Authors. Published by Elsevier Ltd. Open access under CC BY-NC-ND license. Selection and peer-review under responsibility of Romanian Society of Applied Experimental Psychology. doi: /j.sbspro

2 Mara Bria et al. / Procedia - Social and Behavioral Sciences 127 ( 2014 ) (Moustou, Montgomery, Panagopoulou, & Benos, 2010). Burnout has been linked to low performance (Keijsers, Schaufeli, Le Blanc, Zwerts, & Miranda, 1995), high turnover intentions (Leiter & Maslach, 2009) or suboptimal care behaviors (Shanafelt, Bradley, Wipf, & Black, 2002). According to the Job Demands Resources Model (JD-R Model; Demerouti, Nachreiner, Bakker, & Schaufeli, 2001) occupational characteristics have a salient role in burnout development. The most studied occupational risk factors for burnout among healthcare professionals are perceived workload, emotional job demands or work-home interference. High workload was evidenced as the strongest predictor, especially for exhaustion (Lee & Ashforth, 1996). While studies agree that overwhelming emotional demands and negative work-home interference (NWHI) predict burnout (Bakker, Demerouti, & Verbeke, 2004; De Jonge, Van Vegchel, Shimazu, Schaufeli, & Dormann, 2010), the role of cognitive demands have been rarely tested (Bakker, Ten Brummelhuis, Prins, & Van Der Heijden, 2011). Burnout affects a range of healthcare professionals with studies pointing out that obstetrics and gynecology (O&G) professionals have one of the highest burnout rates. For example, almost 90% of a sample of US gynecology residents showed evidence of moderate burnout (Becker, Milad, & Klock, 2006). In a different study (Martini, Arfken, Churchill, & Balon, 2004), 75% of O&G residents met the criteria for burnout, this rate being higher for O&G residents when compared with other specialties. Also, burnout among chairs of O&G is characterized by a high level of emotional exhaustion, moderate-high depersonalization, and high personal accomplishment (Gabbe, Melville, Mandel, & Walker, 2002). The few burnout studies among O&G healthcare professionals are mainly descriptive and are not focused on studying specific occupational risk factors. For example, a study conducted among Spanish O&G residents found that burnout is predicted only by single marital status and the number of patients attended in the of ce per week (Castelo-Branco et al., 2006). Thus our main objective is to investigate the predictive role of job demands and negative work-home interference on burnout among a sample of Romanian healthcare professionals working in O&G clinics. 2. Method 2.1. Participants and procedure The study was conducted between November 2011 and May 2012 in three cities across Transylvania. We contacted the chief executive director of three public and one private O&G clinics. After receiving their approval questionnaires were distributed to healthcare professionals through the ward managers or nurse chiefs. All participants were assured about the anonymity and confidentiality of their responses and encouraged to seal the envelope when returning their questionnaire. From 306 distributed questionnaires 167 were returned and completed. The respondents ages range between 23 and 68 years old (mean age = 39.28; SD = 9.08) and have between 6 months and 39 years of experience in their present job (mean = years; SD = 9.31). The majority of respondents are women (91%), nurses (64.1%) and 75.4% stated that they are married Measures Burnout was measured using the Maslach Burnout Inventory-General Survey (Schaufeli, Leiter, Maslach, & Jackson, 1996). The 16 items of the questionnaire measure work attitudes and are grouped in three subscales: (e.g. I feel burned out from my work, I feel confident that I am effective at getting things done ) on a 6-point frequency scale. The negative influence of work on private life was measured with the corresponding scale from the Survey Work-Home Interaction Nijmegen (Geurts, Taris, Kompier, Dikkers, Van Hoof, & Kinnunen, 2005). The eight items of the scale are measured on a 4-point frequency scale (e.g. You have to work so hard that you do not have time for any of your hobbies ). Job demands (workload, emotional demands and cognitive demands) were measured with the Questionnaire on the Experience and Evaluation of Work (Van Veldhoven, Meijman, Broersen, & Fortuin, 2002). The scales are framed as statements about work characteristics and responses are given on a 4-point

3 38 Mara Bria et al. / Procedia - Social and Behavioral Sciences 127 ( 2014 ) frequency scale. All the subscales used in the current research have acceptable internal consistency, Cronbach s alphas coefficients ranging between 0.73 (cognitive demands scale) and 0.87 (exhaustion scale) Data analyses Analysis of missing values indicated that all the variables have between 0.4% and 3.1% of incomplete cases. We opted for the linear trend at point method for replacing missing data. Descriptive statistics indicated that all the items of professional efficacy scale and the majority of cynicism items have skewed distributions and univariate outliers caused by extreme values. Logarithmic transformations according to Field (2005) recommendations produced nearnormal distributions and eliminated outliers. Three linear regression analyses were performed to predict each burnout dimension from job demands and NWHI controlling for age and number of children under care. Further we tested the mediational role of NWHI between job demands and each burnout dimension according to the Baron and Kenny (1986) recommendations. The Sobel test was used to calculate the statistical significance of the mediations (Preacher & Leonardelli, 2001). 3. Results 3.1. Descriptive statistics Table 1 displays the means, standard deviations, and correlation coefficients between the work demands scales, NWHI and burnout dimensions of the transformed data. Correlation coefficients indicate that exhaustion and NWHI are significantly correlated with all the variables. Cynicism is not correlated with professional efficacy and cognitive demands, while professional efficacy has no significant correlations with workload or emotional demands. Table 1: Summary of Means (M), Standard Deviations (SDs), and Pearson Correlations for Transformed Scores of Burnout, Negative Work- Home Interference, Job Demands, Age, Number of Children under Care, and Estimated Weekly Work Hours (N = 167) Variables Correlations M SDs Exhaustion Cynicism ** 3. Professional efficacy * NWHI **.36** -.16* 5. Workload **.28** ** 6. Emotional demands **.33** **.47** 7. Cognitive demands **.03.16*.30**.46**.35** 8. Age * Children under care * ** Note : NWHI, negative work home interference ; *p<0.05. **p< Multiple regression analyses Results of multiple regression analyses indicate that exhaustion is predicted by job demands and NWHI. Cognitive demands are negative predictors for exhaustion only when NWHI was introduced in the regression analysis. Cynicism is predicted by high emotional demands and NWHI. Professional efficacy is positively predicted by cognitive demands and NWHI (table 2). Controlled variables (age and number of children under care) do not explain variance in any of the burnout dimensions. Results of Sobel test indicate that NWHI partially mediates the relation between workload (z=6.11, p<0.001), emotional demands (6.39, p<0.001), cognitive demands (z=3.86, p<0.001) and exhaustion, respectively. The relation between emotional demands and cynicism is also partially

4 Mara Bria et al. / Procedia - Social and Behavioral Sciences 127 ( 2014 ) mediated by NWHI (z=4.24, p<0.001). Although smaller than the previous mediational effects, the predictive role of cognitive demands on professional efficacy is partially mediated by NWHI (z= -1.94, p<0.05). Table 2. Linear Regression Analyses Predicting Burnout from Job Demands and Negative Work-Home Interference Variables Exhaustion Cynicism Professional Efficacy Age Number of children under care Workload.46**.36** Emotional demands.36**.22**.27**.19* Cognitive demands * *.24** Negative work-home interference.36**.20* -.25** R² F 27.83** 32.69** 7.25** 7.02** ** Note:, initial beta weight when rst entered; 1, nal beta weight after negative work-home interference entered. *p<0.05. **p< Conclusions The results of this research suggest high burnout rates among our sample of healthcare professionals from O&G clinics as the majority of the respondents (108 out of 167) score high and moderate for cynicism and almost half (80 healthcare professionals) have high and moderate scores for exhaustion. Still two-thirds of healthcare professionals (126 out of 167) have high professional efficacy. Congruent with the JD R Model of Burnout (Demerouti et al., 2001) our study underscores the predictive role of job demands and NWHI in shaping healthcare professionals burnout. More precisely, our results indicate that high perceived workload predicts exhaustion while emotional demands predict both exhaustion and cynicism. Contrary to our expectations cognitive demands prove to be a protective factor for burnout as it is an indirect negative predictor for exhaustion and a direct positive predictor for professional efficacy. If the role of workload and emotional demands in burnout is well established by previous studies (e.g., Bakker, Demerouti, Taris, & Schaufeli, 2003; Lee & Ashforts, 1996) few researches investigated the role of cognitive demands in burnout development (Bakker et al., 2011). Our research is in line with previous studies and highlights the salient role of the negative interference of work on private life as it proved to be a partial mediator between occupational characteristics and burnout (Montgomery, Panagopoulou, & Benos, 2006). To summarize, we found high burnout levels among our sample of healthcare professionals from O&G clinics explained by high perceived job demands. Moreover the impact of job demands on burnout development increases if healthcare professionals experience NWHI. Our results have implications for designing interventions focused on both reducing and preventing burnout among healthcare professionals. The present results should be viewed with caution due to cross-sectional, self-report measures. Future studies would bring valuable information on burnout rates if representative samples of healthcare professionals are chosen. Acknowledgements The present research was co-financed from THE SECTORAL OPERATIONAL PROGRAM FOR HUMAN RESOURCES DEVELOPMENT via the POSDRU contract 88/1.5/S/56949 Reform project of the doctoral studies in medical sciences: an integrative vision from financing and organization to scientific performance and impact. The authors wish to thank the Cluj-Napoca Regina Maria Healthcare Clinic for their support in data collection.

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