OJN  Vol.4 No.7 , June 2014
Burnout and Its Association with Working Conditions among Greek Hospital Nurses in a Time of Financial Crisis
ABSTRACT

The recent global economic recession has affected nursing working conditions in terms of salary reductions, increased workload and staff shortages. Poor nursing working conditions are associated with higher levels of burnout. However in Greece this association has not yet been studied. The aim of this study was to explore financial crisis related changes in nurses’ working conditions and their associations with burnout. A cross-sectional quantitative survey was conducted and data were collected through self-reported questionnaires from 299 Greek nurses from two Public Hospitals in 2012. Multiple linear regression analyses were used in order to find independent factors associated with burnout. The results showed that Greek nurses had high levels of burnout. Satisfaction from the job, quality of care and feeling equivalent with other professionals were independent predictors of lower emotional exhaustion. Workload increase and willingness to change career and work department were independent predictors of higher emotional exhaustion. Job satisfaction and satisfaction from care quality were independent predictors of lower depersonalization. Changes in working relationships and willingness to change career were independent predictors of higher depersonalization. Higher personal accomplishments were independently associated with more years in nursing, satisfaction from the salary prior to reductions, better quality of care, feeling suitable for the job and being anxious about future career. Influence on nurse efficiency by income reduction was an independent predictor of lower personal accomplishments. In conclusion, Greek nurses were suffering from high levels of burnout which was independently associated with crisis related working conditions. Interventions are needed in order to reduce the burden of burnout among Greek nurses.


Cite this paper
Skefales, A. , Plakas, S. , Fouka, G. , Goni, M. , Vassiliadou, M. and Bergiannaki, J. (2014) Burnout and Its Association with Working Conditions among Greek Hospital Nurses in a Time of Financial Crisis. Open Journal of Nursing, 4, 548-563. doi: 10.4236/ojn.2014.47058.
References
[1]   Wray, J. (2013) The Impact of the Financial Crisis on Nurses and Nursing. Journal of Advanced Nursing, 69, 497-499.
http://dx.doi.org/10.1111/jan.12031

[2]   Buchan, J., O’May, F. and Dussault, G. (2013) Nursing Workforce Policy and the Economic Crisis: A Global Overview. Journal of Nursing Scholarship, 45, 298-307.

[3]   Aiken, L.H., Clarke, S.P., Sloane, D.M., Sochalski, J. and Silber, J.H. (2002) Hospital Nurse Staffing and Patient Mortality, Nurse Burnout and Job Dissatisfaction. Journal of the American Medical Association, 288, 1987-1993.
http://dx.doi.org/10.1001/jama.288.16.1987

[4]   Leiter, M.P. and Maslach C. (2009) Nurse Turnover: The Mediating Role of Burnout. Journal of Nursing Management, 17, 331-339.
http://dx.doi.org/10.1111/j.1365-2834.2009.01004.x

[5]   Kaitelidou, D. and Kouli, E. (2012) The Health Sector in Greece Has Been Severely Affected by the Economic Crisis, Raising Concerns for the Future of the Greek Health System.
http://blogs.lse.ac.uk/europpblog/2012/07/20/greek-health-system/

[6]   Karanikolos, M., Mladovsky, P., Cylus, J., Thomson, S., Basu, S., Stuckler, D., Mackenbach, J.P. and McKee, M. (2013) Financial Crisis, Austerity, and Health in Europe. Lancet, 381, 1323-1331.
http://dx.doi.org/10.1111/j.1365-2834.2009.01004.x

[7]   Stuckler, D. and McKee, M. (2011) There Is an alternative: Public Health Professionals Must Not Remain Silent at a Time of Financial Crisis. European Journal of Public Health, 22, 2-3.
http://dx.doi.org/10.1093/eurpub/ckr189

[8]   Kentikelenis, A., Karanikolos, M., Papanikolas, I., Basu, S., McKee, M. and Stuckler, D. (2011) Health Effects of Financial Crisis: Omens of a Greek Tragedy. Lancet, 378, 1457-1458. http://dx.doi.org/10.1016/S0140-6736(11)61556-0

[9]   OECD Health Data (2013) How Does Greece Compare.
http://www.oecd.org/els/health-systems/Briefing-Note-GREECE-2013.pdf

[10]   Papathanassoglou, E. and Mpouzika, M. (2012) Critical Care in the Era of Global Economic Crisis: A Nursing Ethics Perspective. Nursing in Critical Care, 17, 275-278.
http://dx.doi.org/10.1111/j.1478-5153.2012.00536.x

[11]   Notara, V., Koupidis, S., Vaga, E. and Grammatikopoulos, I. (2010) Economic Crisis and Challenges for the Greek Healthcare System: The Emergent Role of Nursing Management. Journal of Nursing Management, 18, 501-504.
http://dx.doi.org/10.1111/j.1365-2834.2010.01119.x

[12]   OECD (2013) StatExtracts.
http://stats.oecd.org/Index.aspx?DataSetCode=STLABOUR

[13]   Yannopoulos, D. (2012) Real Wages Tumble by 25% as Tax Burden Soars in 2011.
http://archive.today/Ts1I4

[14]   Laschinger, H.K.S., Leiter, M.P., Day, A. and Gilin, D. (2009) Workplace Empowerment, Incivility, and Burnout: Impact on Staff Nurse Recruitment and Retention Outcomes. Journal of Nursing Management, 17, 302-311.
http://dx.doi.org/10.1111/j.1365-2834.2009.00999.x

[15]   Kitaoka, K. and Masuda, S. (2012) Academic Report on Burnout among Japanese Nurses. Japan Journal of Nursing Science, 10, 273-279.
http://dx.doi.org/10.1111/j.1742-7924.2012.00221.x

[16]   Colff, J.J. and Rothmann, S. (2012) Burnout of Registered Nurses in South Africa. Journal of Nursing Management, Early View.
http://dx.doi.org/10.1111/j.1365-2834.2012.01467.x

[17]   Lee, H.F., Chien, T.W. and Yen, M. (2013) Examining Factor Structure of Maslach Burnout Inventory among Nurses in Taiwan. Journal of Nursing Management, 21, 648-656.
http://dx.doi.org/10.1111/j.1365-2834.2012.01427.x

[18]   Jenkins, R. and Elliott, P. (2004) Stressors, Burnout and Social Support: Nurses in Acute Mental Health Settings. Journal of Advanced Nursing, 48, 622-631.
http://dx.doi.org/10.1111/j.1365-2648.2004.03240.x

[19]   Glasberg, A.L., Eriksson, S. and Norberg, A. (2007) Burnout and ‘Stress of Conscience’ among Healthcare Personnel. Journal of Advanced Nursing, 57, 392-403.
http://dx.doi.org/10.1111/j.1365-2648.2007.04111.x

[20]   Morgan, J.C. and Lynn, M.R. (2009) Satisfaction in Nursing in the Context of Shortage. Journal of Nursing Management, 17, 401-410.
http://dx.doi.org/10.1111/j.1365-2834.2007.00842.x

[21]   Burke, R., Koyuncu, Μ. and Fiksenbaum, L. (2010) Burnout, Work Satisfactions and Psychological Well-Being among Nurses in Turkish Hospitals. Europe’s Journal of Psychology, 6, 63-81.

[22]   Poghosyan, L., Clarke, S., Finlayson, M. and Aiken, L. (2010) Nurse Burnout and Quality of Care: Cross-National Investigation in Six Countries. Research in Nursing & Health, 33, 288-298.
http://dx.doi.org/10.1002/nur.20383

[23]   Li, B., Bruyneel, L., Sermeus, W., Van den Heede, K., Matawie, K., Aiken, L. and Lesaffre, E. (2013) Group-Level Impact of Work Environment Dimensions on Burnout Experiences among Nurses: A Multivariate Multilevel Probit Model. International Journal of Nursing Studies, 50, 281-291.
http://dx.doi.org/10.1016/j.ijnurstu.2012.07.001

[24]   Hasselhorn, H.M., Tackenberg, P., Kuemmerling, A., Wittenberg, J., Simon, M., Conway, P.M., et al. (2006) Nurses’ Health, Age and the Wish to Leave the Profession—Findings from the European NEXT-Study. La Medicina del Lavoro, 97, 207-214.

[25]   Van Bogaert, P., Clarke, S., Roelant, E., Meulemans, H. and Heyning, P. (2010) Impacts of Unit-Level Nurse Practice Environment and Burnout on Nurse-Reported Outcomes: A Multilevel Modelling Approach. Journal of Clinical Nursing, 19, 1664-1674.
http://dx.doi.org/10.1111/j.1365-2702.2009.03128.x

[26]   Estryn-Behar, M., Van Der Heijden, J.M., Fry, C. and Hasselhorn, H.M. (2010) Longitudinal Analysis of Personal and Work-Related Factors Associated with Turnover among Nurses. Nursing Research, 59, 166-177.
http://dx.doi.org/10.1097/NNR.0b013e3181dbb29f

[27]   Aiken, L.H., Cimiotti, J.P., Sloane, D.M., Smith, H.L., Flynn, L. and Neff, D.F. (2011) Effects of Nurse Staffing and Nurse Education on Patient Deaths in Hospitals with Different Nurse Work Environments. Medical Care, 49, 1047-1053.
http://dx.doi.org/10.1097/MLR.0b013e3182330b6e

[28]   Jourdain, G. and Chênevert, D. (2010) Job Demands—Resources, Burnout and Intention to Leave the Nursing Profession: A Questionnaire Survey. International Journal of Nursing Studies, 47, 709-722.
http://dx.doi.org/10.1016/j.ijnurstu.2009.11.007

[29]   Aiken, L.H., Sermeus, W., Van den Heede, K., Sloane, D.M., Busse, R., McKee, M., et al. (2012) Patient Safety, Satisfaction, and Quality of Hospital Care: Cross-Sectional Surveys of Nurses and Patients in 12 Countries in Europe and the United States. British Medical Journal, 344, Article ID: e1717.

[30]   Van Bogaert, P., Kowalski, C., Weeks, S.M., Van Heusden, D. and Clarke, S.P. (2013) The Relationship between Nurse Practice Environment, Nurse Work Characteristics, Burnout and Job Outcome and Quality of Nursing Care: A Cross-Sectional Survey. International Journal of Nursing Studies, 50, 1667-1677.
http://dx.doi.org/10.1016/j.ijnurstu.2013.05.010

[31]   Kutney-Lee, A., Wu, E.S., Sloane, D.M. and Aiken, L.H. (2013) Changes in Hospital Nurse Work Environments and Nurse Job Outcomes: An Analysis of Panel Data. International Journal of Nursing Studies, 50, 195-201.
http://dx.doi.org/10.1016/j.ijnurstu.2012.07.014

[32]   Bartram, T., Casimir, G., Djurkovic, N., Leggat, S.G. and Stanton, P. (2012) Do Perceived High Performance Work Systems Influence the Relationship between Emotional Labour, Burnout and Intention to Leave? A Study of Australian Nurses. Journal of Advanced Nursing, 68, 1567-1578.
http://dx.doi.org/10.1111/j.1365-2648.2012.05968.x

[33]   Van den Heede, K., Florquin, M., Bruyneel, L., Aiken, L., Diya, L., Lesaffre, E. and Sermeus, W. (2013) Effective Strategies for Nurse Retention in Acute Hospitals: A Mixed Method Study. International Journal of Nursing Studies, 50, 185-194.
http://dx.doi.org/10.1016/j.ijnurstu.2011.12.001

[34]   Trivellas, P., Reklitis, P. and Platis, C. (2013) The Effect of Job Related Stress on Employees’ Satisfaction: A Survey in Health Care. Procedia-Social and Behavioral Sciences, 73, 718-726.
http://dx.doi.org/10.1016/j.sbspro.2013.02.110

[35]   Maslach, C. and Jackson, S.E. (1986) Maslach Burnout Inventory Manual. 2nd Edition, Consulting Psychologists Press, Palo Alto, California.

[36]   Karanikola, M.N., Papathanassoglou, E.D., Mpouzika, M. and Lemonidou, C. (2012) Burnout Syndrome Indices in Greek Intensive Care Nursing Personnel. Dimensions of Critical Care Nursing, 31, 94-101.
http://dx.doi.org/10.1097/DCC.0b013e3182445fd2

[37]   Malliarou, M., Moustaka, E. and Konstantinidis, T. (2008) Burnout of Nursing Personnel in a Regional University Hospital. Health Science Journal, 2, 140-152.

[38]   Dilintas, A. (2010) Study of the Professional Burnout Syndrome in the Personnel of a University Hospital. Archives of Hellenic Medicine, 27, 498-508.

[39]   Kiekkas, P., Spyratos, F., Lampa, E., Aretha, D. and Sakellaropoulos, C.G. (2010) Level and Correlates of Burnout among Orthopaedic Nurses in Greece. Orthopaedic Nursing, 29, 203-209.

[40]   Hart, P.L., Brannan, J.D. and Chesnay, M. (2012) Resilience in Nurses: An Integrative Review. Journal of Nursing Management, Early View.
http://dx.doi.org/10.1111/j.1365-2834.2012.01485.x

[41]   Aiken, L.H., Sloane, D.M., Bruyneel, L., Van den Heede, K., Sermeus, W. for the RN4CAST Consortium (2013) Nurses’ Reports of Working Conditions and Hospital Quality of Care in 12 Countries in Europe. International Journal of Nursing Studies, 50, 143-153.
http://dx.doi.org/10.1016/j.ijnurstu.2012.11.009

[42]   Xie, Z.Y., Wang, A.L. and Chen, B. (2011) Nurse Burnout and Its Association with Occupational Stress in a Cross-Sectional Study in Shanghai. Journal of Advanced Nursing, 67, 1537-1546.
http://dx.doi.org/10.1111/j.1365-2648.2010.05576.x

[43]   McHugh, M.D. and Stimpfel, A.W. (2012) Nurse Reported Quality of Care: A Measure of Hospital Quality. Research in Nursing & Health, 35, 566-575.
http://dx.doi.org/10.1002/nur.21503

[44]   Liu, K., You, L.M., Chen, S.X., Hao, Y.T., Zhu, X.W., Zhang, L.F. and Aiken, L.H. (2012) The Relationship between Hospital Work Environment and Nurse Outcomes in Guangdong, China: A Nurse Questionnaire Survey. Journal of Clinical Nursing, 21, 1476-1485.
http://dx.doi.org/10.1111/j.1365-2702.2011.03991.x

[45]   Maslach, C. and Goldberg, J. (1998) Prevention of Burnout: New Perspectives. Applied and Preventive Psychology, 7, 63-74.
http://dx.doi.org/10.1016/S0962-1849(98)80022-X

[46]   Karaniadou, A., Anagnostopoulos, F. and Telioni, M. (2006) Sociodemographic, Labour and Administrative Factors Which Affect the Professional Exhaustion of the Doctors and Nurses. Nosileftiki, 45, 391-403.

[47]   Laschinger, H.K.S. (2012) Job and Career Satisfaction and Turnover Intentions of Newly Graduated Nurses. Journal of Nursing Management, 20, 472-484.
http://dx.doi.org/10.1111/j.1365-2834.2011.01293.x

[48]   Chou, H.Y., Hecker, R. and Martin, A. (2012) Predicting Nurses’ Well-Being from Job Demands and Resources: A Cross-Sectional Study of Emotional Labour. Journal of Nursing Management, 20, 502-511.
http://dx.doi.org/10.1111/j.1365-2834.2011.01305.x

[49]   Piko, B.F. (2006) Burnout, Role Conflict, Job Satisfaction and Psychosocial Health among Hungarian Health Care Staff: A Questionnaire Survey. International Journal of Nursing Studies, 43, 311-318.
http://dx.doi.org/10.1016/j.ijnurstu.2005.05.003

[50]   Happell, B., Dwyer, T., Reid-Searl, K., Burke, K.J., Caperchione, C.M. and Gaskin, C.J. (2013) Nurses and Stress: Recognizing Causes and Seeking Solutions. Journal of Nursing Management, 21, 638-647.
http://dx.doi.org/10.1111/jonm.12037

[51]   Sheward, L., Hunt, J., Hagen, S., Macleod, M. and Ball, J. (2005) The Relationship between UK Hospital Nurse Staffing and Emotional Exhaustion and Job Dissatisfaction. Journal of Nursing Management, 13, 51-60.
http://dx.doi.org/10.1111/j.1365-2834.2004.00460.x

[52]   Cho, J., Laschinger, H.K.S. and Wong, C. (2006) Workplace Empowerment, Work Engagement and Organizational Commitment of New Graduate Nurses. Nursing Leadership, 19, 43-60.
http://dx.doi.org/10.12927/cjnl.2006.18368

[53]   You, L.M., Aiken, L.H., Sloane, D.M., Liu, K., He, G.P., Hu, Y., et al. (2013) Hospital Nursing, Care Quality, and Patient Satisfaction: Cross-Sectional Surveys of Nurses and Patients in Hospitals in China and Europe. International Journal of Nursing Studies, 50, 154-161.
http://dx.doi.org/10.1016/j.ijnurstu.2012.05.003

[54]   Ross, J., Jones, J., Callaghan, P., Eales, S. and Ashman, N. (2009) A Survey of Stress, Job Satisfaction and Burnout among Haemodialysis Staff. Journal of Renal Care, 35, 127-133.
http://dx.doi.org/10.1111/j.1755-6686.2009.00102.x

[55]   Lin, F., St John, W. and McVeigh, C. (2009) Burnout among Hospital Nurses in China. Journal of Nursing Management, 17, 294-301.
http://dx.doi.org/10.1111/j.1365-2834.2008.00914.x

 
 
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