October 2021 Article 3

Burnout in Hospital-Based Healthcare Workers during COVID-19

Burnout is an occupational hazard in healthcare, which harms the healthcare system, patients, and healthcare workers. In the COVID-19 pandemic, burnout has increased to levels that pose a threat to maintaining a functioning healthcare workforce. Elevated burnout and other indicators of stress are anticipated to persist long after the pandemic. 
The COVID-19 pandemic has created a cycle of understaffing alongside difficult work conditions which can drive burnout. Robust interventions to bolster individuals, improve work environments and address health system drivers of burnout are important to maintain and support hospital-based healthcare workers. Interventions need to target those most at risk and affected by burnout: nurses, intensive care unit and emergency department staff, women, recent graduates and trainees.
Interventions to reduce burnout need to be implemented at organizational and structural level of healthcare systems, complemented by intervention at the individual level. Further, leadership is a vital enabler to address burnout from organizational leaders and managers as well as policymakers.
Organizations need to ensure adequate staffing through ongoing evaluation of workload including mitigation of data entry and administrative burdens, efforts to reduce overtime and avoid long shifts, and staff deployment in areas where they lack training. 
Approaches to mitigate, reduce and address burnout should be multi-faceted and include interventions to improve workplace conditions by fostering a supportive culture, relationships and leadership, as well as individual-level interventions (e.g., education, stress reduction tools, access support for moral distress). 

Burnout is characterized by emotional exhaustion, depersonalization, and diminished professional achievement. Prior to the COVID-19 pandemic, severe burnout was typically found in 20%-40% of healthcare workers. Contributors include workplace factors (e.g., workload, interpersonal conflict, moral distress, administrative burdens and documentation) and provider factors (e.g., low self-efficacy, emotional exhaustion, reduced sense of personal accomplishment,). Burnout is harmful for the healthcare system, workers, and patients. Risk factors have been exacerbated during the pandemic, resulting in an urgent need for intervention.
This brief focuses on healthcare workers in hospitals. Similar challenges exist in other healthcare settings (e.g., long-term care, primary health care, public health), which are not reviewed here.
  1. What is burnout and what are the risk factors for burnout? 
  2. How has the prevalence of burnout changed during the COVID-19 pandemic for hospital-based healthcare workers? 
  3. Which hospital-based healthcare workers are at particular risk? 
  4. What interventions for burnout are supported by evidence?
  5. What modifiable mediators of burnout are appropriate targets for intervention?
In spring 2020, the prevalence of severe burnout was 30%-40%. By spring 2021, rates >60% were found in Canadian physicians, nurses, and other healthcare professionals. 
Healthcare professionals in intensive care settings, COVID-19 units or hospitals, and emergency departments have had elevated risk of burnout compared to other hospital healthcare workers. Nurses and younger healthcare professionals or trainees have been at greater risk of burnout.
Organizational interventions have larger effects on reducing burnout than individual ones. Individual-level interventions include education and stress reduction techniques and should be complementary to organization-level interventions. Interventions that reduce burnout by even a small amount reduce adverse consequences. 
Groups that have been most affected should be prioritized: nurses, those in intensive care and emergency departments, recent graduates and trainees. 
Targets for intervention include (i) maintaining adequate staffing, (ii) leadership, (iii) work conditions, (iv) confidence in performing relevant tasks, (v) support networks, and (vi) moral distress (about constraints on doing the right thing). 
System- and organization-level interventions to reduce burnout include visible and authentic senior leadership and managerial support, training to increase worker confidence with unfamiliar tasks, addressing workplace characteristics (e.g., overtime and scheduling shifts >12 hours) and supporting workers experiencing moral distress. 

Hospital-based healthcare workers have experienced substantially increased burnout during the COVID-19 pandemic. Sustained burnout will likely contribute to staff retention challenges due to healthcare providers leaving their workplaces and professions. A vicious circle may be underway where understaffing leads to increased burnout and an even weaker healthcare workforce. 
Maintaining the healthcare workforce will benefit from increasing the number of new graduates and by retaining current staff through financial compensation and fostering supportive workplace characteristics including supportive leadership at executive, director, and manager levels, continued professional development, effective communication, appropriate autonomy, and collegial relationships among workers and managers.
Optimal reduction and prevention of burnout depends on stronger evidence. Research evaluating organization and system-level interventions should be promoted.