Abstract
BackgroundUnqualified/non-registered caregivers (N-R Cs) will continue to play important roles in the mental health services. This study compares levels of burnout and sources of stress among qualified and N-R Cs working in acute mental health care.MethodsA total of 196 nursing staff - 124 qualified staff (mainly nurses) and 72 N-R Cs with a variety of different educational backgrounds - working in acute wards or community mental teams from 5 European countries filled out the Maslach Burnout Inventory (MBI), the Mental Health Professional Scale (MHPSS) and the Psychosocial Work Environment and Stress Questionnaire (PWSQ).Results(a) The univariate differences were generally small and restricted to a few variables. Only Social relations (N-R Cs being less satisfied) at Work demands (nurses reporting higher demands) were different at the .05 level. (b) The absolute scores both groups was highest on variables that measured feelings of not being able to influence a work situation characterised by great demands and insufficient resources. Routines and educational programs for dealing with stress should be available on a routine basis. (c) Multivariate analyses identified three extreme groups: (i) a small group dominated by unqualified staff with high depersonalization, (ii) a large group that was low on depersonalisation and high on work demands with a majority of qualified staff, and (iii) a small N-R C-dominated group (low depersonalization, low work demands) with high scores on professional self-doubt. In contrast to (ii) the small and N-R C-dominated groups in (i) and (iii) reflected mainly centre-dependent problems.ConclusionThe differences in burnout and sources of stress between the two groups were generally small. With the exception of high work demands the main differences between the two groups appeared to be centre-dependent. High work demands characterized primarily qualified staff. The main implication of the study is that no special measures addressed towards N-R Cs in general with regard to stress and burnout seem necessary. The results also suggest that centre-specific problems may cause more stress among N-R Cs compared to the qualified staff (e.g. professional self-doubt).
Highlights
Unqualified/non-registered caregivers (N-R Cs) will continue to play important roles in the mental health services
The only significant differences were found on the Psychosocial Work Environment and Stress Questionnaire (PWSQ): N-R C staff were more dissatisfied with their social relations (p = .05) and qualified staff scored significantly higher on the work demand sub-scale of the Maslach Burnout Inventory (MBI) (p = .001)
In both the univariate and multivariate analyses we found few and generally small differences between the two groups with regard to both sources of stress and burnout. This was confirmed with respect to two of the stresssource variables, where the differences were univariately significant at the .05 level: N-R C staff experienced their social relations at work to be inferior
Summary
Unqualified/non-registered caregivers (N-R Cs) will continue to play important roles in the mental health services. With the academisation of the nursing profession and the general focus on qualification, unqualified staff was gradually seen as mainly as temporarily employed waiting to be replaced by professional health workers, preferably nurses. As temporary workers they are seldom mentioned in official health plans, and in relation to the present work we were unable to find either WHO or EU documents that dealt thematically with how the subprofessional work force can fit in today's health services, except for intentional statements that an effective mental health workforce needs to include both professional and subprofessional workers with a range of different backgrounds (WHO 2005). Being considered "substitutes" lead to a corresponding lack of knowledge about the real competency of subprofessionals, what they can bring into the services and how they experiences specific stress and strains
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