The link between work stress, absenteeism, and sickness absence: The impact of burnout on healthcare workers

High rates of secondary traumatic stress and burnout have been found across nursing populations. However, few studies have focused on neonatal staff. The objectives of this article are to explore the prevalence and severity of secondary traumatic stress (STS) and burnout in neonatal staff, and identify risk factors and protective factors for STS and burnout within this population with the aim of informing future staff support. A quantitative, cross-sectional study using a survey design was conducted; 246 neonatal staff reported measures of STS, burnout, self-compassion and satisfaction with ward climate. Neonatal staff reported high rates of moderate-severe STS and burnout. STS and burnout were negatively associated with self-compassion and satisfaction with ward climate, suggesting them to be protective factors against STS and burnout. STS was found to be a risk factor for burnout and vice versa. Interventions that increase understanding of STS and burnout, nurture self-compassion, provide support and enhance stress management could help mitigate the impact of STS and burnout amongst neonatal staff.

Burnout recognition and mitigation in the context of a global pandemic.

A key limiting factor in the scale up and sustainability of HIV care and treatment programmes is the global shortage of trained health care workers. This paper discusses why it is important to move beyond conceptualising health care workers simply as 'inputs' in the delivery of HIV treatment and care, and to also consider their roles as partners and agents in the process of health care. It suggests a framework for thinking about their roles and responses in HIV care, considers the current evidence base, and concludes by identifying key areas for future research on health care workers' responses in HIV treatment and care in low and middle income settings.

Background Nationalism and right-wing populism are increasingly gaining ground in Europe and the United States. They threaten the foundations of democracy, human rights, and civil societies, opening the doors for social exclusion, violence, and authoritarian regimes including military aggression and war. These developments are deeply worrying and heavily debated across Western countries. However, surprisingly little attention has been paid so far to the threats that are arising for health systems and public health. On top of this, strong anti-migrant politics of nationalist-populist movements and their growing acceptance in mainstream politics and the wider society put the migrant health and care workforce at risk. Almost all European health systems heavily rely on migrant workers to ensure service provision for their populations; in Ireland, for instance, the number of foreign-trained physicians entering the health labour market was greater than domestic graduates; in absolute terms, Germany, Spain and the United Kingdom were the main countries of destination. New labour market barriers, devaluation and lack of inclusion will impact negatively in retention and recruitment and, ultimately, exacerbate the health and care workforce crisis and weaken healthcare provision. Objectives This workshop highlights the threats that nationalist-populist politics pose to migrant health and care workers and health systems, arguing the need for greater attention and sensitivity to the health-related impact. An expert panel will discuss how public health can respond effectively to the new threats, build capacity for awareness, and join forces to take action. It connects European and global evidence, and expertise in global health, health policy and governance, health and care workforce, and human rights. The workshop begins with statements from health workforce migration experts, illustrating the situation from the perspective of European countries and more globally considering low- and middle-income countries as well as the United States. This is followed by insights from public health policy and politics, from governance research into right-wing populist regimes with a focus on the health and care workforce, and finally reflexions on capacities and action taken by EUPHA. Expected outcome The workshop will generate concrete policy recommendations emerging from this multi-perspective expert panel, which will be further discussed in a moderated plenary discussion. Joining forces across EUPHA sections and leading public health organisations, the workshop facilitates knowledge exchange to respond effectively to a new global nationalism and populisms and protect public health values, including protecting migrant health and care workers, health services for the population, and human rights. Key messages • The new nationalism and populism and their global alliances threaten health systems and migrant health and care workers, exacerbating the health workforce crisis. • There is an urgent need to join forces for the protection of human rights, migrant health workers, and resilient health services and systems. Speakers/Panellists Niamh Humphries RCSI Graduate School of Healthcare Management, Dublin, Ireland Ligia Paina Johns Hopkins University School of Public Health, Baltimore, USA Michelle Falkenbach European Observatory on Health Systems and Policies, Brussels, Belgium Marleen Bekker Wageningen University & Research, Wageningen, Netherlands Monica Brînzac EUPHA

Reimagining health preparedness in the aftermath of COVID-19

BackgroundResearch on practical and effective governance of the health workforce is limited. This paper examines health system strengthening as it occurs in the intersection between the health workforce and governance by presenting a framework to examine health workforce issues related to eight governance principles: strategic vision, accountability, transparency, information, efficiency, equity/fairness, responsiveness and citizen voice and participation.MethodsThis study builds off of a literature review that informed the development of a framework that describes linkages and assigns indicators between governance and the health workforce. A qualitative analysis of Health System Assessment (HSA) data, a rapid indicator-based methodology that determines the key strengths and weaknesses of a health system using a set of internationally recognized indicators, was completed to determine how 20 low- and middle-income countries are operationalizing health governance to improve health workforce performance.Results/discussionThe 20 countries assessed showed mixed progress in implementing the eight governance principles. Strengths highlighted include increasing the transparency of financial flows from sources to providers by implementing and institutionalizing the National Health Accounts methodology; increasing responsiveness to population health needs by training new cadres of health workers to address shortages and deliver care to remote and rural populations; having structures in place to register and provide licensure to medical professionals upon entry into the public sector; and implementing pilot programs that apply financial and non-financial incentives as a means to increase efficiency. Common weaknesses emerging in the HSAs include difficulties with developing, implementing and evaluating health workforce policies that outline a strategic vision for the health workforce; implementing continuous licensure and regulation systems to hold health workers accountable after they enter the workforce; and making use of health information systems to acquire data from providers and deliver it to policymakers.ConclusionsThe breadth of challenges facing the health workforce requires strengthening health governance as well as human resource systems in order to effect change in the health system. Further research into the effectiveness of specific interventions that enhance the link between the health workforce and governance are warranted to determine approaches to strengthening the health system.

INTRODUCTION: Burnout syndrome is defined as the state of physical, emotional, and mental exhaustion that results from exposure to stressors. It is prevalent among healthcare workers including pharmacists and is associated with significant detrimental effects on the patients, healthcare workers, and healthcare systems. Nonetheless, few studies have assessed the prevalence and characteristics of burnout among pharmacists. This study aimed to assess the prevalence and characteristics of burnout among pharmacists in governmental primary health care centers in Bahrain.
 
 METHODS: A cross-sectional study was conducted in the period between January 2022 and February 2022 and involved all the pharmacists in the primary health care centers in the kingdom of Bahrain. Burnout syndrome was assessed using the Maslach Burnout Inventory, a validated tool designed to assess the emotional exhaustion, depersonalization, and personal accomplishment aspects of burnout.
 
 RESULTS: A total of 148 pharmacists completed the online questionnaire and were included in the analysis (response rate = 80.4%). The majority of participants were females (n = 130, 87.8%), married (n = 117, 79.1%), and aged between 25 and 35 years (n = 99, 66.9%). Almost 60% (n = 86, 58%) of the pharmacists had high levels of emotional exhaustion, 62 (41.9%) participants reported high levels of depersonalization, and 60.1% (n = 89) of them reported low accomplishment levels. No statistical differences were found between the baseline characteristics of the pharmacists and the aspects of burnout.
 
 CONCLUSION: In conclusion, this study revealed an alarmingly high prevalence of burnout syndrome among pharmacists in primary care centers in Bahrain. Evidence-based preventive strategies and interventions to reduce burnout levels among pharmacists are urgently needed.

consequences for sickness absence. These conditions may cooccur but their joint associations with sickness absence have not been studied. We aimed to examine separate and joint associations of pain and emotional exhaustion with sickness absence. Data derived from the City of Helsinki registers on sickness absence and from a questionnaire survey among 40-60 year old employees of the City of Helsinki in 2000-2002 (n = 6932, 80% women). Self-certified 1-3 day, and medically certified 4-14 day and over 14 day sickness absence spells were followed up for three years. Pain (acute or chronic) and emotional exhaustion were combined to a joint variable with six categories. Negative binomial regression analysis was used and attributable proportions due to interaction (AP) were calculated. Almost two thirds of women and over half of men with emotional exhaustion reported pain and a third of those with pain reported emotional exhaustion. In separate analyses both pain and emotional exhaustion showed associations with each sickness absence outcome among women. However, when the joint variable was used, pain without emotional exhaustion showed associations with sickness absence (e.g. RR for chronic pain for over 14 day absence 2.26, CI 2.00-2.55), but emotional exhaustion without pain was unassociated (RR 1.12, CI 0.931.36) after adjusting for age. The joint associations of pain and emotional exhaustion with all sickness absence outcomes were stronger than the separate associations (e.g. RR for chronic pain and emotional exhaustion for over 14 day absence 3.23, CI 2.77-3.75) showing also synergistic effects i.e. emotional exhaustion intensified the association of pain with sickness absence (AP 9-29%). Adjustments for socio-demographics and health behaviors had only small effects, but adjusting for somatic and mental diseases attenuated the associations to some extent. The results for men were mainly similar, but less stable. Pain increases the risk of sickness absence and co-occurring emotional exhaustion intensifies the risk. To decrease sickness absence, attention should be paid to prevention and treatment of pain, and special attention to those with co-occurring pain and emotional exhaustion. Key messages Emotional exhaustion is common among those with pain and it intensifies the associations of pain with sickness absence. Emotional exhaustion shows associations with sickness absence only when co-occurring with pain.

BackgroundIn Nigeria, several challenges have been reported within the health sector, especially in training, funding, employment, and deployment of the health workforce. We aimed to review recent health workforce crises in the Nigerian health sector to identify key underlying causes and provide recommendations toward preventing and/or managing potential future crises in Nigeria.MethodsWe conducted a scoping literature search of PubMed to identify studies on health workforce and health governance in Nigeria. A critical analysis, with extended commentary, on recent health workforce crises (2010–2016) and the health system in Nigeria was conducted.ResultsThe Nigerian health system is relatively weak, and there is yet a coordinated response across the country. A number of health workforce crises have been reported in recent times due to several months’ salaries owed, poor welfare, lack of appropriate health facilities and emerging factions among health workers. Poor administration and response across different levels of government have played contributory roles to further internal crises among health workers, with different factions engaged in protracted supremacy challenge. These crises have consequently prevented optimal healthcare delivery to the Nigerian population.ConclusionsAn encompassing stakeholders’ forum in the Nigerian health sector remain essential. The national health system needs a solid administrative policy foundation that allows coordination of priorities and partnerships in the health workforce and among various stakeholders. It is hoped that this paper may prompt relevant reforms in health workforce and governance in Nigeria toward better health service delivery in the country.

The article offers a theoretical analysis and the results of an empirical study of the emotional burnout syndrome of doctors. Among other professions, the medical profession has the highest percentage of emotional burnout.
 The authors consider the concept of «emotional burnout» as physical, emotional exhaustion or psycho-emotional fatigue.
 It is determined that the emotional burnout syndrome develops against the background of the influence of socio-professional factors, is characterized by abnormal workload, features of communication and interaction with patients; accompanied by chronic occupational stress, emotional and physical exhaustion.
 It is established that the level of professional burnout in general among doctors in 5 groups of professional orientation is uneven. The component «emotional exhaustion» has the highest percentages in indicators. Signs of emotional burnout in doctors were feelings of physical fatigue, emotional exhaustion, low mood, psycho-emotional and personal tension, increased control. According to empirical data, the problem of burnout is quite acute, as more than 60% of respondents have high levels of components of emotional burnout.
 The component of «exhaustion» in doctors showed symptoms of «emotional economy», emotional (dosage of emotions in professional activities and family environment, lack of anxiety in the work process and increased anxiety towards family members) and personal detachment (complete or partial loss of interest in non-professional spheres of life, a sense of burden in communication with the subjects of the non-professional sphere).
 Doctors characterize emotional burnout as emotional and physical fatigue or exhaustion, depersonalization; reduction of personal motivation, and which is accompanied by excessive professional effort; reduction of personal self-esteem and positive emotional mood, feelings of depression, etc.

Burnout has many definitions but the most commonly accepted is “a state of physical, emotional or mental exhaustion caused by long-term involvement in situations that are emotionally demanding.”1 It tends to be most common among medical professionals as a result of long working hours, stresses associated with the responsibilities of patient care, and emotional contact with patients2. According to Jones, burnout—a syndrome of progressive emotional, attitudinal, and physical exhaustion—is a critical occupational hazard for people in a wide range of helping professions3. Those who are affected find themselves plagued by chronic fatigue, low energy, irritability, and a negative attitude toward themselves, toward others, and toward their jobs. Because they are emotionally depleted and cynical, they may have a negative impact on those around them, including the individuals with whom they work and the patients they treat. Among the members of the so-called helping professions, physicians are clearly most afflicted with burnout and, as we noted in our previous report4, they have by now been quite intensively studied. Characteristically, burnout syndrome involves the development of a cynical attitude and the loss of concern for people with whom one is working. In addition to physical exhaustion, which harms physical health through many pathways5, burnout is also characterized by an emotional exhaustion wherein the professional experiences growing negative feelings, cynicism, or disrespect for patients and colleagues. “A very cynical and dehumanized perception of these people often develops in which they are labeled in derogatory ways and therefore treated accordingly.”6 Gabbe et al.7 undertook a cross-sectional study, in which a questionnaire was sent to 131 chairs of academic departments of obstetrics and gynecology in the United States and Puerto Rico, and had a 91% response rate. The study found that 22% of the …

Executive Summary What are the issues related to health professionals’ changing scope of practice in Australia? There is evidence that the current organisation of health professionals and health practitioners, and their associated scope of practice, are not suited to meet the needs of the Australian health system. This is contributing to unsafe and inefficient care delivery. There have been substantial changes in population health needs and the technologies, structures and processes of the health care system, yet there has been little change in the health workforce to adapt to the system requirements. Many of the difficulties in adapting the workforce are created by existing legislation and regulation, the funding models for health professional services, and entrenched professional cultures. There is no agreement on coherent policy for the health workforce even though the national, state, and territory governments have focused on this issue What are the implications if these issues are not addressed? Individual health services and health systems will be unable to implement changes to their health professional and practitioner workforce that enable them to meet the access, quality and financial targets necessary for sustainable operation of the public health system. What can we do? While there have been a range of health practitioner scope of practice changes documented in the literature, there is no analytical framework to categorise the changes to enable benchmarking of achievements and outcomes. In addition, few of the scope of practice changes have been evaluated, and those that have, suffer from poor methodology and lack of economic evaluation. This suggests that there are no ready-made solutions waiting on the shelf and leads to the following recommendations. Include health professional and practitioner scope of practice as a standing item on the national, and state and territory health policy agendas, with the goal to develop national policy directions that are supported by all parties. Three actions are required to procure the data needed to enable this policy development to proceed: Establish and maintain a central repository of Australian health professional and practitioner scopes of practice. Develop inter-disciplinary agreement on essential work roles in community and primary care, mental health, aged and chronic care and Aboriginal and Torres Strait Islander health. Prioritise health services research directed to evaluation of changes in health professional and health practitioner scope of practice. Once the policy has been developed, undertake legislative changes to facilitate scope of practice changes, amend health service purchasing rules to encourage safe service delivery by a broader range of health professionals, and reform health professional education to better address the workforce needs of the health system. These changes will be required to support health workforce policy that encourages a flexible approach to health practitioner scope of practice, but that still ensures sufficient protection for the population.

Understanding women's contribution to the health workforce

Health workers are central to people-centred health systems, resilient economies and sustainable development. Given the rising importance of the health workforce, changing human resource for health (HRH) policy and practice and recent health policy and systems research (HPSR) advances, it is critical to reassess and reinvigorate the science behind HRH as part of health systems strengthening and social development more broadly. Building on the recently published Health Policy and Systems Research Reader on Human Resources for Health (the Reader), this commentary reflects on the added value of HPSR underpinning HRH. HPSR does so by strengthening the multi-disciplinary base and rigour of HRH research by (1) valuing diverse research inferences and (2) deepening research enquiry and quality. It also anchors the relevance of HRH research for HRH policy and practice by (3) broadening conceptual boundaries and (4) strengthening policy engagement. Most importantly, HPSR enables us to transform HRH from being faceless numbers or units of health producers to the heart and soul of health systems and vital change agents in our communities and societies. Health workers’ identities and motivation, daily routines and negotiations, and training and working environments are at the centre of successes and failures of health interventions, health system functioning and broader social development. Further, in an increasingly complex globalised economy, the expansion of the health sector as an arena for employment and the liberalisation of labour markets has contributed to the unprecedented movement of health workers, many or most of whom are women, not only between public and private health sectors, but also across borders. Yet, these political, human development and labour market realities are often set aside or elided altogether. Health workers’ lives and livelihoods, their contributions and commitments, and their individual and collective agency are ignored. The science of HRH, offering new discoveries and deeper understanding of how universal health coverage and the Sustainable Development Goals are dependent on millions of health workers globally, has the potential to overcome this outdated and ineffective orthodoxy.

Health workers are central to people-centred health systems, resilient economies and sustainable development. Given the rising importance of the health workforce, changing human resource for health (HRH) policy and practice and recent health policy and systems research (HPSR) advances, it is critical to reassess and reinvigorate the science behind HRH as part of health systems strengthening and social development more broadly. Building on the recently published Health Policy and Systems Research Reader on Human Resources for Health (the Reader), this commentary reflects on the added value of HPSR underpinning HRH. HPSR does so by strengthening the multi-disciplinary base and rigour of HRH research by (1) valuing diverse research inferences and (2) deepening research enquiry and quality. It also anchors the relevance of HRH research for HRH policy and practice by (3) broadening conceptual boundaries and (4) strengthening policy engagement. Most importantly, HPSR enables us to transform HRH from being faceless numbers or units of health producers to the heart and soul of health systems and vital change agents in our communities and societies. Health workers’ identities and motivation, daily routines and negotiations, and training and working environments are at the centre of successes and failures of health interventions, health system functioning and broader social development. Further, in an increasingly complex globalised economy, the expansion of the health sector as an arena for employment and the liberalisation of labour markets has contributed to the unprecedented movement of health workers, many or most of whom are women, not only between public and private health sectors, but also across borders. Yet, these political, human development and labour market realities are often set aside or elided altogether. Health workers’ lives and livelihoods, their contributions and commitments, and their individual and collective agency are ignored. The science of HRH, offering new discoveries and deeper understanding of how universal health coverage and the Sustainable Development Goals are dependent on millions of health workers globally, has the potential to overcome this outdated and ineffective orthodoxy.