Location via proxy:   [ UP ]  
[Report a bug]   [Manage cookies]                

Nursing Research and Practice - 2022 - Opoku - Attrition of Nursing Professionals in Ghana An Effect of Burnout On

Download as pdf or txt
Download as pdf or txt
You are on page 1of 9

Hindawi

Nursing Research and Practice


Volume 2022, Article ID 3100344, 9 pages
https://doi.org/10.1155/2022/3100344

Research Article
Attrition of Nursing Professionals in Ghana: An Effect
of Burnout on Intention to Quit

Douglas Aninng Opoku ,1,2 Nana Kwame Ayisi-Boateng,3,4 Joseph Osarfo,5


Alhassan Sulemana ,6 Aliyu Mohammed,7 Kathryn Spangenberg,8 Ali Baba Awini,1
and Anthony Kwaku Edusei9
1
Department of Occupational and Environmental Health, School of Public Health, Kwame Nkrumah University of Science
and Technology, Kumasi, Ghana
2
Allen Clinic, Family Healthcare Services, Kumasi, Ghana
3
Department of Medicine, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology,
Kumasi, Ghana
4
University Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
5
Department of Community Medicine, School of Medicine, University of Health and Allied Health Science, Ho, Ghana
6
Department of Environmental Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
7
Department of Epidemiology and Biostatistics, School of Public Health, Kwame Nkrumah University of Science and Technology,
Kumasi, Ghana
8
Family Medicine Directorate, Komfo Anokye Teaching Hospital, Kumasi, Ghana
9
Department of Health Promotion and Education, School of Public Health, Kwame Nkrumah University of Science and
Technology, Kumasi, Ghana

Correspondence should be addressed to Douglas Aninng Opoku; douglasopokuaninng@gmail.com

Received 1 April 2022; Accepted 25 June 2022; Published 12 July 2022

Academic Editor: Masoud Behzadifar

Copyright © 2022 Douglas Aninng Opoku et al. This is an open access article distributed under the Creative Commons
Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is
properly cited.

Background. Burnout among nursing professionals at the workplace and how it influences their decision to quit the profession is
crucial to the delivery of quality health service. The shortage of nursing professionals has serious consequences on the healthcare
system. Aim. To examine the effect of burnout on intention to quit the profession among nursing professionals. Methods. A cross-
sectional study among 375 randomly selected nursing professionals in active service at a tertiary healthcare setting in Kumasi,
Ghana. The Maslach Burnout Inventory was used to determine burnout, and their intention to quit the profession was assessed by
asking participants whether they ever thought about quitting the profession in the past 12 months. The effect of burnout on
intention to quit was analyzed using logistic regression analysis. Results. The overall prevalence of burnout among participants was
2.1% (8/375) with 10.1% (38/375), 24.0% (90/375), and 56.3% (211/375) experiencing high emotional exhaustion, deperson-
alisation, and low personal accomplishment, respectively. Nearly half (49.3%, 185/375) of the participants had intention to quit the
profession. Emotional exhaustion (adjusted odds tatio, AOR  5.46; 95% CI  2.25–13.20), depersonalisation (AOR  1.77 95%
CI  1.07–2.95), and personal accomplishment (AOR  2.27; 95% CI  1.30–3.96) were associated with intention to quit the
profession. Conclusion. Burnout has a negative effect causing intention to quit nursing profession. It is imperative to identify
strategies such as occupational health surveillance that will aim at reducing the incidence of burnout at the workplace due to its
consequences, one of them being the intention to quit.

1. Background and continue to be a major public health issue. Burnout, due


to its severity on professionals, has been accepted as an
Burnout and turnover intention among nurses and mid- occupational phenomenon by the World Health Organi-
wives are often studied phenomena in the healthcare settings zation’s (WHO) International Classification of Diseases
7053, 2022, 1, Downloaded from https://onlinelibrary.wiley.com/doi/10.1155/2022/3100344, Wiley Online Library on [08/07/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
2 Nursing Research and Practice

(ICD-11) [1]. Burnout is defined by the WHO as “a syn- their intention to quit the educational course in Italy, South
drome conceptualized as resulting from chronic workplace Africa, and Ethiopia [25–27]. Similarly in Ghana, a preva-
stress that has not been successfully managed [1].” )e lence rate of 69.0% of nurses with intention to quit their
Action Collaborative on Clinician Well-Being and Resilience profession has been reported [28]. )e predictors to un-
was launched by the National Academy of Medicine (United derstand intention to quit the profession in the nursing
States) to address the increasing rate of burnout among profession have been explored [28, 29].
healthcare professionals by improving the understanding of Most of the studies that have been conducted either
challenges to clinician well-being, advocating for clinician focused on only burnout [3, 7, 20] or intention to quit the
burnout, and prefer evidence-based, multidisciplinary so- profession [27, 29, 30]. Little is known about the two
lutions that will improve patient care by giving care to phenomena (burnout and intention to quit the profession)
healthcare professionals [2]. Burnout has been classified into simultaneously, especially in the nursing profession in
three dimensions: emotional exhaustion, depersonalisation, Ghana and Africa. )is study, therefore, sought to determine
and lack of personal accomplishment [3]. Burnout directly the prevalence of intention to quit the profession and ex-
affects the health of the professional (depression, suicide, amine the effect of burnout on intention to quit the pro-
substance use etc.) and adversely affects the healthcare fession among nurses and midwives. )e study findings are
system [4–6]. One such group of health professionals that expected to feed into future policies to reduce the rate of
easily suffer burnout are the nursing professionals. Burnout burnout and intention to quit the profession among the
lowers nurses’ quality of life, performance level, and orga- nursing professionals in Ghana and ultimately in Africa.
nizational commitment and increases their intention to quit )is is deemed key against the backdrop of the current
the job [7, 8]. Burnout also increases turnover rates and COVID-19 pandemic and beyond.
negatively affects the quality of nursing care [9, 10].
Studies that were conducted before the coronavirus 2. Methods
disease (COVID-19) reported a high prevalence of burnout
in the nursing profession similar to other healthcare pro- 2.1. Study Design. )is was a cross-sectional study that in-
fessionals [7, 11, 12]. In Sweden, a study reported that volved nursing professionals at Komfo Anokye Teaching
approximately 50% of new nurses experienced burnout Hospital (KATH), a tertiary healthcare institution located in
which influenced their intention to quit the profession [13]. Kumasi, Ghana.
Studies that were conducted during the outbreak of the
COVID-19 reported a high prevalence of burnout and other
psychological disorders such as moral injury, insomnia, 2.2. Study Setting and Population. Komfo Anokye Teaching
anxiety, and depression among healthcare workers (HCWs) Hospital has a bed capacity of 1,200. It serves as a referral
[14, 15]. As frontline health workers that were heavily in- centre for health facilities in the northern belt of the country.
volved in the case detection and management of COVID-19 Komfo Anokye Teaching Hospital has about 2000 nursing
and other illnesses, they were exposed to pressure. )is thus professionals with different professional backgrounds.
resulted in a lot of them getting infected with the COVID-19 )e target population was all nursing professionals at the
disease. In Italy, data released by the National Health In- facility. Nursing professionals in this study were defined as
stitute on 26 February 2021 showed that about 123,025 registered nurses and midwives that provide nursing care to
HCWs were infected with COVID-19 which was about 4.0% patients. Nursing professionals at the facility that had
of the total cases since the outbreak of the pandemic [16]. worked for at least one year were included in the study. All
About 152,000 and 1413 COVID-19 infections and mor- nursing professionals that were on their annual leave
tality, respectively, were also reported among HCWs throughout the time of the study were excluded.
globally as of May 8, 2020 [17]. During the COVID-19
pandemic, it was reported that predictors such as being a 2.3. Sample Size Calculation. )e Charan and Biswas [31]
female and a frontline HCW were significantly associated formula (sample size � (Z2 (P)(1 − P))/(E∧2 ) for calculat-
with burnout [14]. ing sample size was used to determine the sample size for this
Burnout has been linked to nurses’ intention to quit the study. Using a 95% confidence interval (Z), 5% allowable
profession [18, 19]. In Ghana, moderate to high burnout has margin of error E, and 64.9% [29] of nurses that had in-
been reported among nurses and other healthcare profes- tention to quit (P), a sample size of 350 was obtained for the
sionals [20–22]. Individuals have several mechanisms that study. )is was overestimated to 385 participants to cater for
they adopt to cope with high workloads or stress at the a nonresponse rate of 10%.
workplace. One can either continue to be exposed to these
conditions for a long time and end up experiencing burnout
or quit the profession or organization. Several determinants 2.4. Data Collection and Sampling Procedure. Data collection
of burnout among nurses and midwives in Ghana, partic- took place from July 1, 2020 to September 31, 2020. )is was
ularly high workload, years of practice, resilience, inade- done after the first wave of the COVID-19 pandemic in
quate staffing, and lack of leadership support have been Ghana. A structured questionnaire that consisted of the
identified [21, 23]. Intention to quit the profession is one’s Maslach Burnout Inventory (MBI) [3] was used to collect
desire or contemplation to quit the current profession in the data from study participants. )e MBI is a validated tool that
future [24]. Up to 50% of nurse respondents have indicated has been adopted in several studies to assess burnout
7053, 2022, 1, Downloaded from https://onlinelibrary.wiley.com/doi/10.1155/2022/3100344, Wiley Online Library on [08/07/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
Nursing Research and Practice 3

[32, 33]. )e questionnaire was pretested among 15 nursing graphs. )e relationship between burnout and intention to
professionals in a government hospital in a nearby district. quit was analyzed using the chi-square test and logistic
)e MBI tool measures the three burnout components regression analysis. A p-value of ≤0.05 was deemed statis-
(emotional exhaustion, depersonalisation, and personal tically significant.
accomplishment). )e MBI is made up of 22 items (emo-
tional exhaustion � 7 items, depersonalisation � 7 items, and 3. Results
personal accomplishment � 8 items) with all the items
evaluated on a 7-point Likert scale ranging from “never” � 0 3.1. Demographic and Work-Related Characteristics of Study
to “every day” � 6. )e first seven items measure the emo- Participants. Table 1 indicates the demographic and work-
tional exhaustion dimension while the second seven items related characteristics of study participants. )is study
measure the depersonalisation dimension. )e last eight recorded a response rate of 98.7% (375/385). )e mean age
items measure the personal accomplishment dimension of of the study participants was 31.5 (SD ± 5.0) with a mini-
burnout. )e burnout scores for each of the dimensions of mum age of 21 years and a maximum age of 57 years. More
burnout were computed and categorized as low, moderate, than fifty per cent (56.0%, 210/375) were between the ages 30
and high. )e emotional exhaustion dimension was cate- and 39 years. Over eighty per cent (84.5%, 317/375) were
gorized as low (≤17), moderate (18–29), and high (≥30). )e females, and 54.4% (204/375) had diploma education.
depersonalisation dimension was categorized as low (<6), Approximately 36.8% (138/375) of the study participants
moderate (6–11), and high (≥12: high) while the personal were of the rank “staff nurse/midwife.” )e mean working
accomplishment dimension was categorized as low (≥40), hours per week was 41.8 hours with a range of 20 to 96 hours.
moderate (34–39), and high (≤33). )e Cronbach alpha’s Approximately 46.9% (176/375) of the participants worked
coefficient reliability test for this study was 0.773, 0.624, and for 31–40 hours per week. )e median working experience of
0.788 for emotional exhaustion, depersonalisation, and the study participants was 4.0 years with a range of 1 to 30
personal accomplishment, respectively. )e overall burnout years. Approximately 56.0% (210/375) of the participants
in this study was defined as the proportion of staff with high had a working experience of between 6 and 10 years. Over
emotional exhaustion, depersonalisation, and low personal 82.4% (309/375) of the participants indicated their reason
accomplishment. for working as a nurse/midwife was their passion to care for
)e intention to quit the profession was measured by the sick.
asking study participants if they had considered leaving the
profession in the past 12 months. )e question elicited a
3.2. Intention to Quit the Profession and Burnout among Study
“yes” or “no” response with “yes” indicating that the par-
Participants. )e proportion of study participants that had
ticipant had considered quitting the profession in the past 12
an intention to quit the profession was 49.3% (185/375)
months. Participants that indicated they had considered
(Table 2). Lack of motivation and management support
quitting the profession were asked about reasons for their
(n � 44) was the predominant reason for having intention to
intention to quit the profession.
quit the profession by study participants (Figure 1).
)e simple random sampling technique was used to
)e overall prevalence of burnout among study par-
recruit 375 study participants from six (randomly selected)
ticipants was 2.1% (8/375). About 10.1% (38/375) of the
out of thirteen clinical departments. )e total number of
study participants experienced high emotional exhaustion
active nurses in each department was retrieved, and a
while over 24.0% (90/375) experienced high depersonali-
proportional sample was estimated. Specifically, the total
sation. About 56.3% (211/375) experienced low personal
number of nurses in a selected department was divided by
accomplishment (Table 2).
the total number of nurses in all the selected departments. A
code was assigned to each nurse and these were written on a
piece of paper and put in a bowl. )is was shaken to ensure 3.3. Relationship between Burnout and Intention to Quit the
that they were evenly mixed. )e papers were selected one Profession. Table 3 represents the relationship between
after the other until the allocated number for each de- burnout and intention to quit among study participants. )ere
partment was obtained. )e participants that were recruited was a statistically significant relationship between emotional
were all those who were approached by the investigators and exhaustion (p < 0.001), depersonalisation (p < 0.001), personal
agreed to participate in the study. )e purpose of the study, accomplishment (p � 0.002), and intention to quit the
risks, benefits, and confidentiality of the study were profession.
explained to all the study participants before being recruited Table 4 represents the multiple logistic regression
into the study. All study participants that consented to take analysis of the relationship between burnout and intention
part in the study signed informed consent. to quit among study participants. )e odds of participants
that experienced high emotional exhaustion having an in-
tention to quit the profession was about five times (Adjusted
2.5. Data Management and Analysis. Data were entered into Odds Ratio, AOR � 5.46; 95% CI � 2.25–13.20, p < 0.001)
an excel spreadsheet. )e data were cleaned and double- higher compared to those that experienced low emotional
checked to ensure that there were no double and wrong exhaustion. )e odds of participants that experienced
entries. Data were exported to Stata version 16 for analysis moderate depersonalisation having an intention to quit the
and presented as means, frequencies, percentages tables, and profession was about two times (AOR � 1.77 95%
7053, 2022, 1, Downloaded from https://onlinelibrary.wiley.com/doi/10.1155/2022/3100344, Wiley Online Library on [08/07/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
4 Nursing Research and Practice

Table 1: Demographic and work-related characteristics of study participants.


Variables Frequency Percentage, % [range]
Age (years)
>30 146 38.9
30–39 210 56.0
40+ 19 5.1
Mean (±SD) 31.5 (±5.0) [21–57]
Gender
Male 58 15.5
Female 317 84.5
Marital status
Married 212 56.5
Single 163 43.5
Religion
Christian 355 94.7
Muslim 20 5.3
Level of education
Diploma 204 54.4
Graduate 151 40.3
Post-graduate 20 5.3
Professional rank
Staff nurse/midwife 138 36.8
Senior staff nurse/midwife 70 18.7
Nursing/midwifery officer 102 27.2
Senior nursing/midwifery officer 45 12.0
Principal nursing/midwifery officer 20 5.3
Reasons for working as a nurse/midwife
Passion to care for the sick 309 82.4
To earn an income 18 4.8
)e program I chanced on after school 4 1.1
Not indicated 44 11.7
Working experience (years)
1–5 146 38.9
6–10 210 56.0
11+ 19 5.1
Median (years) 4.0 [1–30]
Working hours per week (hours)
<31 26 6.9
31–40 176 46.9
41–50 154 41.1
51+ 19 5.1
Mean (±SD) 41.8 (±8.5) [20–96]
SD: standard deviation, not indicated � missing values, post-graduate: masters holders.

CI � 1.07–2.95, p � 0.027) higher compared to those that of all the dimensions of burnout on intention to quit the
experienced low depersonalisation. Similarly, the odds of profession among nursing professionals in Ghana. )e
participants that experienced high personal accomplishment growing demand for quality healthcare services makes it
having an intention to quit the profession was about two essential to improve the human resource of the healthcare
times (AOR � 2.27; 95% CI � 1.30–3.96, p � 0.004) higher industry. Retention of nursing professionals is the key to
compared to those that experienced low personal sustaining and improving the health system and quality
accomplishment. healthcare delivery. Reducing burnout among these pro-
fessionals is a key step towards this goal. Identifying the
4. Discussion effect of burnout on intention to quit the profession will help
all key stakeholders of health to set up public health policies
)e study showed the prevelence of an overall burnout and that will reduce the incidence of burnout and intention to
intention to quit that is about 2.1% and 49.3%, respectively. quit the profession to the barest minimum at the workplace.
All dimensions of burnout were found to be significantly )e outcome of the present study suggests that the
associated with intention to quit the profession. To the best overall prevalence of burnout among nursing professionals
of our knowledge, this is the first study to report on the effect was low (2.1%). )e prevalence of the dimensions of burnout
7053, 2022, 1, Downloaded from https://onlinelibrary.wiley.com/doi/10.1155/2022/3100344, Wiley Online Library on [08/07/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
Nursing Research and Practice 5

Table 2: Intention to quit the profession and burnout among participants.


Variables Frequency Percentage, % [range]
Intention to quit the profession
Yes 185 49.3
No 190 50.7
Burnout emotional exhaustion
Low 223 59.5
Moderate 114 30.4
High 38 10.1
Mean (±SD) 16.4 (±9.1) [0–42]
Depersonalisation
Low 143 38.1
Moderate 142 37.9
High 90 24.0
Mean (±SD) 8.1 (±6.1) [0–41]
Personal accomplishment
Low 211 56.3
Moderate 80 21.3
High 84 22.4
Mean (±SD) 38.4 (±8.5) [2–48]
Overall burnout
Yes 8 2.1
No 367 97.9
SD: standard deviation.

45 43 44

40

Numnber of participants
35
30
25
19
20 16
15 11 12
9 10 10
10 8
5
5 2
0
Staff abuse

Blames for mistakes

Greener pastures

Less days off

Less time for my family

Denial of study leave

Inadequate resources

Poor working conditions

Low salary

Poor leadership treatment

High workload

No motivation and
management support

Reasons for intention to quit


Figure 1: Reasons for intention to quit the profession among study participants.

in this study were 10.1% for high emotional exhaustion, outbreak. However, our findings are at variance with those
24.0% for high depersonalisation, and 56.3% for low per- from a study that reported a pooled prevalence of high
sonal accomplishment. Our study is similar to an earlier one burnout of 51.0% emotional exhaustion, 52.0% deperson-
that reported 10.8% high emotional exhaustion, 5.5% high alisation, and 28% low personal accomplishment with about
depersonalisation, and 65.0% low personal accomplishment 52.0% of healthcare workers experiencing overall burnout
among health workers in Ghana [22]. )e present study is during the COVID-19 pandemic [34]. In the United States,
also consistent with a similar study in China that found that 65.1% high emotional exhaustion, 38.40% high deperson-
about 8.02%, 15.93%, and 79.21% of nurses experienced high alisation, and 90.4% low depersonalisation have been re-
emotional exhaustion, depersonalisation, and low personal ported among nurses working in a tertiary healthcare centre
accomplishment, respectively, during the COVID-19 [35]. )e variations in the study could be attributed to the
7053, 2022, 1, Downloaded from https://onlinelibrary.wiley.com/doi/10.1155/2022/3100344, Wiley Online Library on [08/07/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
6 Nursing Research and Practice

Table 3: Relationship between burnout and intention to quit among study participants.
Intention to quit
Variable p-value
Yes n (%) No n (%)
Emotional exhaustion <0.001
Low 84 (37.7) 139 (62.3)
Moderate 71 (62.3) 43 (37.7)
High 30 (79.0) 8 (21.1)
Depersonalisation <0.001
Low 52 (36.4) 91 (63.6)
Moderate 83 (58.5) 59 (41.6)
High 50 (55.6) 40 (44.4)
Personal accomplishment∗ 0.002
Low 88 (41.7) 123 (58.3)
Moderate 44 (55.0) 36 (45.0)
High 53 (63.1) 31 (36.9)

Table 4: Multiple logistic regression analysis of the relationship between burnout and intention to quit among study participants.
Variables Unadjusted OR (95% CI) p-value Adjusted OR (95% CI) p-value
Emotional exhaustion
Low 1.00 1.00
Moderate 2.73 (1.72–4.35) <0.001 2.49 (1.51–4.09) <0.001
High 6.21 (2.72–14.17) <0.001 5.46 (2.25–13.20) <0.001
Depersonalisation
Low 1.00 1.00
Moderate 2.46 (1.53–3.97) <0.001 1.77 (1.07–2.95) 0.027
High 2.19 (1.28–3.74) 0.004 1.06 (0.57–1.98) 0.843
Personal accomplishment
Low 1.00 1.00
Moderate 1.71 (1.02–2.87) 0.043 1.52 (0.88–2.62) 0.135
High 2.39 (1.42–4.02) 0.001 2.27 (1.30–3.96) 0.004
NB: each of the variables emotional exhaustion, depersonalisation, and personal accomplishment was adjusted for the other two ORs (odds ratio)s.

different study designs and the severity of the COVID-19 Japan [30]. However, it is higher than the findings of a
pandemic. )e impact of the COVID-19 pandemic was very multicentre European study in which a prevalence of 9.0%
severe in the United States which could influence the nurses was reported among nurses [36] and lower than the 64.9%
in the United States experiencing high burnout compared to reported in Ethiopia [29]. )e variations in the study
the nurses in this study. )e study reporting an overall findings may be attributed to the study population, facility
burnout prevalence of 52.0% among HCWs [35] was a type, methods, and tools for measuring intention to quit the
systematic review and meta-analysis that assessed a pooled profession. In the Ethiopian study [29], intention to quit the
prevalence of burnout which could increase the burnout profession was measured using the Hand tool [37] which
rates compared to this study. measures intention to quit using seven questions with a 5-
In this study, nearly half of the study participants had point Likert scale while the present study measured inten-
intentions to quit the profession. )is is a matter of concern, tion to quit with a single question that elicited a “yes” or “no”
especially amidst a global pandemic. )is can also be very response.
challenging for the health system as a whole where nursing In the current study, all the dimensions of burnout were
professionals require optimum motivation and needed re- associated with intention to quit. )is is in line with other
sources to deliver quality healthcare to patients. )e par- studies that reported that burnout affects intention to quit
ticipants harbouring an intention to quit the profession can the profession among nurses and midwives [38–40]. )e
result in high turnover among the nursing professionals participants that experienced high burnout for emotional
which can affect quality healthcare delivery. )is is because exhaustion and personal accomplishment were more likely
those intending to quit the profession have been in practice to have an intention to quit compared to those that expe-
for at least four years and have acquired some experience rienced low burnout for emotional exhaustion and personal
which will be difficult to replace in a short time. accomplishment, respectively. )is is in consonance with a
)e proportion of participants intending to quit the study that reported that a feeling of high emotional ex-
profession in the present study (49.3%) is comparable to haustion for a prolonged time may increase the thought of
other reports of 46.1% in South Africa [25] and 44.6% in intention to quit the profession [26]. )e effect of high
7053, 2022, 1, Downloaded from https://onlinelibrary.wiley.com/doi/10.1155/2022/3100344, Wiley Online Library on [08/07/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
Nursing Research and Practice 7

burnout for personal accomplishment on intention to quit questionnaire did not allow for a qualitative exploration of
could be that after long years of practice, they may have participants’ response choices and this limits full compre-
given up challenging the unfavourable work conditions hension of the dynamics underlying burnout and intention
(such as poor leadership style, inadequate personal pro- to quit. Nevertheless, the study provides useful insights into
tective equipment, high workload etc.) since previous at- burnout and intention to quit the profession among the
tempts may not have yielded fruit. )is can influence their study participants, and this can be beneficial for nurses and
decision to consider quitting their job or changing the work organizational managers.
environment.
Moderate depersonalisation was also found to increase 5. Conclusion
intention to quit the profession by 77% in the multivariate
regression. )is is comparable to a study that found Moderate to high burnout for all three dimensions in-
depersonalisation as a predictor of intention to quit the creases the risk of intention to quit the profession among
profession among nurses [41]. )is could be because nursing staff at a tertiary healthcare facility in Ghana.
people that experience moderate to high burnout for Work-based programmes and strategies such as occu-
depersonalisation may develop a negative attitude towards pational health surveillance that aim at reducing the
patients and work which can negatively affect their in- incidence of burnout can impact positively on intention
volvement in the workplace [42]. Developing a negative to quit the profession among nursing professionals.
attitude towards patients and work can lead to the HCW Future studies should therefore adopt a qualitative ap-
feeling that his or her current profession may not be good proach to fully explore the dynamics of burnout and its
for him or her. )is can result in professional detachment effect on intention to quit the profession among nursing
in him or her from the work which could induce his or her professionals.
decision to quit.
)e outcome of this study highlights the need to pay
critical attention to all the dimensions of burnout in an
Data Availability
attempt to reduce intention to quit the profession among )e datasets used for this study are available from the
nursing professionals. It also highlights the need to improve corresponding author upon reasonable request.
on the personal accomplishment of the nursing staff for a
high retention rate. It is therefore important for organiza-
tional managers to put in place interventions (such as ca- Ethical Approval
pacity building and rewarding hard work) that will promote
Ethical approval for the study was granted by Komfo Anokye
the feeling of personal accomplishment of nurses and
Teaching Hospital Institutional Review Board (KATH-IRB)
midwives at the workplace. Nurse and organizational
with reference number KATH-IRB/AP/040/20. All study
managers should put in place strategies such as reducing
participants accepted to take part in the study of their own
workloads by employing more nurses or providing adequate
free will and were assured of strict confidentiality.
resources to work with.
It is important that in formulating policies to address the
retention of nursing professionals, a premium should be Consent
placed on the psychological and mental health of the pro-
fessionals such as reducing the incidence of burnout at the Written informed consent was sought from the study
workplace due to its consequences on intention to quit and participants.
retention. )is can be mitigated through regular occupa-
tional health surveillance and workplace health promotion Conflicts of Interest
programs implemented with strategies combined with in-
terventions by public and occupational health stakeholders Authors have no conflicts of interest to declare.
[43, 44]. In situations where these strategies are not efficient,
burnout levels could increase and lead to higher intention to Authors’ Contributions
quit, cause reduction in the quality of care, and result in high
malpractice litigation [45]. DAO, NKAB, and AKE were involved in the conceptuali-
zation, design, and methods of the study. DAO, NKAB,
AAB, AS, JO, KS, and AM were involved in the data col-
4.1. Limitation of the Study. Due to the use of cross-sectional lection, analysis, and interpretation. DAO drafted the
study design, drawing statistical associations to causal effect original manuscript. All the authors read, revised, and ap-
between burnout and intention to quit the profession is proved the final manuscript for publication.
limited. In addition, the study findings are of limited gen-
eralizability as the study was conducted in only one facility. Acknowledgments
)e odds ratio estimate for the association between high
emotional exhaustion and intention to quit had a rather wide )e authors are grateful to the management and staff of
confidence interval suggesting low precision and should be Komfo Anokye Teaching Hospital that participated in the
interpreted with caution. )e use of a structured study.
7053, 2022, 1, Downloaded from https://onlinelibrary.wiley.com/doi/10.1155/2022/3100344, Wiley Online Library on [08/07/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
8 Nursing Research and Practice

References Environmental Research and Public Health, vol. 18, no. 8,


p. 4361, 2021.
[1] World Health Organization, Burn-out an “Occupational [16] Istituto Superiore di Sanità, “COVID-19 integrated surveil-
Phenomenon”: International Classification of Diseases, World lance data in Italy,” 2020, https://www.epicentro.iss.it/en/
Health Organization, Geneva, Switzerland, 2019. coronavirus/sars-cov-2-dashboard.
[2] National Academy of Medicine, Establishing Clinician Well- [17] S. Bandyopadhyay, R. E. Baticulon, M. Kadhum et al., “In-
Being as a National Priority (Meeting 5), National Academy of fection and mortality of healthcare workers worldwide from
Sciences, Chicago, IL, USA, 2017. COVID-19: a systematic review,” BMJ Global Health, vol. 5,
[3] C. Maslach and S. E. Jackson, “)e measurement of experi- no. 12, Article ID e003097, 2020.
enced burnout,” Journal of Organizational Behavior, vol. 2, [18] S. A. Boamah and H. Laschinger, “)e influence of areas of
no. 2, pp. 99–113, 1981. worklife fit and work-life interference on burnout and
[4] A. Shorofi, H. Jafari, H. Azimi Lolaty, J. Yazdani Cherati, and turnover intentions among new graduate nurses,” Journal of
M. Karimzadeh, “Nurse burnout and patient satisfaction with Nursing Management, vol. 24, no. 2, pp. E164–E174, 2016.
nursing care at dialysis and cardiac care units,” Journal of [19] Y. Liu and Y. Aungsuroch, “Factors influencing nurse-
Critical Care Nursing, vol. 9, no. 1, pp. 1–7, 2016. assessed quality nursing care: a cross-sectional study in
[5] L. N. Dyrbye, T. D. Shanafelt, C. A. Sinsky et al., “Burnout hospitals,” Journal of Advanced Nursing, vol. 74, no. 4,
among health care professionals: a call to explore and address pp. 935–945, 2018.
this underrecognized threat to safe, high-quality care,” NAM [20] AK. Nkyi and M. Blay, “Occupational burnout among nurses
Perspectives, vol. 7, no. 7, 2017. working in cape coast metropolitan hospital Ghana,” Indian
[6] I. Duarte, A. Teixeira, L. Castro et al., “Burnout among Journal of Health and Wellbeing, vol. 11, pp. 459–465, 2020.
portuguese healthcare workers during the COVID-19 pan- [21] B. P. Nimako, “Resilience and burnout among registered
demic,” BMC Public Health, vol. 20, no. 1, p. 1885, 2020. nurses in Ghana during Covid-19 pandemic,” International
[7] J. Adriaenssens, V. De Gucht, and S. Maes, “Determinants and Journal of Nursing Science, vol. 11, no. 1, pp. 20–30, 2021.
prevalence of burnout in emergency nurses: a systematic [22] N. K. Ayisi-Boateng, E. M. Bankah, G. K. Ofori-Amankwah
review of 25 years of research,” International Journal of et al., “A cross-sectional self-assessment of burnout amongst a
Nursing Studies, vol. 52, no. 2, pp. 649–661, 2015.
sample of doctors in Ghana,” African Journal of Primary
[8] S. P. D. N. Clarke, “Nurse staffing and patient care quality and
Health Care & Family Medicine, vol. 12, no. 1, pp. 1–6, 2020.
safety. Patient safety and quality,” in An Evidence-Based
[23] C. A. Poku, E. Donkor, and F. Naab, “Determinants of
Handbook for Nurses, National Center for Biotechnology,
emotional exhaustion among nursing workforce in urban
Bethesda, MD, USA, 2008.
Ghana: a cross-sectional study,” BMC Nursing, vol. 19, no. 1,
[9] M. A. Kanai-Pak, L. H. Aiken, D. M. Sloane, and
p. 116, 2020.
L. Poghosyan, “Poor work environments and nurse inexpe-
[24] G. Cohen, R. S. Blake, and D. Goodman, “Does turnover
rience are associated with burnout, job dissatisfaction, and
intention matter? evaluating the usefulness of turnover in-
quality deficits in Japanese hospitals,” Journal of Clinical
tention rate as a predictor of actual turnover rate,” Review of
Nursing, vol. 17, no. 24, pp. 3324–3329, 2008.
[10] R. H. Mudallal, W. M. Othman, and N. F. Al Hassan, “Nurses’ Public Personnel Administration, vol. 36, no. 3, pp. 240–263,
burnout: the influence of leader empowering behaviors, work 2016.
conditions, and demographic traits,” Inquiry: Be Journal of [25] J. S. Sojane, H. C. Klopper, and S. K. Coetzee, “Leadership, job
Health Care Organization, Provision, and Financing, vol. 54, satisfaction and intention to leave among registered nurses in
Article ID 4695801772494, 2017. the north west and free state provinces of south Africa,”
[11] F. Chirico, A. A. Afolabi, O. S. Ilesanmi et al., “Prevalence, risk Curationis, vol. 39, no. 1, pp. 1–10, 2016.
factors and prevention of burnout syndrome among [26] L. Sasso, A. Bagnasco, G. Catania, M. Zanini, G. Aleo, and
healthcare workers: an umbrella review of systematic reviews R. Watson, “Push and pull factors of nurses’ intention to
and meta-analyses,” Journal of Health and Social Sciences, leave,” Journal of Nursing Management, vol. 27, no. 5,
vol. 6, no. 4, pp. 465–491, 2021. pp. 946–954, 2019.
[12] M. D. McHugh, A. Kutney-Lee, J. P. Cimiotti, D. M. Sloane, [27] F. Ayalew, A. Kols, Y.-M. Kim et al., “Factors affecting
and L. H. Aiken, “Nurses’ widespread job dissatisfaction, turnover intention among nurses in Ethiopia,” World Health
burnout, and frustration with health benefits signal problems & Population, vol. 16, no. 2, pp. 62–74, 2015.
for patient care,” Health Affairs, vol. 30, no. 2, pp. 202–210, [28] M. Bonenberger, M. Aikins, P. Akweongo, and K. Wyss, “)e
2011. effects of health worker motivation and job satisfaction on
[13] A. Rudman and J. P. Gustavsson, “Early-career burnout turnover intention in Ghana: a cross-sectional study,” Human
among new graduate nurses: a prospective observational Resources for Health, vol. 12, no. 1, p. 43, 2014.
study of intra-individual change trajectories,” International [29] E. Ayalew and Y. Workineh, “Nurses’ intention to leave their
Journal of Nursing Studies, vol. 48, no. 3, pp. 292–306, 2011. job and associated factors in Bahir Dar, Amhara region,
[14] F. Chirico, G. Ferrari, G. Nucera, L. Szarpak, P. Crescenzo, Ethiopia, 2017,” BMC Nursing, vol. 19, no. 1, p. 46, 2020.
and O. Ilesanmi, “Prevalence of anxiety, depression, burnout [30] Y. Sato, N. Hayashida, M. Orita et al., “Factors associated with
syndrome, and mental health disorders among healthcare nurses’ intention to leave their jobs after the fukushima
workers during the COVID-19 pandemic: a rapid umbrella daiichi nuclear power plant accident,” PLoS One, vol. 10, no. 3,
review of systematic reviews,” Journal of Health and Social Article ID e0122389, 2015.
Sciences, vol. 6, no. 2, pp. 209–220, 2021. [31] J. Charan and T. Biswas, “How to calculate sample size for
[15] N. Magnavita, F. Chirico, S. Garbarino, N. L. Bragazzi, different study designs in medical research?” Indian Journal of
E. Santacroce, and S. Zaffina, “Sars/mers/sars-cov-2 outbreaks Psychological Medicine, vol. 35, no. 2, pp. 121–126, 2013.
and burnout syndrome among healthcare workers. An um- [32] S. Y. Ang, S. S. Dhaliwal, T. C. Ayre et al., “Demographics and
brella systematic review,” International Journal of personality factors associated with burnout among nurses in a
7053, 2022, 1, Downloaded from https://onlinelibrary.wiley.com/doi/10.1155/2022/3100344, Wiley Online Library on [08/07/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
Nursing Research and Practice 9

Singapore tertiary hospital,” BioMed Research International,


vol. 2016, Article ID 6960184, 12 pages, 2016.
[33] E. Lahana, K. Papadopoulou, O. Roumeliotou, A. Tsounis,
P. Sarafis, and D. Niakas, “Burnout among nurses working in
social welfare centers for the disabled,” BMC Nursing, vol. 16,
no. 1, p. 15, 2017.
[34] S. Ghahramani, K. B. Lankarani, M. Yousefi, K. Heydari,
S. Shahabi, and S. Azmand, “A systematic review and meta-
analysis of burnout among healthcare workers during
COVID-19,” Frontiers in Psychiatry, vol. 12, Article ID
758849, 2021.
[35] H. Wei, J. Aucoin, G. R. Kuntapay et al., “)e prevalence of
nurse burnout and its association with telomere length pre
and during the COVID-19 pandemic,” PLoS One, vol. 17,
no. 3, Article ID e0263603, 2022.
[36] M. M. Heinen, T. van Achterberg, R. Schwendimann et al.,
“Nurses’ intention to leave their profession: a cross-sectional
observational study in 10 European countries,” International
Journal of Nursing Studies, vol. 50, no. 2, pp. 174–184, 2013.
[37] M. C. Hand, Job Satisfaction and Intent to Leave of Nursing
Assistants in the Hospital Setting, East Carolina University,
Greenville, NC, USA, 2015.
[38] C. A. Poku, E. Donkor, and F. Naab, “Impacts of nursing work
environment on turnover intentions: the mediating role of
burnout in Ghana,” Nursing Research and Practice, vol. 2022,
Article ID 1310508, 9 pages, 2022.
[39] J. W. Pienaar and C. L. Bester, “)e impact of burnout on the
intention to quit among professional nurses in the free state
region-a national crisis?” South African Journal of Psychology,
vol. 41, no. 1, pp. 113–122, 2011.
[40] M. P. Leiter and C. Maslach, “Nurse turnover: the mediating
role of burnout,” Journal of Nursing Management, vol. 17,
no. 3, pp. 331–339, 2009.
[41] H. Jiang, L. Ma, C. Gao, T. Li, L. Huang, and W. Huang,
“Satisfaction, burnout and intention to stay of emergency
nurses in Shanghai,” Emergency Medicine Journal, vol. 34,
no. 7, pp. 448–453, 2017.
[42] D. R. Mahmod and R. Rosari, “)e impact of burnout toward
affective commitment and turnover intention,” Jurnal Siasat
Bisnis, vol. 24, no. 1, pp. 18–33, 2020.
[43] F. Chirico, A. Sacco, and G. Ferrari, “Total Worker Health”
strategy to tackle the COVID-19 pandemic and future
challenges in the workplace,” Journal of Health and Social
Sciences, vol. 6, no. 4, pp. 452–457, 2021.
[44] F. Chirico and G. Ferrari, “Role of the workplace in imple-
menting mental health interventions for high-risk groups
among the working age population after the COVID-19
pandemic,” Journal of Health and Social Sciences, vol. 6, no. 2,
pp. 145–150, 2021.
[45] N. Magnavita, F. Chirico, and A. Sacco, “COVID-19: from
hospitals to courts,” Lancet, vol. 397, no. 10284, p. 1542, 2021.

You might also like